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Lauren Schleimer '12: Enforcing integrity on the MCAT


As the security guard at the Prometric test center emptied my pockets and confiscated my wristwatch, it occurred to me that the procedure for entering the Medical College Admission Test testing room was not so different from incarceration. You will be videotaped at all times, including breaks, and a fingerprint scan, signature and ID card are required in order to leave and re-enter the testing room. Nothing is allowed on your desk except the two pencils and four sheets of bright red scratch paper provided by the test center. Jewelry, eyeglasses and articles of clothing must be worn at all times and if you remove so much as a hairclip, it has to be stored in your locker outside.  

At first shaken, then indignant, I took the heightened security measures as a personal affront. The MCAT is a stressful experience, to say the least, and the TSA-level security screening put everyone just a little more on edge. Sure, the middle-aged proctor smiled sympathetically when she called my name, but then she had me spread my legs, pull out all my pockets, empty my hood and keep my hands above my head while she scanned me with a metal detector.  

In an open letter to 2012 examinees, the Association of American Medical Colleges offered this explanation: "The MCAT exam has been a key entry point for medical and other health-related professions for more than 80 years. Members of those professions must adhere to the highest level of ethics, earning and keeping the public's trust each and every day. Following the rules of the MCAT exam is an essential step in demonstrating a lifelong commitment to professionalism." I don't know about the rest of my fellow examinees, but "trust" and "professionalism" were the last words I would use to describe the way I was treated on exam day. There's nothing honorable about not cheating when the test center's security guard makes doing so a virtual impossibility.

The security measures were shocking, but, as it turns out, they're not entirely unwarranted. Last year, two Canadian students coordinated a high-tech plot to transmit exam questions via a wireless pinhole camera. The only reason the scam was unsuccessful is that the conspirators — one taking the test, the other figuring out the answers — were also trying to dupe a crew of MCAT tutors into answering the questions live. When the tutors wised up, the police were called and the perpetrators arrested. 

Standardized tests are imperfect measures and easy to criticize. But much like the heightened security was needed to eliminate the cheaters, the MCAT was originally instituted to weed out the academically unfit. In the 1920s, high attrition rates were taking a toll on universities, wasting precious time, energy and resources as up to 50 percent of students dropped out in the first two years. Combined with overall GPA, the test was and remains a remarkably accurate predictor of academic success in medical school. 

But as the AAMC pointed out, the MCAT is the gateway to the medical profession. The values that are prioritized at this stage of the game dictate the qualities of character that will be prized in medical professionals. In content and execution, the MCAT exam teaches conformity and acquiescence to the rules with an iron fist. Ability to perform well on the exam requires accepting a certain premise: that subjective interpretations can and should be reduced to objectively "correct" answers. Even if I could converse fluently on the topic a question posed, my expertise was useless if I could not oversimplify to their standard of "correctness."

In the same way that the "highest standards of moral and ethical conduct" are guaranteed on the MCAT by tyrannical proctors, the looming threat of malpractice attorneys enforce a strictly by-the-book standard of care in the industry. An estimated 75 to 99 percent of physicians will at some point in their career be sued for medical malpractice, and the cost of insurance premiums is becoming dangerously high.  

There are consequences for mistrusting people, and in the vast majority of malpractice lawsuits, the accusations are vindictive and unwarranted. Lawsuits cause physician burnout, but they also change the way doctors practice medicine. Physicians are less likely to take on high risk cases and more likely to reduce their workload after they've been sued. The looming threat of a lawsuit leads doctors to practice the sort of "defensive medicine" that — combined with the exorbitant price of malpractice insurance — has driven up health care costs through unnecessary procedures. For all of the "trust" placed in medical professionals, there is little room for honor and professionalism when persecution is a near certainty.

When I walked out of the MCAT exam, I realized that what nagged at my conscience was not the questions I couldn't answer, but the pervasive air of mistrust. The security measures took away my coffee and probably cost a few points in the added stress, but the real insult was to my dignity. There's nothing honorable about not cheating when the system makes it a virtual impossibility. We've institutionalized suspicion in the medical profession, persecuting the majority to prevent the misdeeds of a few. In the end, whether it is $240 for the MCAT to offset the costs of fingerprinting or $70,000 a year for medical malpractice insurance, if I want to be a doctor, I'll have to pay the price.


Lauren Schleimer '12 is still waiting for her MCAT score.



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