A more holistic view of health with sociology, psychology on the MCAT

The new MCAT has sections on sociology and psychology and this has led to new patterns of study:

The test has been thoroughly revamped and is now three hours longer. It takes 7 1/2 hours to complete, including breaks, and covers four new subjects, including a combined section on psychology and sociology that account for a quarter of the overall score.

Test takers will now have to define terms like “institutional racism” and “social constructionism,” and answer applied questions about how race and class affect health…

“Whether or not someone becomes ill has a lot to do with the society in which they live,” says Catherine Lucey, vice dean of education at University of California, San Francisco School of Medicine and a member of the committee that will assess the new MCAT…

How those conditions are treated has also evolved. Doctors know how to treat acute infection now. But managing chronic disease has become a much bigger part of medical care, and doctors need to develop different skills and a different kind of relationship with the patient. Doctors need to build trust, Lucey says, to understand how patients think and make decisions, in order to convince them to exercise more and change their diet.

For those in the comments who think that this is injecting liberal and untrue social science into the practice of medicine, there is plenty of evidence from a variety of fields that medical conditions are not solely dependent on physical traits or conditions. If you want to treat the whole patient, you need some knowledge of the patient’s social and mental well-being.

All that said, it will still be interesting to see whether this affects future doctors. Taking one class in sociology and psychology or looking at study materials on this subject doesn’t necessarily mean the principles will stick if med school programs don’t say much about these topics or knowledge in other areas is more incentivized.

Inequality in American schools: students in certain states compare well with international leaders, those in other states do not

Where American students go to school matters as those in certain states score comparably to international leaders while students living in other states don’t do as well:

The average TIMSS score is a 500, and the test uses four benchmarks—low, intermediate, high, and advanced—to describe student scores. In math, two-thirds of U.S. states scored above the TIMSS average…

Massachusetts was the highest-scoring state in math, coming in behind four educational systems—Republic of Korea, Singapore, Chinese Taipei, and Hong Kong—and outranking 42 education systems. The lowest-ranking state, Alabama, outperformed only 19 educational systems…

In science, 47 states scored above the TIMMS average…

Massachusetts and Vermont outperformed 43 educational systems, while the District of Columbia ranked above only 14 educational systems. Singapore was the only education system to outrank all U.S. states.

This isn’t a new argument. The documentary Waiting for Superman raises a similar question: do we want children’s education to rest primarily on where they live, a factor over which they have little control? A Time story on education in Finland a few years ago suggested they had a different approach: raise rest scores and education overall by helping the students at the bottom. The United States and some other countries use the opposite approach where they provide resources to the best students to help them achieve even more. Both approaches can lead to higher average test scores but they would lead to different levels of variation in scores. In other words, how much of a gap between the higher and lower scorers is desirable for a society? Of course, this could go far more local than the state level. For example, some public schools in Chicago are among the best in the states while others in the city are among those that struggle the most.

This does reinforce an idea from urban sociology: where people do and can live makes a big difference in their life outcomes. Live in an area with generally more wealthy people and the outcomes are likely to be better.

The sociology knowledge you need to take the MCAT

I noted last year that the MCAT, the exam for applicants to medical school, was changing to include knowledge about sociology. Since then, I have been curious about what exact sociological knowledge is required for the exam and a report from the American Association of Medical Colleges provides some insights. Here is “Behavioral and Social Science
Learning Outcomes at Graduation” that sociology (and psychology) can fulfill (p.24 of the document):

Accurately describe how social determinants of health influence health outcomes and how physicians can incorporate this knowledge in the care of patients.

Here is how a sociological vantage point can help deal with a particular scenario (p.16):

A woman newly diagnosed with breast cancer is searching for a physician to help her think through her situation, set goals, and develop a “health strategy.” While waiting to meet with a new physician for consultation, she tells a medical student that she has been mostly receiving “treatment options,” instead of health strategies…

• How do we conceptualize the difference between a “health strategy” and “treatment options”?
• How is the care of a cancer patient embedded in a network of friends, family, and health care providers?

And here is a more broad statement about what the social sciences can bring to medicine (p.10):

Given the daunting breadth of behavioral and social science, the contributions from this family of sciences can best be understood by attending to three core areas: 1) the use of behavioral and social sciences theory, 2) behavioral and social science research methods, and 3) core behavioral and social science concepts and contributions to the fund of medical knowledge.

On the whole, it seems like sociology is meant to help doctors and health care providers understand the social and cultural context of the patient. Added to an expanded matrix of care, sociology helps provide a more holistic approach to medical care.

It seems like these requirements could be fulfilled by an Introduction to Sociology course though without seeing the particular questions on the MCAT, it is hard to know.

