The changing dynamic of medical school admissions.

Old-school pedagogues must be cringing. The Medical College Admissions Test (MCAT) and panel interviews dispatched to the dustbins of medical school history? Spaces set aside for those trained in the humanities? Have the caretakers of all that is good and time-honoured in the hallowed halls of medical schools gone entirely mad? There is little doubt that the medical school admissions landscape in Canada has changed in recent years, largely as a consequence of efforts to adopt a more evidence-based approach to selecting students and measures designed to diversify the composition of incoming classes. The latter appears the primary rationale for the change, as many believe the profession was increasingly the purview of the privileged. It only makes sense that most medical students come from such an environment, as individuals flourish when they come from a “stable environment with high expectations,” says Joseph Finkler, dean of admissions for the University of British Columbia (UBC) Faculty of Medicine. Many applicants haven’t had to worry about finances and have been able to focus on “diverse, exotic extracurricular activities and sports,” in addition to their studies. Yet there’s been a move toward use of broader admissions criteria so as to achieve a more socio-economically diverse student population because of a belief that physicians “should, in some way, mirror the population they are treating in racial, ethnic, and socio-economic diversity,” Finkler says. The goal is to ensure a “more broadly representative profession,” says Saleem Razack, assistant dean of admissions, equity and diversity at the McGill University School of Medicine in Montreal, Quebec. “We want a class where not everyone ... [appears as if they came out of the same] cookie cutter.” The push for diversity has prompted UBC to reach out to students from less affluent backgrounds, develop mentorship programs and help applicants from small or rural communities, who may be intimidated by the notion of taking classes at a large, urban university, prepare for medical school by first taking approved, prerequisite courses at smaller universities, essentially grooming them for the rigours of medical school. But despite such moves, Finkler and other administrators stress, core capabilities are still essential. Finkler says most medical schools look first for evidence of “academic stamina” to ensure that applicants won’t “collapse under the volume of information they have to process and analyze.” As well, he says schools seek applicants with qualities such as conscientiousness, leadership, and empathy. Razack adds communication skills to that list. Traditionally, medical schools have sought such qualities through an application process in which selections were made on the basis of such criteria as grades, MCAT scores, extracurricular activities and work experience. Students were also required to complete a slew of prerequisite courses, submit letters of reference and an autobiographical essay laying out their background and motivation for pursuing a medical career, as well as attend a panel-style interview that many students believe was borrowed from the Inquisition. No longer. Even time-honoured elements of applications are being abandoned. Several schools, including the University of Saskatchewan in Saskatoon and UBC, have already phased out autobiographical essays. At UBC, the change came after essays were found to have been edited by professionals. Instead, some applications leave a space for applicants to explain inconsistencies in their transcripts or lack of extracurricular activities. Some institutions offer coaching to applicants while others, such as McMaster University in Hamilton, Ontario, have adopted variations on autobiographical essays. McMaster requires students to complete a computer-based test called CASPer, the Computer-based Assessment for Sampling Personal characteristics, which is designed to assess interpersonal skills and decision making. Perhaps most surprising is the move by some schools to eliminate the need to write the MCAT. The Northern Ontario School of Medicine in Sudbury, Ontario, has never required applicants to write the test and this year, McGill announced that it was removing the requirement for Canadian applicants on the grounds that it was biased against French-speaking students. Developed in 1928, the MCAT assesses scientific problem solving, verbal reasoning and writing ability. Karen Mitchell, head of MCAT Program for the Association of American Medical Colleges, defends it as a better indicator of ability than are university grades, which can be highly variable,