Building a better physician--the case for the new MCAT.

n engl j med 366;14 nejm.org april 5, 2012 1265 and biologic sciences. A 2004 Institute of Medicine report on “Improving Medical Education” and several years of evaluation identified a need to redesign the MCAT to better reflect physicians’ current challenges. Beginning in 2015, the test will include a section on behavioral and social sciences, and a section on critical analysis and reasoning will replace the writing sample. These revisions reflect the recognition that behavioral and social factors not only play major roles in health and illness, but also interact with biologic factors to influence health outcomes. Fundamental knowledge about behavioral and social sciences is critical to the effective practice of medicine. The new subtest entitled “Psychological, Social, and Biological Foundations of Behavior” will measure that foundational knowledge with the use of stimulus paragraphs illustrating behavioral and social science constructs, followed by multiple-choice questions covering five content areas: ways in which people perceive and react to the world; factors that influence behavior and behavior change; factors that influence how we think about ourselves and others; ways in which culture and social differences influence wellbeing; and ways in which social stratification affects access to resources. The test will emphasize established theory and concepts as well as experimental and observational science. For example, the section on perception considers the integration of sensory processes through attention, cognition, memory, and language and the roles of stress and emotions in sensory processes. Clinical applications are reserved for medical school instruction, but students will be expected to have a sufficient foundation on which to build medical knowledge. Why change the MCAT? Evidence indicates that behavioral and social factors profoundly affect health — as both determinants and key factors in preventive or therapeutic interventions (see box). In its 2011 report, Behavioral and Social Science Foundations for Future Physicians, the Association of American Medical Colleges (AAMC) emphasizes that health is influenced by biology, genetics, behavior, interpersonal relationships, culture, and physical environment. Furthermore, several Building a Better Physician — The Case for the New MCAT