The Transition to Competency-Based Admissions: Background and Requirements
The Association of American Medical Colleges (AAMC) has asked medical schools to address the challenge that applicants face in preparing for medical school requirements that are in a period of transition, as well as for a revised MCAT in 2015. Should we, for example, continue to require a traditional chemistry course sequence in preparation for medical school biochemistry, or is there another way that applicants can demonstrate that they have attained this content knowledge? And how can undergraduate schools provide exposure to required concepts/pre-requisites now that learning has become a process that extends beyond the classroom, and courses have migrated from single titles like, "Biology," to integrative units like, "Psychobiology of Stress and Disease?"
Medicine is increasingly appreciated as a discipline that requires skills and abilities that are acquired through experiences and venues both inside and outside the classroom. Dr. Darrell G. Kirch, President and CEO of the AAMC has stated, "Many students who would make excellent doctors are not extended an interview because admissions committees do not have ready opportunities to consider their broader personal characteristics before granting one." ("See the person before the rule.")
In response and to prepare applicants for holistic review that will evaluate, equally, their personal characteristics and academic readiness for medical school, the Albert Einstein College of Medicine has instituted a competency-based admissions process. We believe, as Dr. Kirch has stated, that this approach "will allow applicants the opportunity to demonstrate the complex personal dimensions that contribute to being a good doctor," in addition to the cognitive capabilities that have traditionally identified applicants as being ready for the academic rigor of medical school. This "competency-based" approach also provides candidates greater flexibility, for example, by substituting laboratory experience gained, while employed, for laboratory and or course requirements taken in school, or by substituting online courses that free up time to pursue interests that enhance the applicant's level of maturity and readiness for the medical profession.
The Committee on Admissions will use the entire application to ensure that the candidate has demonstrated reasonable accomplishment of all of the identified competencies; this includes the AMCAS application, academic record, personal comments, roster of experiences, letters of recommendation, the Einstein secondary application, written and verbal communication with the Admissions Office, and interview (where applicable).
Competency-based admissions will become effective this year for entrance to the class entering in 2015.
There are 4 competencies:
- Co-Curricular Activities and Relevant Experiences
- Communication Skills
- Personal and Professional Development
Co-Curricular Activities and Relevant Experiences
Applicants must be able to demonstrate an understanding of the clinical aspects of the career on which they are about to embark. As such, they must engage in meaningful experiences, at home or abroad, that provide exposure to clinical settings involving patient care and also provide opportunities for interaction with and learning from persons who are living with illness and/or disabilities.
Recognizing that time is limited, however, and that work, research and other activities can contribute to a student's overall preparedness for medical school but might compete with time that would have been devoted to clinical exposure, Einstein will consider, holistically, the full set of activities described in a candidate's application.
Communication skills are essential to work effectively with patients and meaningfully collaborate with colleagues. Applicants must have:
- excellent spoken and written language abilities;
- language abilities that enable them to read, evaluate and use the information from scientific and public health literature;
- excellent interpersonal interaction and communication skills, including empathic listening, and the ability to interact with people from diverse socioeconomic, cultural, racial and ethnic backgrounds;
- computer skills that enable them to utilize common software given its importance in medical education and practice.
Personal and Professional Development
Physicians must maintain a high standard of ethical and professional behavior, characterized by patience, empathy, maturity, self-motivation, emotional stability, personal integrity, accountability to colleagues and patients, and dedication to the practice of medicine. They must also be able to give primacy to the needs of their patients while maintaining appropriate interpersonal boundaries. Applicants are expected to have demonstrated that they have acquired these attributes:
- the ability to work cooperatively as a member of a team;
- cultural awareness, sensitivity and advocacy for, as well as interest in, individuals who are served by the health care system and/or who are the participants of clinical research;
- the ability to withstand the stressors inherent in the intensive medical school training process, and the ability to adapt to these stressors;
- commitment to leadership, teaching, collegial interactions, advocacy, and life-long learning to enhance the practice of medicine.
Applicants with specific interests and career goals such as academic medicine or public health should:
- participate in hypothesis-driven basic science, translational or clinical research;
- study and/or participate in experiences that provide them with an appreciable understanding of the public health issues of chronic disease, health disparities, and/or global health.
In recognition of the importance of intellectual multiplicity in the medical profession, applicants are encouraged to major in any area of the humanities or sciences that is of interest to them. Regardless of an applicant's chosen major, in preparation for studies in human physiology, pharmacology and the biological basis of disease, applicants applying to medical school should obtain a solid foundation in the biological, chemical and physical sciences. Premedical coursework should include laboratory-based courses in which applicants learn to collect data, analyze it and draw scientifically rigorous conclusions.
