Thread by @memesMD, Ladies, gentlemen, and non-binary pals of #MedTwitter

Ladies, gentlemen, and non-binary pals of #MedTwitter — here’s a

on the absolute disaster that has gone down with @AAMC_MCAT this year.

Please read, please help, please advocate for future doctors.

#MedEd #premedtwitter #MedStudentTwitter #MCAT
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This is gonna be long, so I’ll start with a backwards tl;dr…
The @AAMC_Today and medical schools are neglecting their role as advocates for public health by requiring the @AAMC_MCAT MCAT this year. There is no need for an in-person exam amidst pandemic and protests.
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The MCAT is a *standardized*, norm-referenced, multiple choice exam. That means examinees are given a %tile score that compares their performance to the performance of other examinees. This results in a

curve of test-takers.
3/ https://students-residents.aamc.org/applying-medical-school/article/mcat-exam-score-scale/

The MCAT Exam Score Scale

You will receive five scores from your MCAT exam: one for each of the four sections and one combined total score.

https://students-residents.aamc.org/applying-medical-school/article/mcat-exam-score-scale/

The MCAT is required by every US medical school, and most Canadian schools. Many med schools even use it as a “screen” to decide who gets a secondary application (which is school-specific, compared to the more general @AMCASinfo primary application). A few examples

As everyone knows, the MCAT is an often feared part of any premed’s journey to becoming a doctor. This ~8hr, 230 question test has 4 sections: Chemistry/Physics, CARS (Reading Comp), Biology/Biochemistry, and Psychology/Sociology. Seems fine, right?
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Now, this would be fine if the MCAT actually predicted success in medical school. The MCAT has never been proven to predict success in med school. It shows a *slight* correlation to scores on Step 1. Even then, Step 1 is now pass/fail, so moot point.
https://pubmed.ncbi.nlm.nih.gov/25850120/
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Moreover, the MCAT is consistently more predictive of an applicant’s race and SES than it is their academic ability!

The only time the MCAT does not show a bias towards a specific race is when schools intentionally correct for it. Means test much?
https://pubmed.ncbi.nlm.nih.gov/31425184/
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This issue is compounded by the cost of taking the test. A basic registration costs $320. All applicants know they must also buy the AAMC Official Prep Materials for ~$300.

This doesn’t include any additional materials, such as extra practice exams or a course.
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This issue is compounded by the cost of taking the test. A basic registration costs $320. All applicants know they must also buy the AAMC Official Prep Materials for ~$300. This doesn’t include any additional materials, such as extra practice exams or a course. 8/

@AAMCtoday offers a Fee Assistance Program for low income students, but it’s not exactly accessible. Cost of living and expected parental contribution aren’t considered. That means a *financially independent* 35yo who has parents >400% the federal poverty line is out of luck.
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FAP is a great deal, if you can get it. It’s slightly less restricted this year due to #COVID19, but still excludes many students — esp those who have strained family situations. I hope someone with experience applying will share their story here as well.
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All this is to say that applying to med school is expensive! Up to $10,000, at times. With an annual acceptance rate of just ~40%, might this have something to do with the fact that 3/4ths of med students come from families in the top 2 quintiles?
11/ https://www.cnbc.com/2019/10/04/it-can-cost-10000-to-apply-for-medical-school.html

Here's how much medical students are paying just to get into school

While some medical schools are making headlines for covering students' tuition bills, aspiring students face some steep expenses before they start classes. That's because they often must pay $5,000...

https://www.cnbc.com/2019/10/04/it-can-cost-10000-to-apply-for-medical-school.html

Okay, so... let’s talk about 2020 in particular! Most years, med school applicants must take the @AAMC_MCAT MCAT and submit their @AMCASinfo app by June 1ish. Anything later than that and they are going to be disadvantaged via rolling admissions. This year is weird, though.
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When the coronavirus pandemic occurred, @AAMCtoday was forced to cancel March, April, and May MCAT dates. Makes sense — safety first! They also decided to push the application cycle back 2 weeks and shorten the MCAT.
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The purpose of this shortened MCAT was to allow all students who had their exams cancelled due to COVID sit for the exam before all hope would be lost for their admissions cycle (because June tests, in most years, are too late). This is where they lost their standardization.
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At 5pm on a Friday, they announced (via Twitter!) on @AAMC_MCAT that they would remove all experimental ?s from the test (sound familiar @TheUSMLE?) and offer it 3x per test date. (6:30a, noon, and 6p (ends at midnight!))!
15/ https://students-residents.aamc.org/applying-medical-school/article/covid-19-changes-mcat-exam-administrations-may-29-/

