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Domains of Learning and the MCAT-The Psychomotor Domain

by Dr. James L Flowers

August 22, 2008

The pertinent literature makes it clear the MCAT is pretty good at predicting early medical school success, only fair to poor at predicting late medical school success and virtually worthless in predicting success as a physician (Evolution of the MCAT, Validity of MCAT).

Beginning in the late 1940’s an extensive effort was undertaken to try to classify education goals and objectives and how learning occurs. This effort resulted in three domains (or see domain details) of how students learn. How do these relate to the MCAT and the prediction of who will become a successful physician?

Now, lets focus on the Psychomotor Domain.

The Psychomotor Domain involves the physical or kinesthetic component of learning. This domain includes physical movements, coordination of movements, and use of the motor-skill areas. This domain is only achieved through practice and is measured by parameters such as speed, precision, distance, procedures, or techniques in execution. Simpson proposed seven dimensions from the simple to the complex as:

1. Perception (The use of sensations to determine actions. Begins with sensory stimulation, to selection of specific cues, to the translation of these stimuli);

2. Set (Readiness to act mentally, physically, and emotionally. These predetermine a person’s response to situations (or mindsets));

3. Guided Response(Earliest stage of trial and error learning. Only practice results in proficiency);

4. Mechanism(Intermediate stage of motor actions becoming habitual with increasing confidence of performance);

5. Complex Overt Response(The final stage of most proficient performance indicated by quickness, accuracy, high coordination of performance, with minimum of effort/energy and with automaticity.);

6. Adaptation (Skills are well developed and the individual can modify movement patterns to adapt to special situations/circumstances);

7. Origination (New movement patterns are created to fit special situations/circumstances.)

(Reference: Simpson E.J.(1972). The Classification of
Educational Objectives in the Psychomotor Domain. Washington, DC: Gryphon House.)

How do the learning domains relate to success as a physician and the role of the MCAT? See: MCAT Validity in Perspective

Refer To: Why MCAT Fails to Predict Physician Success, MCAT and Cognitive Domain, MCAT and Affective Domain

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Domains of Learning and the MCAT-The Affective Domain

by Dr. James L Flowers

August 21, 2008

The pertinent literature makes it clear the MCAT is pretty good at predicting early medical school success, only fair to poor at predicting late medical school success and virtually worthless in predicting success as a physician (Evolution of the MCAT, Validity of MCAT).

Beginning in the late 1940’s an extensive effort was undertaken to try to classify education goals and objectives and how learning occurs. This effort resulted in three domains (or see domain details) of how students learn. How do these relate to the MCAT and the prediction of who will become a successful physician?

Now, lets focus on the Affective Domain.

The Affective Domain includes the manner in which one deals with activities, objects or others emotionally. The emotional arena includes your feelings, values, appreciations, enthusiasms, motivations, and attitudes. There are five dimensions (listed from the simplest to the most complex):

1. Receiving Phenomena(Awareness, willingness to hear, selected attention),

2. Responding to Phenomena(Active participation on the part of the learners. Attends and reacts to a particular phenomenon. Learning outcomes may emphasize compliance in responding, willingness to respond, or satisfaction in responding (motivation)),

3. Valuing(The worth or value a person attaches to a particular object, phenomenon, or behavior. This ranges from simple acceptance to the more complex state of commitment. Valuing is based on the internalization of a set of specified values, while clues to these values are expressed in the learner’s overt behavior and are often identifiable),

4. Organization(Organizes values into priorities by contrasting different values, resolving conflicts between them, and creating an unique value system. The emphasis is on comparing, relating, and synthesizing values),

5. Internalizing values(characterization): (Has a value system that controls their behavior. The behavior is pervasive, consistent, predictable, and most importantly, characteristic of the learner. Instructional objectives are concerned with the student’s general patterns of adjustment (personal, social, emotional)).