Sociologist argues that SATs not the best predictor of college success

In another round of the battles over standardized testing, a Wake Forest sociologist argues that the SAT is not the best predictor of college performance:

His conclusion? SATs don’t tell us much about how well a student will perform in college.

A better predictor of college success lies in a student’s high school grade-point average, class rank and course selection, Soares said…

Soares is editor of a new book, “SAT Wars: The Case for Test-Optional College Admissions,” that takes a critical look at the SAT while calling for a rethinking of the college admissions process…

When it dropped the SAT option, Wake Forest revamped its admissions process, beefing up its written response section and encouraging students to be interviewed by an admissions officer, a move that created a huge logistical challenge for the school.

This is not a small argument: as the article notes, this is a multi-billion dollar industry.

I wouldn’t be surprised if more schools continued to play around with the admissions processes, both to get around some of the difficulties with particular measures but also to get a competitive advantage in grabbing good students before other schools realize what is going on (the Moneyball approach to admissions?).

ACT scores suggest most students not ready for college

The ACT has released a report that says the majority of students who take the test are not ready for college:

Only one in four college-bound high school graduates is adequately prepared for college-level English, reading, math and science, according to report released Wednesday by the ACT college admissions test.

Some 28 percent of the members of the high school class of 2011 failed to meet readiness benchmarks in any of the four core subject areas.

“ACT results continue to show an alarmingly high number of students who are graduating without all the academic skills they need to succeed after high school,” the report stated…

Readiness was defined as a student having a 50 percent chance of getting a B or a 75 percent chance of getting a C in first-year courses English Composition, College Algebra, Biology and social sciences.

Additionally, there are some pretty big gaps between racial and ethnic groups.

Here are some possible courses of action in response to this information:

1. Tell colleges that they need to offer more remedial classes and get students up to speed.

2. Add to the argument that perhaps college isn’t for all students.

3. Tell high schools that they need to keep their standards high and improve their ability to prepare students for college.

3a. Push the issue further down the educational ladder before high school.

4. Attack the ACT test. Perhaps it isn’t a great predictor of success, perhaps it is culturally biased, perhaps the students who take the ACT are not the same who take the SAT, etc.

I wonder how colleges will respond to this information. I would guess that this really doesn’t impact more elite schools who have their pick of students who have higher ACT scores. But where does this leave schools that accept a broader range of students?

The effect of motivation on IQ scores, standardized tests

A study suggests that IQ tests are not just testing intelligence but are also indicators of the test taker’s motivation:

The link between our IQs and our fates becomes muddier when we consider motivation – an aspect of test-taking that is often ignored. Simply put, some people try harder in IQ tests than others. If you take this into account, the association between your IQ and your success in life becomes considerably weaker. The tests are not measuring intelligence alone, but also the desire to prove it.

Many standardized tests assume that the people who take them are alert and motivated. As such, their scores reflect the height of their abilities. IQ tests are no different. The questions are ordered by difficulty to keep people’s morale up. Edward Thorndike, a pioneer of intelligence testing, wrote that “all our measurements assume that the individual in question tries as hard as he can to make as high a score as possible”, although he admitted that no one knew if that was the case…

Duckworth herself recognizes that people who actually administer the tests will be well aware of the issue of motivation. She says, “Where the problem lies, in our view, is in the interpretation of IQ scores by economists, sociologists, and research psychologists who have not witnessed variation in test motivation firsthand. [They] might erringly assume that a low IQ score invariably indicates low intelligence.”

Is this view common? Sternberg thinks so, pointing to the fact that Duckworth’s study was newsworthy enough to be published in PNAS, one of the world’s most prestigious scientific journals. “[This shows] how off-track our society has gone in its acceptance of commercial persuasive appeals to buy into standardized tests as some kind of panacea for predicting almost any outcome in life that we value.

I would be interested in hearing more about what helps determine a test-taker’s motivation. This report hints at this: “motivation is itself affected by a person’s background, and their beliefs in their future options and their chances of success.” This sounds like it is tied to social class and might fit with Annette Lareau’s work regarding the “concerted cultivation” of middle- and upper-class parenting versus the “natural growth” approach taken by lower-class parents.

The last two paragraphs of the quoted section above gets at two broader issues: academics (including sociologists?) who might take IQ tests as signs of intelligence and the public’s faith in standardized testing. I can’t imagine too many sociologists would say that IQ tests are a great measure of intelligence but the larger issue regarding standardized testing is an important one. But if standardized tests are also picking up the effect of motivation, is this necessarily bad – wouldn’t higher levels of motivation be seen as a good thing for most uses of standardized tests?

Additionally, I think I have heard of elementary school teachers trying to boost the motivation levels of students for standardized tests. But does the same thing happen at higher levels, like high school or college? Is this something that college professors should pay more attention to?