While preparing for the MCAT® exam, 2018 college graduate Lauren Pinchbeck has been working 40-hour weeks as a medical scribe to squirrel away money to apply to medical school. Her former job in a Phoenix, Arizona, hospital made it tough to squeeze in study time, and she didn’t score as well as she wanted the first time she took the test.
“I need to take the MCAT again, and I'm really hoping they won’t cancel more test dates,” she says. “I can’t go spending all the money I've saved for applications unless I’m sure I have a high chance of getting in.” Even as an undergrad at Virginia Commonwealth University, Pinchbeck worked full-time. “I have to finance everything myself,” she explains. “My dad’s unemployed, and there are three other kids back home.”
Applying to medical school is always time-consuming and stress-inducing — in addition to the MCAT exam, there are essays to write, recommendations to accumulate, interviews to ace, and more — but the COVID-19 pandemic has thrown many new obstacles into the paths of thousands of aspiring doctors. And medical schools face their own issues as they try to build classes that will serve their missions and the nation’s need for talented future physicians.
“There are so many unknowns now,” says Geoffrey Young, PhD, AAMC senior director for student affairs and programs. “This causes significant anxiety for students who need information from schools, which all have their own policies. And it causes concerns for admissions deans who will be reviewing applications that won’t be as complete as in previous years.”
Admissions officials aren’t terribly concerned about 2020 applicants who already went through most of the process before the pandemic hit, but instead are worried about the many essential steps in the 2021 application cycle.
That means academic medicine leaders are scouring options to move the process forward as quickly, fairly, and effectively as possible.
On April 20, after conferring with admissions deans, college prehealth advisors, and other stakeholders, the AAMC’s American Medical College Application Service® (AMCAS®) announced that it would postpone the date that schools can access applicants’ files — which include GPAs, MCAT scores, essays, and other key indicators — from June 26 to July 10. That’s to give students more time to complete their applications before the AMCAS release date.
“Due to the pandemic, this cycle is going to be like no cycle we’ve ever experienced before. We may not even know what some of the stages will look like until we get there.”
Geoffrey Young, PhD
AAMC Senior Director for Student Affairs and Programs
Individual schools are also contemplating and making COVID-19-related changes daily, and dozens of schools have posted policy changes on the AAMC’s page.
So far, a recent AAMC survey shows that 78% of respondents say they will accept pass/fail grades for prerequisite coursework taken between January and August this year, and 76% say they will accept online lab courses for spring 2020 and any subsequent semesters affected by the global pandemic. Other schools are also considering these options. In addition, many are considering extending application deadlines, and more than 30% of responding schools have done so. Yale, for example, has moved its secondary application — meant to supplement the AMCAS package — back a full month, from Nov. 15 to Dec. 15.
And more changes likely lie ahead for both students and schools.
“Due to the pandemic, this cycle is going to be like no cycle we’ve ever experienced before. We may not even know what some of the stages will look like until we get there,” says Young.
Still, he adds, “the admissions community is really trying to listen to and provide support to applicants and prehealth advisors. They are doubling down on their use of holistic review to ensure they have a thorough picture of applicants. Collectively, they are really coming together to try to get through this together.”
What about the MCAT exam?
Even in ordinary times, the MCAT exam — the rigorous multiple-choice test that helps schools evaluate applicants’ problem-solving skills, scientific knowledge, and more — often tops lists of concerns about admissions.
In an attempt to protect examinees and halt the spread of the novel coronavirus, MCAT exams were suspended from March 27 through May 21. To compensate, the AAMC three new testing dates — June 28, September 27, and September 28. There will be a total of 21 dates between now and the end of September.
To further accommodate more test-takers, all 2020 sessions will offer three sittings per day: an early morning, an afternoon, and an evening option. To pull that off, the exam will be trimmed for the remainder of the calendar year from 7½ hours to 5 hours and 45 minutes. The cuts will come from parts of the exam that don’t impact scores, such as some questions that are being given a test run and an end-of-day survey. The plan is to return to the regular format in January.
In addition, MCAT officials are reducing the results-reporting timeframe from one month to two weeks for the June 19 through August 1 dates to allow examinees to include MCAT scores in their package earlier in the application cycle.
Given the unclear course of the pandemic, it’s impossible to predict whether all upcoming exams will be available, notes Valerie Parkas, MD, senior associate dean of admissions and recruitment for the Icahn School of Medicine at Mount Sinai. “Each school needs to figure out how they want to handle the MCAT,” she says. “If they used to accept scores only up until September, maybe they will take them in October or even January,” she notes. “Here, one change we’ve made is that we will allow older scores than we had previously.”
“This is a rapidly evolving situation, and we thank examinees for their patience. We want to work to ensure the use of safe practices in the test centers.”
Karen Mitchell, PhD
AAMC Senior Director of Admissions Testing
Elsewhere, schools are considering whether they would screen applicants — or even interview them — without MCAT scores for now and then require the scores later in the process.
The MCAT serves as a bit of an equalizer, admissions leaders say. “It allows us to compare applicants from different schools and who have taken different courses,” explains Iris Gibbs, MD, associate dean of admissions for Stanford University School of Medicine, which signed a pandemic-related together with all other California medical schools. “Of course, we always view the MCAT in the context of a holistic review of the entire application,” she says.
Meanwhile, MCAT officials are focused on balancing speed and safety.
“This is a rapidly evolving situation, and we thank examinees for their patience. We want to work to ensure the use of safe practices in the test centers,” says Karen Mitchell, PhD, AAMC senior director of admissions testing. Once centers open up, they will practice social distancing measures and rigorous cleaning protocols, and they will allow test-takers to wear gloves and masks.