How do the learning domains relate to success as a physician and the role of the MCAT? See: MCAT Validity in Perspective

Refer To: Why MCAT Fails to Predict Physician Success, MCAT and Cognitive Domain, MCAT and Psychomotor Domain

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MCAT Validity in Perspective

by Dr. James L Flowers

August 21, 2008

Careful review of the structure and question types on the MCAT as found in the MCAT Student Manual demonstrate they correlate closely with the Cognitive Domain dimensions of Bloom. These are also the dimensions important for the first two years of medical school and for the USMLE’s. It then makes sense that the MCAT is a great predictor of the first two years of medical school and the USMLE I (or really any standardized test). So, the MCAT’s strength is in predicting the cognitive domain…but, is this enough to predict physician success?

I do not believe it is. A good physician is much more than the cognitive domain. If the job of the physician is to diagnose and heal, certainly a level of knowledge is essential, but, it is not sufficient. An appreciation of the other learning domains make this clear.

The description of the Affective Domain reads like the characteristics of an ideal and effective physician. We might simply call it “bedside manner”. It is this aspect of learning which begins during the second two years of medical school, the clerkships, and continues for the lifetime of the physician. Yet, it is not measured prior to admission. For a physician, all physicians, it is as important as the Cognitive Domain. The Affective Domain is probably one of the reasons why certain students seem to bloom during the clerkship years who may have some difficulty during the first two years. The combination of the Cognitive Domain and the Affective Domain is critical to all physicians and especially to primary care physicians. The ability of a student to learn and apply themselves in the Affective Domain will make him/her a more effective and successful physician. But, the MCAT does not measure this domain at present.

Finally, the Psychomotor Domain is critical to physicians who rely on motor skills and abilities. This will include the surgeons, specialists, such as interventional cardiologists, and many others. Again, the MCAT does not measure the ability of a potential physician in this domain. How many great surgeons have been bypassed, who had great psychomotor ability, because it was never assessed?

In summary, the MCAT is good at what it does, measurement of aspects of the Cognitive Domain, but, the total physician requires significant contributions from the Affective Domain and the Psychomotor Domain which are not measured. This is good reason for legitmate admission considerations beyond just the MCAT or GPA.

Refer To: Why MCAT Fails to Predict Physician Success, MCAT and Cognitive Domain, MCAT and Affective Domain, MCAT and Psychomotor Domain

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Domains of Learning and the MCAT-The Cognitive Domain

by Dr. James L Flowers

August 20, 2008

The pertinent literature makes it clear the MCAT is pretty good at predicting early medical school success, only fair to poor at predicting late medical school success and virtually worthless in predicting success as a physician (Evolution of the MCAT, Validity of MCAT).

Beginning in the late 1940’s an extensive effort was undertaken to try to classify education goals and objectives and how learning occurs. This effort resulted in three domains (or see domain details) of how students learn. How do these relate to the MCAT and the prediction of who will become a successful physician?

First, lets focus on the Cognitive Domain.

The Cognitive Domain was finalized by the work Dr. Bloom in the mid 1950’s. His derivations became known as Bloom’s Hierarchy. His dimensions from simple to the complex:

1. Knowledge(recalls or recognizes information,ideas, and principlesin the approximate form in which they were learned),
2. Comprehension(translates,comprehends, or interprets information based on prior learning),
3. Application(selects, transfers, and uses data and principles to complete a problem or task with a minimum of direction),
4. Analysis(distinguishes,classifies, and relates the assumptions,hypotheses, evidence,or structure of a statement or question),
5. Synthesis(originates,integrates, and combines ideas into a product, plan or proposal that is new to him or her),
6. Evaluation(appraises,assesses, or critiques on a basis of specific standards and criteria).

Refer To: Why MCAT Fails to Predict Physician Success, MCAT and Affective Domain, MCAT and Psychomotor Domain, MCAT Validity in Perspective

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Trick Questions on The MCAT?

by Dr. James L Flowers

August 20, 2008

I was recently in a session where two of the brighter students from a major university (a Pac-Ten university) were discussing their experiences with taking a MCAT prep course and their experiences on the MCAT exam. Both students had taken the same one of the big TWO commercial MCAT preparation courses.

