The fact of the matter is that no one is **really** sure what makes an excellent physician. Is it high academic achievements, lots of compassion and empathy, or just a good head on one's shoulders? Probably a bit of all of the above. That said, how does one establish thresholds in choosing among the piles applicants who all want to be doctors some day? We are not the first to ask these questions...
Keep in mind that the purpose of standardized admission tests, like the MCAT, is *not* to help schools pick the candidates with the highest probability of becoming the finest physicians in the world. Quite the contrary: It is to weed out students who will have a difficult time handling the rigors of a medical school curriculum. The MCAT people make this point clear. It is a point that keeps getting lost in the din: There is a point of diminishing returns on traditional predictors of academic success (MCAT and GPA).
The few studies that have examined the validity of MCATs and GPAs as predictors of success consistently conclude that those variables are only part of the overall equation. There is a growing interest among admission officers and researchers, including myself, in noncognitive predictors of medical student success:
TITLE: Evaluating the predictive validity of MCAT scores across diverse applicant groups.
AUTHORS: Koenig JA; Sireci SG; Wiley A
AUTHOR AFFILIATION: Association of American Medical Colleges, Washington, DC 20037-1127, USA.
[email protected]
SOURCE: Acad Med 1998 Oct;73(10):1095-106
CITATION IDS: PMID: 9795629 UI: 99011721
ABSTRACT: PURPOSE: To examine the predictive validity of MCAT scores, alone and in combination with other preadmission data, for medical students grouped by race/ethnicity and sex. METHOD: This study included two samples: 1,109 students who entered in 1992 any of the 14 medical schools participating in the MCAT Predictive Validity Study; and all 11,279 students who entered medical school in 1992 and took the USMLE Step 1 in June 1994. Criterion measures included each student's cumulative GPA in the first two years of medical school and his or her pass/fail status on Step 1. Differential predictive validity was examined by comparing prediction errors across racial/ethnic and sex groups. For cumulative GPA; residuals were compared, and for Step 1, classification errors were studied. RESULTS: The patterns of prediction errors observed across the groups indicated that, on average, (1) no difference between the sexes in prediction errors was evident; (2) performances of the three racial/ethnic minority groups tended to be overpredicted, with significant findings for Asians and Hispanics; and (3) Caucasians' performance tended to be underpredicted, although the magnitude of this underprediction was quite small. When USMLE Step 1 scores were the criterion for success in medical school, the majority of errors were overprediction errors. CONCLUSION: The authors caution that although MCAT scores, alone and in combination with undergraduate GPA, are good predictors of medical school performance, they are not perfect. The authors encourage future research exploring additional predictor variables, such as diligence, motivation, communication skills, study habits, and other relevant characteristics. Similarly, they indicate that high grades and Step 1 scores are not the only indicators of success in the medical profession and call for studies examining other important qualities, such as integrity, interpersonal skills, capacity for caring, willingness to commit to lifelong learning, and desire to serve in underserved areas.
TITLE: Predicting medical students' academic performances by their cognitive abilities and personality characteristics.
AUTHORS: Shen H; Comrey AL
AUTHOR AFFILIATION: Neuropsychiatric Institute, University of California, Los Angeles, USA.
SOURCE: Acad Med 1997 Sep;72(9):781-6
CITATION IDS: PMID: 9311320 UI: 97457511
ABSTRACT: PURPOSE: To utilize multiple regression analyses with both linear and quadratic models to explore and confirm the relationships among students' cognitive abilities, personality traits, and medical school performances at the University of Los Angeles, California, UCLA School of Medicine. METHOD: Ninety-seven "not-disadvantaged" students' pre- medical grade-point averages (GPAs), Medical College Admission Test (MCAT) scores, and personality traits as measured by the Comrey Personality Scales (administered at their application to medical school in 1985) were used to predict their medical school performances according to several criteria. "Disadvantaged" students were excluded from the study because their poor performances on all criteria would confound the relationships of personality, cognitive ability, and performance. RESULTS: The MCAT score was a strong predictor of medical school performances, particularly those criteria measured by medical school GPAs and the National Board of Medical Examiners examination scores, but its predictive power dropped sharply when clinical performance and personal suitability were part of the performance evaluation. Specific personality traits not only strengthened the predictive power of cognitive and personality variables jointly, they became the primary predictors of clinical performance and personal suitability. A single personality-profile index failed to show any power of prediction. As expected, quadratic relationships were found between some personality traits and some medical school performance measures. CONCLUSION: According to these data it is not realistic to use one or two personality traits to predict personal suitability on all medical performance measures. The multiple regression analysis results indicate that different personality characteristics are incorporated in different types of medical performances, which is perhaps why the overall personality-profile score failed to predict any of the studied criteria. Because of the study's relatively small sample size, however, cross-validation studies are necessary to confirm these findings.
Now, osteopathic medical schools seek not to only produce excellent and comprehensively trained physicians, they also seek to produce *osteopathically minded* physicians as well. So, there is a whole other layer of subjectvice assessment in the D.O. school admissions process that does not exist in the MD world. The scant data, and I mean *scant* data, that address the question, What is osteopathic [or holistic, or patient centered]? suggest that life experiences and attitudes toward patient care **prior to medical school matriculation** are important predictors in the development of osteopathic [or holistic, or patient centered] attitudes later on down the line. Therefore, D.O. schools must pay attention to these variables in their own selection process. To not do so would undermine their whole reason for existing. Remember: Osteopathic medicine developed as social movement, a reform movement, in American medicine.