What about an online exam? Mitchell says that while her team has been evaluating various options to deal with the outbreak, online testing raises possible concerns, including that some students may face obstacles to an online offering, such as not having the right display resolution, reliable internet coverage, or a quiet spot to take the test. “Fairness must be central to any solutions,” she says.
What about everything else in the application process?
Certainly, the MCAT exam is only one portion of the application process, experts note. Most schools take a holistic approach, looking at GPA, letters of recommendation, volunteer activities, and “a broad range of other information, such as the context in which you were learning,” says Steven Gay, MD, assistant dean for admissions at the University of Michigan Medical School.
Students, therefore, have many concerns about this multifaceted process. Below are some key issues.
As undergraduate institutions shuttered campuses and moved courses online, many switched to pass/fail grades — or at least offered the option.
Although these changes were meant to serve students, they have also generated some stress. Kaitlyn Tindall, a junior at Ohio State University, notes that she didn’t feel comfortable opting for pass/fail. “Depending on the class, a passing grade can sometimes be anywhere from an A to a D,” she notes. “I don’t know how medical schools will view transcripts, so I didn’t want to take any chances.”
Medical schools are taking a range of approaches to pass/fail, with some saying they prefer letter grades in prerequisite courses and others explicitly declaring no negative consequences for anyone who chooses the option this spring.
Meanwhile, says Young, the AAMC is developing resources to help medical schools and prehealth advisors understand how to work with changes caused by online courses and pass/fail grading. “Above all,” he says, “we are encouraging schools to be flexible and transparent with students who are trying to figure out how to apply at an unprecedented time.”
Letters of recommendation
Some students worry about their ability to solicit all-important recommendation letters from professors, mentors, and prehealth advisors given the current circumstances.
“I was hoping to have enough time to show professors that I could make a good medical school candidate, but we only really got to meet for the first half of the semester,” says Tindall. “Some of my classes have something like 500 people in them, so although a professor might recognize my face if I went to office hours, I’m not sure that he would recognize my name in an email.”
Another concern is whether students can garner gold-standard “committee letters” — a composite document capturing an applicant’s overall preparation — given that campuses have shut down.
In response, several schools have loosened their rules around recommendation letters. “We will take a packet of letters rather than a committee letter, for example, and it won’t hurt applicants,” says Christina Grabowski, PhD, associate dean for admissions and enrollment management at the University of Alabama School of Medicine. “We completely understand that the recommendation process has really been disrupted.”
Medical experiences and volunteer activities
The COVID-19 outbreak has also severely limited applicants’ ability to access health care and research-related experiences.
“Opportunities to get clinical experience, to volunteer in hospitals, and even to work in communities have been greatly reduced,” says Gibbs. “We are completely understanding about those opportunities not being available, and if a student is ready to apply in other areas, we will still take that person's application quite seriously.”
But experts note that recent experiences might have made a significant difference for some candidates. “For most students, applying isn’t about the last three months,” notes Grabowski. “My fear is for students who are really counting on this time to make their applications more competitive. Unfortunately, those students may feel like they shouldn’t apply now.”
In fact, she adds, “I’m interested to see whether our application volumes will go down because of students who decide, ‘I’m just not ready, and I’m going to wait another year to apply.’”
In a March 19 statement, the AAMC strongly encouraged medical schools and teaching hospitals to conduct all interviews virtually to help promote public health. While students may understand the need to move online, some consider it a setback.
“I would be disappointed to do an interview on camera. I like to be able to get a sense of someone’s demeanor and to read them during the interaction,” says John Thurber, a University of Alabama student working on his master’s degree in biomedical and health sciences. “I’d be frustrated because I think I could crush an in-person interview.”
Others, though, would welcome the shift. “Taking off work and having to pay for flights, a place to stay, and food would put me in a bad place financially,” says Pinchbeck. “Sure, it would be great to see the campus, but I’d rather do virtual interviews.”
Schools have their own issues to consider. Grabowski offers one scenario: Say there’s a dip in the pandemic when her school launches in-person interviews in August but then they have to switch to online interviews during a resurgence. “That means we would be giving different students different interview experiences, which isn’t completely equitable,” she says.
“The question then becomes if we should offer virtual interviews the whole season, or if it isn’t really necessary to jump to that level from the get-go. Both options have disadvantages, but we want to try to mitigate the downsides as best we can.”
The greatest impacts
Admissions officers say they’re committed to focusing on how the COVID-19 pandemic has taken a toll on the applications — and the lives — of medical school applicants.
“We’ve always had a question on our application asking students to describe any adversity that might have impacted their journey,” notes Parkas. “Now, though, we have explicitly indicated that applicants should let us know about anything they feel was impacted by the pandemic.”
In addition, leaders recognize that some students are harder hit than others. “We need to look through the lens of equity as we think about how this has impacted communities of color more, urban communities more,” Parkas says.
In some cases, experts note, students are back home studying in increasingly impoverished conditions, in locations with poor Wi-Fi connections, or while acting as caregivers for younger siblings. “I need to keep all this in mind as I try to understand what students have gone through during these last few months,” says Gay. “If I ignore this, I do so to the detriment of the applicant and my school.”
What’s more, schools need to recognize that current concerns will not evaporate with this round of applications, Parkas notes.
“We’ve lost thousands of people during this pandemic,” she says. “Those people were parents and grandparents and parts of an applicant’s community. We have to remember that these effects will linger into many upcoming application cycles, too.”