When one of the students described that the instructor, and based on the course’s philosophy, had told him that the MCAT tries to trick you by how they write their questions…its putting it mildly to say that I was profoundly awakened from the momentary snooze that had beset me. So, I later Googled “trick questions on the MCAT” and found that there is a belief by many that the MCAT has trick questions. The Student Doctor Network has a forum discussing this question.

Categorically, my belief is there is no reason for the AAMC to trick anyone…the test is difficult enough without tricks. And, based on my experience of analyzing real MCAT’s in detail, I cannot honestly recall one question that I would seriously call a trick question. So, what might this course and instructor mean by making this statement? Whereas I cannot speak for them definitively, I will offer my thoughts:

1. There are no trick questions on the MCAT
2. If there were truly “trick questions” on the MCAT,
1. There would be no effective way to prepare (too many ways to trick you)
2. AAMC would have been sued already
3. Any perception of trick questions is
1. a reflection of the lack of understanding of the structure of the MCAT
2. lack of effective preparation for the MCAT
3. lack of skills appropriate for taking the MCAT
4. Relying on mock or simulated exams will increase this misperception of “trick” questions on the real MCAT.
5. So, don’t waste your time trying to determine if a question is a trick question…because there are not any.

My belief is simple. When there is appropriate preparation of content and skills using real MCAT’s, the specter of “trick questions” will magically disappear.

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Does the MCAT Generate Anxiety and How to Handle It?

by Dr. James L Flowers

February 2, 2008

Of course it does.

Why does anxiety affect taking the MCAT?

Anxiety is an affect, a mood, and is closely related to fear. Fear is for a specific situation/object/event. Anxiety is a vague state not necessarily associated with a specific situation/object/event. Anxiety is an apprehension and feeling of uneasiness about something whose outcome is uncertain-this definitely describes the MCAT. Anxiety has two components-worry and emotionality. Worry is the cognitive component, the thinking component, and involves troubling thoughts and doubts about ones ability to deal with a situation/event. The other is emotionality, the affective component, which has physiologic (racing heartbeat, the butterflies, the muscle tightness, the sweats, etc.) and behavioral (pacing, restlessness, etc) components.

Its effect on testing is very interesting and has been fairly well researched. If you plot test performance on the y-axis and anxiety level on the x-axis, an inverted “U” curve results. This means there is an optimal level of anxiety, the peak of the inverted curve, for optimal performance. So, some anxiety is good and it varies from person to person and situation to situation. But, there are some general rules. The Yerkes-Dodson Law states “a high level of anxiety enhances your performance on easy and automatic tasks”. But, it has also been demonstrated that the same degree of anxiety about a test may enhance the performance of high ability students, for whom the test is easy, while lowering the performance of low ability students, for whom the test is more difficult. So, anxiety becomes a negative if the student is poorly prepared. This is when the student sees the test as a threat (student believes they have little chance of success and the anxiety becomes debilitating), versus a challenge (students believe they can succeed and anxiety becomes a positive factor).

Another negative effect of anxiety is the worry component. Worrying takes up space in working memory. So, to the extent that anxiety generates worry, you have less space in working memory to solve the problem. This is part of debilitating anxiety’s effect on testing.

How do you handle your anxiety?

Its my view that anxiety can be a friend if you are well prepared…this should be your first strategy for dealing with anxiety. But, many will need some additional preparation to decrease their anxiety to manageable and effective levels. Here are some sites which can assist you:
Student Forum on MCAT Test Anxiety

Studentdoctor.net anxiety forum
This is discussion of anxiety and MCAT by students.

General Discussion on Anxiety

Natural Anxiety Management Suggestions
A discussion of natural methods to manage anxiety.

Readers Digest 37 Stress Management Tips
Generic methods to decrease anxiety.

The 10 Best Ever Anxiety Management Techniques
Speaks for itself. From a University Counseling Center ( Australian National University).

Specific Discussions on Test Anxiety

Overcoming Test Anxiety
A free site with strategies to deal with test anxiety.

University of Buffalo Counseling Center
Recommendations by a university counseling center regarding Test Anxiety.

http://www.how-to-study.com/testanxiety.htm
General suggestions from how-to-study.com regarding test anxiety. Also has multiple other test-taking skills discussed.