One interesting finding in a study examining which medical students are more likely to adopt a "patient-centered" (about as close as you can get to "holistic" in the academic literature) approach to care during their clinical training concluded, "Clinical students who were older were more likely to have a 'patient-centred' approach to disease prevention and health promotion."
[Med Educ 1996 Mar;30(2):97-104
Disease prevention and health promotion: a study of medical students and teachers.
Meakin RP, Lloyd MH]
Is it any wonder then that the average age of matriculation at D.O. schools is older than many M.D. schools? What do you think this might mean?
A few toughts on D.O. discrimination: Vastly exaggerated in the pre-med internet world. Sure, some residency program directors have biases against D.O. students. This is not news. Other directors also have biases against older students, black students, and women. Minority issues, be they ethnic, gender, or professional, are generally similar across minority groups.
It is the rule and not the exception that D.O.'s compete on par with M.D.'s for primary care residencies. Moreover, in the great scheme of things D.O.'s and M.D.'s are political allies against all those professional/interest groups trying to interfere in the scope of practice of medicine. The AOA and AMA sit on the same side of the table. I encourage you to read the proceedings of Josiah Macy Foundation's conference, "Current Challenges for MD's and DO's" to learn more about the professional and political state of affairs between the two professional groups.
Now, I can't find any studies that compare MD's and DO's in the day to day practice of medicine. But, there are a few studies that compare performance of D.O.'s who completed MD or DO residencies on national board exams. Generally, they find that the performance is comparable:
TITLE: Comparison of performance on the American Osteopathic Board of Internal Medicine certifying examination 1986 to 1996 by type of residency.
AUTHORS: Slick GL
AUTHOR AFFILIATION: Department of Internal Medicine, Chicago College of Osteopathic Medicine, Midwestern University, IL 60615, USA.
SOURCE: J Am Osteopath Assoc 1997 Jul;97(7):417-22
CITATION IDS: PMID: 9257513 UI: 97401874
ABSTRACT: The purpose of this study was to determine if internal medicine residency type or location was associated with differences in performance of candidates as measured by the internal medicine certifying examination. Included in the study were all first-time taker candidates for the 1986 to 1996 American Osteopathic Board of Internal Medicine certifying examinations in internal medicine. Group analysis was performed based on the type of residency track leading to board eligibility: (1) traditional internship plus 3 years of internal medicine residency; (2) traditional internship plus 2 years of internal medicine residency and 1 year of subspecialty training; (3) specialty track internship plus 2 years of internal medicine residency; and (4) traditional internship plus 3 years of allopathic internal medicine residency. Subgroup analysis of the subspecialty track group was performed to determine if any particular subspecialty-trained subgroup performed better than the others. Results indicate that all groups had similar scores and pass rates except for the allopathic-trained residents, whose scores and pass rates were lower. Subgroup analysis of the subspecialty-trained candidates revealed that procedure-oriented subspecialty candidates performed similar to non-procedure-oriented candidates. No gender differences were noted in scores or pass rates. It is concluded that the overall performance of candidates is equivalent for each of the residency training tracks developed by the American College of Osteopathic Internists. Future performance on the recertification examination will need to be tracked to determine if these trends continue for practicing internists.
TITLE: Performances of candidates with osteopathic compared with allopathic subspecialty training on the American Osteopathic Board of Internal Medicine subspecialty certifying examinations 1984 to 1992.
AUTHORS: Slick GL; Dolan S
AUTHOR AFFILIATION: Department of Internal Medicine, Chicago College of Osteopathic Medicine of Midwestern University, IL 60615.
SOURCE: J Am Osteopath Assoc 1994 Dec;94(12):1050-3
CITATION IDS: PMID: 7852104 UI: 95155070
ABSTRACT: The American Osteopathic Board of Internal Medicine has been examining various factors that may affect candidate performance on subspecialty certifying examinations. To see whether taking subspecialty training in an osteopathic compared with an allopathic institution could predict better performance on the certifying examinations, the authors analyzed examination performance for all candidates from 1984 through 1992. There was no significant difference between the mean scores for the two groups for any of the nine subspecialty certifying examinations. When the results from all nine examinations were pooled, the mean first-time examination takers' score for candidates in allopathic subspecialty programs (n = 201) was 78.3 and for those in osteopathic subspecialty programs (n = 153), 77.4 (P > 0.2). On the basis of these results, we cannot conclude that osteopathic subspecialty training is a factor that predicts better performance on the subspecialty certifying examination.
Bottom line: Ultimately, one's own success in medicine will be determined by the drive, ambition, and passion one holds for becoming the best physician he or she can be. There are some differences between MD and DO training, perhaps some differences in post-graduate opportunities too. Still, both professionals are recognized as complete physicians. I know no starving D.O.'s or M.D.'s.
Do what you like.
[This message has been edited by drusso (edited 03-08-99).]