COVID-19 Changes to MCAT Exam Administrations: May 29 – September 28, 2020

https://students-residents.aamc.org/applying-medical-school/article/covid-19-changes-mcat-exam-administrations-may-29-/

The next week, they informed us of the new test’s layout. After many students pointed out that the new format provided students *less time per question* as the format taken by students prior to COVID, AAMC announced that it was fine because it was “about the same.”! Really!
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Finally, a few days later, they announced they would open their system for re-registration (as we had all had our exams cancelled) between 6am-noon EST of 5/7. Yes. 3am-9am PST. They didn’t seem to mind how absolutely whacky this was!
17/ https://twitter.com/medschooladvice/status/1257443793684619265

https://twitter.com/medschooladvice/status/1257443793684619265

So, 5/7 came. I honestly lack the energy to recount it all, so I refer you to @joycefr's article on the matter. Essentially, the website crashed, 60k students tried to register, the AAMC President gaslit us on Twitter, and many students waited 12hrs.
18/ https://www.medpagetoday.com/publichealthpolicy/medicaleducation/86557?vpass=1

AAMC Under Fire Over Issues With MCAT Rescheduling

Pre-med students waited hours online after computer snafu

https://www.medpagetoday.com/publichealthpolicy/medicaleducation/86557?vpass=1

Here is @DavidJSkorton's response to premeds who were frustrated about being woken up at 3am to log into a website that didn't work. One student said it best, "Preparation and accountability are also important qualities for future physicians, sir."
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Everyone was frustrated. If you have time, I urge you to look at @AAMC_MCAT's threads from that day. There are some *high-quality* memes, as well as plenty of deserved outrage.
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Now, let's discuss accommodations. Students with disabilities are entitled to "reasonable accommodations" under the ADA while taking the MCAT. @AAMCtoday doesn't care. This is just my experience, for one.
21/ https://twitter.com/memesMD/status/1263628829555294209

https://twitter.com/memesMD/status/1263628829555294209

Rather than rescheduling online on 5/7, students with disabilities had to register via phone by calling @PearsonVUE (the @PrometricGlobal of the premed world) on the phone. This wouldn’t have been an issue if the phones had been connected!
https://twitter.com/CallMeMeyer/status/1258490118387781633?s=20
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https://twitter.com/CallMeMeyer/status/1258490118387781633?s=20

When they finally managed to get through on the phone, they were asked to add their name to a list and “receive a callback w/in 48 hours.” One student just got her call back on JUNE 8! All the early exam dates were taken and she can't apply this year.
23/ https://twitter.com/AAMC_MCAT/status/1263506812701204480

https://twitter.com/AAMC_MCAT/status/1263506812701204480

It doesn’t take a disability expert to know that this is a problem. Why couldn’t students w/ disabilities reschedule online? Why aren’t they given the same opportunity to become physicians? I hope some of the students affected by this reply (if willing) w/ their story.
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Now, COVID… Let’s begin by acknowledging that it’s probably *not* a great idea to have students sit in a cramped @pearsonvue test center to take this exam. A/presymptomatic transmission is a true risk!
25/ https://www.medicalnewstoday.com/articles/40-45-who-contract-new-coronavirus-are-asymptomatic

40–45% who contract new coronavirus are asymptomatic

New research warns that the high number of asymptomatic people who have likely contracted SARS-CoV-2 must motivate more testing and caution.

https://www.medicalnewstoday.com/articles/40-45-who-contract-new-coronavirus-are-asymptomatic

In addition, the AAMC/Pearson have said they will cancel exams “by region” in the event of a second wave. Students last weekend had their exam cancelled w/ 6hrs notice. What happens when states reinstate stay at home orders?
26/ https://www.marketwatch.com/story/utah-and-oregon-put-reopening-of-economies-on-hold-amid-spike-in-coronavirus-cases-but-texas-arkansas-and-arizona-press-on-despite-warning-signs-2020-06-13

Utah and Oregon put reopening of economies on hold amid spikes in coronavirus cases, but Texas,...

