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The Medical College Admission Test (MCAT) is a computer-based standardized examination for prospective medical students in the United States, Australia, Canada, and Caribbean Islands. It is designed both to help admission committees select students who are academically-prepared for medical school and to predict success in the first two years of medical school. The exam assesses problem solving, critical thinking, written analysis and knowledge of scientific concepts and principles.

Prior to 2006, the exam was a paper-and-pencil test; since 2007, all administrations of the exam have been computer-based. The most recent version of the exam was introduced in April 2015 has four sections, takes 7.5 hours to complete and is scored in a range from 472 to 528.

MR5 and the 2015 Exam

The MR5 advisory committee was appointed by AAMC in fall 2008 to conduct the fifth comprehensive review of the MCAT exam and to recommend changes for the new exam set to be released in 2015. The advisory committee had 21 members including medical school deans and administrators, basic and clinical science faculty, pre-health advisors, one medical student and a medical resident. The recommendations determined were also based on responses from 2,700 surveys, over 75 meetings and conferences, and 90 outreach events to solicit input. The recommendations considered the content and format of the MCAT, the resources that should be provided relating to the exam, and the changes that should be made to medical school admissions in general.

Ratings of the Importance of Natural and Behavioral Sciences Topics for Mastery of Future Medical School Curricula

To determine the content that should be tested for the exam, the MR5 committee surveyed medical school faculty, residents, and medical students and asked what concepts entering students need to know to be successful in current and future medical school curricula. Three separate surveys were sent asking about concepts in the natural sciences, research methods, and behavioral sciences. The MR5 committee also consulted various expert committees from within and beyond the AAMC.

The largest changes in the exam consist of testing in biochemistry, psychology and sociology concepts. The addition of biochemistry material follows survey results placing biochemistry concepts as highest importance for success in future medical school curricula. The addition of behavioral and cultural material was recommended to provide a solid foundation for learning of these concepts in medical school. According to the committee, psychological science should be understood by medical students as an essential aspect of healthcare. The writing sample section was also removed, since data showed that these scores were not used by most admission committees. These changes were revealed in 2012 so that undergraduate premedical advisers studied the MR5 documents to translate tested core competencies into premedical course recommendations at their campuses.

Test Structure

The current MCAT consists for four distinct sections that are individually scored. Each section is allotted either 90 or 95 minutes and test between 50 and 60 questions. Including breaks, the full examination lasts approximately 7.5 hours. The information for each of the science sections is organized into 10 foundational concepts and four Scientific Inquiry & Reasoning Skills. The science passages are guided by Scientific Reasoning and Inquiry Skills identified by the MR5 for medical school success. The Critical Analysis and Reasoning Skills section focuses on three skills, since this section does not require outside knowledge to answer questions.

Section	Questions	Minutes
Chemical and Physical Foundations of Biological Systems	59	95
Critical Analysis and Reasoning Skills	53	90
Biological and Biochemical Foundations of Living Systems	59	95
Psychological, Social and Biological Foundations of Behavior	59	95

Scientific Inquiry and Reasoning Skills

In the new MCAT exam, changes have been made not only in the content of the exam, but also in the way in which content is presented on the exam. MCAT questions will require examinees to demonstrate four Scientific Inquiry and Reasoning Skills that have been identified by the MR5 as crucial to success in science and medicine. The first skill is Knowledge of Scientific Concepts and Principles, which requires students to not only recognize and recall scientific information, but also to identify relationships between similar concepts. Scientific Reasoning and Problem Solving tests the student's ability to relate scientific theories and formulas to presented information to explain findings and draw conclusions. Reasoning about the Design and Execution of Research requires examinees to show that they can understand science in the context of experiments. The fourth skill of Data-based and Statistical Reasoning requires students to be able to read graphs and tables and draw conclusion from evidence.

Biological and Biochemical Foundations of Living Systems

This section tests mainly tests biology and biochemistry but also requires an understanding of organic and inorganic chemistry. Students will have to answer questions about the functions of biomolecules, processes unique to living organisms, and the organization of biological systems. Understanding of research methods and statistics are also important to successfully reason through this material.

Chemical and Physical Foundations of Biological Systems

This section tests chemistry and physics in the scope of biological systems, requiring understanding of organic and inorganic chemistry and physics as well as biology and biochemistry. Specifically, this section focuses on the physical principles underlying biological processes and chemical interactions that form the basis of a broader understanding of living systems. Understanding of research methods and statistics are also important to successfully reason through this material.