Praxis Series Suggestions
From Praxis, a general discussion of how to handle test anxiety.

http://www.campusblues.com/test.asp
From Campusblues, a discussion of test anxiety and how to manage it.

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How can a shorter CBT MCAT be as effective as the longer paper MCAT?

by Dr. James L Flowers

January 11, 2008

This is a very good question because the answer can tell you a lot about what to study and why.

AAMC spent considerable effort convincing the medical community that the paper based MCAT was a valid predictor of success in medical school:
MCAT as Predictor of Success in Medical School

Why should we be convinced that the new CBT MCATs are equivalent to these old paper MCATs? Because AAMC has also spent a considerable amount of effort demonstrating the basis for their beliefs in a number of monographs and articles which are not as well known:

AAMC Monograph 1
AAMC Monograph 2

These monographs explain how the MCAT conforms with Item Response Theory (IRT). IRT has become the standard for constructing tests like the MCAT:

Wikipedia and IRT
General IRT Comments I
General IRT Comments II
General IRT Comments III

To make the CBT equivalent to the old paper MCAT, the following steps are performed:

1)  Items are created and tested on a large number of individuals;

2)  Each item is described by an ICC (Item Characteristic Curve) based on the research;

3) Each item is further described by an IIF (Item Information Function);

4)  Any test is composed of the summation of individual items (and IIFs) and is characterized by the TIF;

5)  Any two tests will be equivalent if the TIF’s are equal regardless of the number of individual items.

So, what is the practicality of all of this for your taking of the MCAT? These are my “take it to the test” messages based on this analysis:

1)  Mock or simulated MCATs are useful if they have done the research and generated ICC’s, IIF’s and TIF’s. Since they do not, they are for the most part of much less value;

2)  If you want the best idea of how you will do on the real MCAT, take the practice MCATs (which were the “Real” MCATs at one time) under as close to real test conditions offered by AAMC at http://www.e-mcat.com.

See this prior Blog entry:

CBTs versus Paper MCAT

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How long should I take to study for the MCAT?

by Dr. James L Flowers

July 21, 2007

As long as it takes!

This sounds simplistic… and it is. You can find many suggestions on how to study. E.g.,
1. ehow-studying for mcat
2. aamcmcatstudysuggestions
3. studentdoctorforumsuggestions
4. studysuggestionssomethingawful .

The real issue is more profound and penetrating. In determining how long you need to do anything will depend on where you want to go and where you are at in relation to that point. I feel the steps to answer this question are as follows.

Step 1: Set your goal MCAT score. This doesn’t mean you have to get all 12’s or 14’s. It means you should spend some time deciding which medical schools you want to attend, and reviewing their statistics as relate to MCAT scores and GPA’s. The best source for this is found at  AAMC MCAT and GPA Scores.

Step 2: Assess your current MCAT score. The simplest way to get an idea of where you are at currently is to take one or more of the AAMC practice tests. The CBT3 is free…you will have to purchase the others. But, this will give you the most realistic idea of where you are at in relation to your goal.

Step 3: Assess what you need to focus on to bridge the gap between current and goal scores. This can be tricky. The AAMC practice tests provide some analysis of what your strengths and weaknesses are. Start here. You can now spend time on your areas of weakness that will translate into the greatest impact on your target score.

Step 4:  Develop a realistic schedule based on the realities of your life and the results of your practice tests. It is unlikely that there are any two students out there with the same identical factors of goals, current status, strengths and weaknesses, and non-MCAT schedule. This is why certain canned or preset MCAT prep courses will miss the mark for so many students. Use the information you have generated to set your schedule. It should be evident, that the further your current score and goals are apart, the more time it will take. Also, if you have only a limited amount of time per day to study, it will take longer, calendar-wise, for you to prepare. The average student will need 300-400 hours of actual study time.

But, using these steps, you can determine how long you need. I guess after all, it is “as long as it takes” anyway, but with a little more substance and thought. Good luck.

