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Letters to the Editor

Holistic Admissions and the MCAT as Predictors of Competence

Thomas, Billy MD

Author Information
doi: 10.1097/ACM.0000000000003736
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To the Editor:

Given the correlation of race/ethnicity, socioeconomic status, parental education, and geographical location with student performance on the MCAT (Medical College Admission Test), a pass/fail scoring system that is part of a holistic admissions process is not unthinkable. Economically disadvantaged students and those from races and ethnicities underrepresented in medicine score lower on the MCAT.1 Mean scores for students receiving fee assistance (economically disadvantaged) is 496 compared with 501 for those not receiving assistance. The mean score for White students is 502, compared with 494 for African Americans, 496 for Hispanics, 497 for American Indian/Alaska Native, and 499 for Native Hawaiians/Pacific Islander. Using these data, we can make well-informed decisions on MCAT pass/fail cutoffs.1 Nationally, 93% of students with midrange (494–505) MCAT scores progressed to their second year (on-time) with a first-attempt United States Medical Licensing Examination (USMLE) Step 1 pass rate of 89%.1 Additionally, students who score in the midrange of MCAT scores progress academically, pass on their first attempt of USMLE Step 1 at a high rate, and are more diverse.2

Prior knowledge of MCAT scores of different racial/ethnic and economic groups can serve as a guide to defining the lower limits of MCAT scores in a pass/fail system. This includes those most frequently posted by disadvantaged and minority students.

The fear of lowering academic standards and expectations can be abated through a holistic admissions process that includes a pass/fail MCAT and targeted institutional support. Once students are admitted, there is an institutional responsibility to provide transitional programs, early intervention, and academic and wellness support services that optimize the chances of academic progression. This must be taken in context with racial, ethnic, and gender biases that exist across the medical school continuum and may play a role in grading, academic progression, and graduation. The use of a single test score to predict academic progression, graduation rates, and individual competence for diverse populations is probably not reasonable. A holistic admissions process that includes a pass/fail MCAT coupled with transition programs, early intervention, and academic and student wellness services can produce a diverse, competent, and humane physician workforce.

Billy Thomas, MD
Professor, Department of Pediatrics, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas; [email protected]; ORCID:


1. Association of American Medical Colleges. Using MCAT data in 2020 medical student selection. Published 2019 Accessed August 14, 2020
2. Terregino CA, Saguil A, Price-Johnson T, Anachebe NF, Goodell K. The diversity and success of medical school applicants with scores in the middle third of the MCAT score scale. Acad Med. 2020; 95:344–350
Copyright © 2020 by the Association of American Medical Colleges