Psychological, Social and Biological Functions of Behavior

This section tests psychology and sociology so that student can demonstrate their understanding of the behavioral and sociocultural determinants of health. Specific material tested include behavior and behavior change, perceptions of self and others, cultural and social differences that influence well-being and social stratification. Understanding of research methods and statistics are also important to successfully reason through this material

Critical Analysis and Reading Skills (CARS)

The CARS section is similar to verbal reasoning sections providing passages with questions testing reading comprehension. The 500-600 word passages can cover topics ranging from the social sciences to the humanities, sometimes presenting in a convoluted or biased manner requiring the reader to consider what is being written from multiple perspectives. The passages are designed to discuss topics that are unfamiliar to the reader, but success in this section requires strictly using information from the passage without using previously known knowledge.

Scoring

The test consists of four sections, each scored from 118 to 132 with a median score of 125. The total MCAT score is a sum of the scores from each of the four sections, ranging from 472 to 528 with a median score of 500. Scores are released on a pre-determined date between 30–35 days after the exam date.

Preparation

The MCAT exam covers material that are taught in the coursework that pre-medical students are expected to take. Additionally, most students take some time to study intensely for the exam, since material covered on the exam is not always analogous to material taught in classes. The AAMC provides official study materials for purchase on their website with hundreds of questions written by the developers of the MCAT including three scored practice exams. 74% of students who sat for the MCAT exam used official MCAT Practice exams while only about 40% used question packs and section bank questions written by the AAMC. The official questions supplied online by the AAMC were rated to be most useful by test takers. The AAMC also began to provide free online resources to prepare for the MCAT through Khan Academy. The preparatory material includes 1,100 free videos and 3,000 review questions including content review and passage-based questions. About 62% of test takers used these resources and 83% of them found them to be useful.

Another popular study option for students is to use MCAT preparatory materials from a commercial company. Many companies provide preparatory classes in-person and online, sets of preparatory books, full-length practice exams, flashcards and many more. 77% of students used commercial preparation books and 67% of students used practice exams published by a commercial company in 2017. 85% of test takers in found MCAT prep books to be useful.

The average student spent 12 weeks preparing for the MCAT exam spending about 23 hours per week, excluding time taking regular courses.

Relevance

Medical School Acceptance based on MCAT Scores, 2016-2018

Almost all United Stated medical schools and most Canadian medical Schools require prospective students to submit MCAT scores for their applications. In a survey conducted by the AAMC of 130 medical schools, MCAT scores were among the most important metrics used to identify applicants to interview and admit. Furthermore, in a recent survey by Kaplan, 54% of medical school said that a low MCAT score was "the biggest applications dealbreaker". Medical school admissions is a holistic process and AAMC provides recommendations on how MCAT scores should be used in admissions, specifically recommending that MCAT scores should not outweigh an applicants other materials.

Results from the previous version of the MCAT that was administered between 1992 and 2014 have been studied in relation to academic success in medical school and beyond. There is conflicting evidence as to whether results from this version of the MCAT exam is correlated with results on the USMLE. The AAMC states that undergraduate grades and scores from the MCAT predict scores on USMLE Step exams. Data collected from a cohort from 14 medical schools' in 1992 and 1993 found that MCAT scores were stronger predictors of USMLE Step scores than undergraduate GPA and were also good predictors for probability of experiencing academic difficulty. Data from students from 119 U.S. medical schools who matriculated between 2001-2004 found that undergraduate GPA and MCAT total scores predicted unimpeded progress towards medical school graduation better than GPA alone. A third study using data from students from the University of Minnesota Medical School from five graduating classes between 2011-2015, and found that MCAT component scores were significantly associated with USMLE Step 1 and Step 2 scores, although the effect was small. Higher MCAT scores are correlated with membership in the national medical honors society Alpha Omega Alpha (AOA), suggesting that MCAT scores can be useful to identify potential top-performing medical students.

Since the most recent version of the MCAT exam was only released in 2015, insufficient years have passed to determine correlation between MCAT scores and medical school benchmarks. The AAMC plans to use medical school data from 2017-2021 to determine the predictive ability of the new MCAT. The data will be collected from 18 medical schools who have agreed to collect data from students from entry to graduation including academic performance, USMLE Step exam scores, time to graduation and graduation rates.