 See these prior entries:

Use of textbooks for MCAT Prep

Best College Major For MCAT

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Shhh! Don’t Tell Anyone You Need A Structured Course to Prepare for the MCAT

by Dr. James L Flowers

June 17, 2007

I often hear students say, “The reason I want a structured MCAT prep course is that I need the discipline.” All I can say is “Shhh! Don’t let anybody know.”

We often make utterances that may be true but don’t always give full thought to the implications…I know, I am very proficient at this technique. For a pre-medical student to tell me they need discipline is like a major league baseball pitcher telling me they need to learn how to throw a fastball. There’s a problem.

It may well be true that a structured course, usually meaning a classroom course with set lectures and testing, etc is the way for some students to prepare for the MCAT. But, by your expressing this to anyone, you are also telling them you cannot create that structure for yourself…you need outside imposed discipline. Are you then going to write in your medical school admission’s essay, “I needed ________ prep course because I did not have the discipline to prepare myself.” Of course not.

Medicine is certainly disciplined and requires discipline but a lot of your learning and education will not be by forced external discipline but by how you discipline yourself. Interviewers and medical school faculty want you to be able to discipline yourself for the lifelong learning you will need to remain a competent physician. This lifelong learning will not be a classroom with structured lectures telling you what you need to know…whether you need it or not.

This is one of the major reasons there is such a difference between some student’s performance in the pre-clinical, usually first two years, and the clinical, the last two years. Whereas the first two years are generally classroom with imposed structure, the final two years are not. You have to impose your own discipline in multiple dimensions to be successful in your clinical years. If you have not practiced this or made yourself discipline yourself, you will have difficulty during the clinical years.

So, certainly, you don’t want anyone to know that you’re taking a structured classroom MCAT prep course because you need the discipline. There are a few courses out there that allow you to create the discipline for your own course. This might be the type of practice you need, and you can proudly state in your essay, I really wouldn’t, that you created your own MCAT prep through your own discipline.

Just food for thought.

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What is the best college major for the MCAT?

by Dr. James L Flowers

June 12, 2007

It may be surprising to some, but the answer is NONE…there is NO one best college major for the MCAT. There are best course types for the MCAT, though.

I have had innumerable encounters like the following over the years. A student has just taken the MCAT and felt he/she got toasted because there was something on the MCAT they feel they had not taken. One year the MCAT may have one or more difficult passages on microbiology. The student comes back stressed out about the difficulty of the test because they had NOT taken an advanced course in microbiology. They become convinced that if they had taken an advanced course in microbiology, they would now be in medical school. Nonsense.

Each year, there will be variable emphasis of topics on the MCAT. This will occur for several reasons and will be even more striking now given the shorter version of the Computer Based Test (CBT). Whereas in the past on paper, there may have been 10-11 passages in the sciences, now there may be only seven or so. Now each of these passages will loom larger in terms of importance. Remember each science subtest is testing two distinct subjects, Biology/Organic Chemistry and Physics/General Chemistry. So, even fewer topics will appear for each subject. Now a passage on lasers in space will loom large and may cause the unwary to think they need more and advanced physics. This will be a horrendous mistake.

The AAMC people have accurately and honestly told you what is needed for the MCAT…one year of biology (mainly zoology), one year of physics (non-calculus), one year of general chemistry and one year of organic chemistry…all introductory courses and all with laboratory. That is it. That is ALL that you need to do well on the MCAT. Advanced courses are NOT needed…period.

This means you can select any major you want…any major. As long as you take these basic courses, you can be adequately prepared for the MCAT. What you need to know and do is take the correct type of basic course and adjunctive courses.

You need to take the courses, or the section of the courses where the teacher or teaching assistant emphasizes Higher Order Thinking Skills (HOTS). This is one time you really need the HOTS. HOTS include the skills of analysis, evaluation, comparison and inference…not just memory and recall of facts. In other words, you want courses where the instructor makes you think about the information, makes you massage the information and tests you in the same manner. This is the type of course, science or nonscience, which will best prepare you for the MCAT.

So, does this mean there is no best major for pre-meds? I didn’t say that. I said there is no one best major in terms of preparation for the MCAT.

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