Utah and Oregon put any further reopening of their economies on hold Saturday amid a spike in coronavirus cases, but there was no turning back in such states...

https://www.marketwatch.com/story/utah-and-oregon-put-reopening-of-economies-on-hold-amid-spike-in-coronavirus-cases-but-texas-arkansas-and-arizona-press-on-despite-warning-signs-2020-06-13

Additionally, students have been home w/ their families since MARCH. The mental health implications of this are significant for many students, esp those with toxic home lives or many siblings. Add in a pandemic... and the premeds are hurting.
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On top of all of the complications with the pandemic, the end of May introduced new factors to the picture: #BLM protests in major cities all around the country. As future physicians, we all have a duty to stand for social justice when called to action.
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As tensions rose and protests continued, many students felt the need to hit the streets. Some brought PPE and first aid to assist in caring for injured protestors. This, of course, took away from the time they could have studied for the @AAMC_MCAT MCAT.
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Students should not be forced to choose between their constitutional right to protest and their MCAT score. By failing to account for the protests as something that come students will prioritize over their exam, @AAMC_MCAT is upholding medicine’s institutionalized racism.
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AAMC and med schools that are continuing to require the MCAT/an in-person MCAT are telling pre-meds that the desire for social change is unimportant. Racism is a major problem in medicine that is perpetuated by resistance to change and an aversion to advocacy.
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On top of that, @AAMC_MCAT is telling Black students that their lives don’t matter. Recall that one of the new testing times during the pandemic is 6pm-12am. In order to curb the protests, many cities have implemented nightly curfews.
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Once these curfews are in effect, anyone can be pulled over and detained. PDs in many big cities have been accused of using excessive force and/or chemical weapons against peaceful protestors and bystanders (see NYPD below)
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This has disproportionately affected Black people, as seen in the viral video from Atlanta below. So what does this mean for Black students who are leaving their 6pm MCATs?
34/ https://twitter.com/Georgia_NAACP/status/1266952518933905408?s=20

https://twitter.com/Georgia_NAACP/status/1266952518933905408?s=20

@AAMC_MCAT apparently attempted to address this situation in the thread below. But, rescheduling was already free at this point due to COVID-19 concerns. AAMC’s “response” to the protests was just a rehashing of already empty words.
35/ https://twitter.com/AAMC_MCAT/status/1267578955105796096?s=20

https://twitter.com/AAMC_MCAT/status/1267578955105796096?s=20

Due to the uncertainty of the rescheduling system and the often 4hr wait times to speak with someone on the phone, some June 5 test takers decided to proceed with their testing as planned.
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On June 5, @AAMCtoday had examinees stay out past curfew in dozens of cities including Chicago. The 6:15 MCAT didn't let out until 11:45pm downtown at which point being outside was *against the law* putting Black premeds especially at risk:
37/ https://chicago.suntimes.com/crime/2020/6/14/21286741/chicago-city-curfew-african-american-arrest-aclu

Blacks make up 75% of those charged with violating city curfew, data shows

"It’s infuriating and tragic," said Colleen Connell of the Illinois ACLU. "The curfew basically gave the Chicago Police Department carte blanche to continue over-policing people of color."

https://chicago.suntimes.com/crime/2020/6/14/21286741/chicago-city-curfew-african-american-arrest-aclu

By forcing Black students to stay out past curfew, @AAMC_MCAT is directly endangering student’s lives. Because taking an exam is not considered essential travel, students taking the 6pm MCAT are subject to detainment *or worse* by police officers.
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And of course, @AAMC_MCAT ignored all student replies about the disproportionate risk they are posing to Black pre-meds. As students began to realize that Black classmates could be killed while leaving their exam, many called for the AAMC to administer the exam remotely.
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Truly, is this reasonable? Or is this a way for AAMC to protect their bottom line financially? Is it a way for medical schools to 'weed out" future physicians?
40/ https://twitter.com/olivia49631873/status/1267875756845043712?s=21