An understanding of inorganic and organic chemistry is essential to understanding the biochemistry of living organisms. Applicants should have a working knowledge of:
- atomic and molecular structure, chemical reactions, catalysis, chemical equilibrium, thermodynamics, reaction rates, binding constants and reaction mechanisms with a focus on redox reactions, acid-base chemistry, enzyme catalysis and biological chemistry;
- the structure and function of biologically important molecules including DNA, RNA, proteins, lipids and carbohydrates and the pathways for synthesis, modification and degradation of these macromolecules.
Applicants should understand the molecular and cellular organization of prokaryotic and eukaryotic organisms and viruses. This includes understanding the:
- structure and function of cells and subcellular organelles;
- major biological processes and the regulation of these processes including life cycle, metabolism, bioenergetics, and replication;
- cellular basis for organ function and how organs contribute to the viability of living organisms.
Physics provides a fundamental foundation for understanding chemistry, biology and physiology. Applicants should have knowledge of Newtonian mechanics, work and energy, fluid dynamics, electricity and magnetism, circuit diagrams, and waves.
Applicants should have a firm foundation, i.e., college level course exposure to quantitative reasoning and the mathematical analysis and interpretation of data. They should be able to:
- construct and interpret functions and graphs;
- understand the use of basic statistics and probability in testing hypotheses and validating experimental results, particularly as it relates to the critical reading of medical and scientific literature.
While not part of the required competencies, computer science and programming, and knowledge of the concepts of limits, integration and differentiation may be useful skills, depending on an applicant's interests and career goals, especially for those applicants interested in a career in research and/or academic medicine.
5. Humanities, Social and Behavioral Sciences
While applicants are not expected to achieve expertise in all disciplines, it is important that they understand the factors that influence individual, community and societal decisions regarding health and health care. This awareness can be gained through courses in disciplines such as psychology, sociology, anthropology, public health, literature, economics, history, philosophy and ethics. Applicants should have a basic understanding of key issues in medical ethics.
Where to Meet the Knowledge Competencies
- Whereas course work at a four-year college or university is our benchmark, if a student chooses to meet a competency component via an alternate route such as through laboratory experience, through an advanced placement course, a course taken at a community college, a course taken abroad (during a semester abroad for which the undergraduate U.S. degree-granting institution gives credit, or for which AMCAS will verify and report the grade), or an online course, he or she should either seek guidance from an academic advisor to ensure that the option meets the above guidelines as well as the rigorous academic standard required by the Albert Einstein College of Medicine. Flexibility is not license to pursue a non-rigorous course of study. The Knowledge competencies can be met also by following the traditional courses that are acceptable to most medical schools.
Suggested Minimum Credit Hours and Experience
- In our experience, the above Knowledge Competencies are most successfully attained by applicants who have had a minimum of three years of study toward a baccalaureate degree from an accredited college or university in the U.S. or Canada as well as 40 credit hours of science and mathematics, including advanced biology courses for which letter grades are available (not Pass/Fail, unless college policy), 40 credit hours of humanities and social sciences, and substantial experience in clinical, community, and/or research activities (as described above). Students who complete their science course work in a post-baccalaureate program must have completed at least 30 credit hours in a U.S.-chartered college or university whose grades can be reported and verified by AMCAS.
- All applicants must take the MCATs not later than November of the year preceding matriculation and not earlier than three years prior to application (2011).
- Applicants who have earned baccalaureate degrees outside the U.S. or Canada are required to complete, prior to applying, at least one year of formal coursework in the sciences (about 30 credit hours for which letter grades are available) in a U.S.-chartered college or university whose grades can be reported and verified by AMCAS.
Course Work Older than Five Years
- Applicants who have completed all of their pre-medical course requirements five years prior to the time of application must show evidence of participation in either academic or work experience in the biological sciences. Academic experience should include at least one course in a discipline such as cell biology, molecular biology, genetics, immunology or neuroscience. Work experience may include research in the biological or physical sciences or clinical investigation.
Special Note to MD-PhD Applicants
- Applicants to the combined MD-PhD Medical Scientist Training Program have additional requirements that are listed on the MSTP website.
Technical Standards for Admissions, Retention, Promotion, and Graduation
All accepted students must be able to meet theTechnical Standards established by the College of Medicine. After a decision is made to offer an acceptance to a given applicant, that candidate is required to certify his/her ability to meet the Einstein College of Medicine Technical Standards, but at this juncture (prior to matriculation) the candidate is required to indicate whether or not he/she is able to satisfy the Technical Standards without accommodation; or if the candidate asserts a disability, whether that disability necessitates provision of accommodation(s). In the latter case, the Office of Student Affairs directs the review of medical and other documentation as provided by and/or required of the candidate and Einstein College of Medicine must then determine if "reasonable accommodation" can be provided, and if so, acceptance and matriculation is approved. Formal applications for specific accommodations by matriculated students are encompassed within the by-laws of the Committee on Student Promotions and Professional Standards (CSPPS).