https://twitter.com/olivia49631873/status/1267875756845043712?s=21

So, here we are with a rapidly worsening pandemic, civil unrest, and an exam that doesn't seem to do much in terms of helping select good med students. So what are the options?
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OPTION 1: An online exam, just like the LSAT, GRE, and AP exams were this year. Recognizing the risks that in an-person exam poses to immunocompromised people and their families, as well as the risk to Black premeds testing at night, many students have called for this.
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After many days, AAMC wrote me the below message explaining why they feel they couldn't have an online MCAT. I'll explain why this is insufficient in a moment.
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AAMC said they can't administer the test online because the MCAT includes "many complex figures, graphs, and equations that require high resolution to be displayed properly." Have you ever been in a testing center? Do you think those computers are somehow special?
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^*44/

Pearson VUE technical specifications require that all monitors in their testing site require any of the 3 resolutions: 1920 x 1080, 1280 x 1024, 1024 x 768. Most people have laptops that have these resolutions or better.
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Furthermore, while Pearson VUE requires the monitors at their testing site to be any of those 3, the individual testing site can choose to have a mix of the 3 or opt for the lowest resolution (not standardized). The program itself does not require anything special to run.
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The program itself does not require anything special to run. According to Pearson VUE technical specs, the minimum amount of RAM is 4 GB which most computers have. In fact most computers now are sold with a standard 8 GB of ram regardless.
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And I should note that an at-home exam is NOT ideal for everyone. Some students might need to go to a test center (or perhaps utilize a study room at their local medical school... any takers?). These things CAN be arranged.
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Another justification the AAMC used to keep the MCAT in person is that some students will attempt to cheat on the exam. The number of questions per section, along with the time limit for each section makes this virtually impossible.
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Not only is it almost impossible, but Pearson VUE has an online proctoring service so it can monitor all students to prevent cheating. Many testing companies have programs that lockdown the browser to prevent the use of unauthorized programs making cheating impossible.
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If it’s good enough for AP, LSAT, and GRE… it’s good enough for the MCAT. Premeds aren’t some rare breed of student (sorry guys). I find it amazing that the company that controls American #MedEd finds us trustworthy to eventually become physicians, but not to take a test.
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OPTION 2: Waive the MCAT. Don't transmit scores for anyone this cycle. Use this as an opportunity to research how useful this test really is.
52/ https://www.insidehighered.com/admissions/views/2020/06/08/mcat-should-be-optional-opinion

The MCAT should be optional (opinion)

This year, there is no reason to require the test, writes Lala Tanmoy Das.

https://www.insidehighered.com/admissions/views/2020/06/08/mcat-should-be-optional-opinion

Yes -- this is unfair to those who have already taken the test. But, an in-person or online exam isn't really fair either. It's not standardized. The new exam is shorter. Testing at 6:30am and noon are objectively different experiences.
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It would be *so* useful to have a data set of students who didn't take the exam. The long term impact this research could have on medical education would be profound! We would finally know is this was all necessary.
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What would it take for the MCAT to be waived this year? First, a recognition that the test doesn't have great evidence backing it, and that basic science exams are often a way to URM students out of higher education.
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Then, the ball is in the court of either the @AAMCPreMed or medical schools. AAMC could do the just thing and withhold everyone's score, give refunds, and run some great research. Or, med schools could say "No. We don't want to play this game anymore."
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We know that AAMC is not going to just cancel the MCAT, and we don't think there's any chance of them moving it online, so some solidarity on behalf of medical schools is necessary.
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AAMC says that "medical schools view the MCAT as important." I would like to know if it's really more important than the health and wellbeing of America's future doctors? Is it worth keeping low-income and Black students out of medicine?
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Because make no mistake -- that's what the MCAT will do this year (to an even more extreme degree than usual). Reapplying is too expensive for many. These students will walk away from medicine, not because they want to, but because they can't afford it.
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This thread is too long, so I'll end with our ask and drop links below:

To US Med Schools and the AAMC -- Please either waive the MCAT exam or offer it online. Any shred of standardization is lost. Premeds are suffering. Please do the right thing.

60/

Via @londyloo
https://twitter.com/londyloo/status/1273268481308360704?s=21 https://twitter.com/londyloo/status/1273268481308360704