Does Masking MCAT Scores During Admissions Increase Equity?

PURPOSE: To improve admissions process equity, the Uniformed Services University masked Medical College Admission Test (MCAT) scores at or above the 51st percentile to admissions committee members. This policy was aimed at improving admissions rates for applicants in 2 priority groups: those from races and ethnicities underrepresented in medicine (URM) and those from lower socioeconomic status, represented by first-generation college (FGC) graduates. METHOD: All applicants invited to interview were included: 1,624 applicants from admissions years 2014-2016 before MCAT score masking and 1,668 applicants from admissions years 2018-2020 during MCAT score masking. Logistic regression determined admissions likelihood before and during masking. Independent sample t tests compared average admissions committee scores for all applicants and for those in priority groups. Linear regression determined the weight of MCAT scores on admissions committee scores. RESULTS: Despite there being more priority group applicants during MCAT score masking, the admissions likelihood for an individual priority group applicant decreased during this period. URM applicants had an odds ratio of 0.513 for acceptance during MCAT score masking compared to before masking, and FGC applicants had an odds ratio of 0.695. Masking significantly reduced mean admissions committee scores, which decreased approximately twice as much for priority group applicants as for nonpriority group applicants (0.96 points vs 0.51 points). These score decreases were highest for priority group applicants with MCAT scores above the 67th percentile. Masking reduced the weight of MCAT scores; 10.9% of admissions committee score variance was explained by MCAT scores before masking and only 1.2% during masking. CONCLUSIONS: Despite known disparities in MCAT scores with respect to race, ethnicity, and socioeconomic status, admissions decisions in this study were more equitable when MCAT scores were included. While masking MCAT scores reduced the influence of the exam in admissions decisions, it also reduced admissions rates for URM and FGC applicants.

Blinding of Admissions Committee to MCAT Scores: Is There a Difference in Subsequent Medical School Performance Between Cohorts?

BACKGROUND: The Medical College Admission Test (MCAT) is designed to inform members of the admissions committee about applicants' academic readiness for medical school. Although previous work has shown that MCAT scores have some predictive validity evidence for a variety of medical student outcomes, there is also a concern that the MCAT is overly emphasized by admissions committees, which may, for example, affect matriculant diversity. The purpose of this study was to understand whether deemphasizing the MCAT by blinding committee members to applicants' specific scores has resulted in matriculants with different pre-clerkship and clerkship performance. METHOD: The Admissions Committee from the Uniformed Services University of the Health Sciences (USU) created a policy to blind admissions committee members to MCAT scores. The MCAT-blinded policy was implemented for classes of 2022 to 2024. This MCAT-blinded cohort's performance was compared with a previous cohort, classes of 2018 to 2020. Two analyses of covariance were performed to test for differences in the pre-clerkship and clerkship module scores. Undergraduate grade point average (uGPA) and MCAT percentile for matriculants were included as covariates. RESULTS: There were no statistically significant differences in either pre-clerkship or clerkship performance between the MCAT-revealed and MCAT-blinded cohorts. CONCLUSION: This study found similar medical school performance between the MCAT-blinded and MCAT-revealed cohorts. The research team plans to continuously follow these two cohorts to understand their performance further down their education path, including step 1 and step 2 examinations.

The Validity of MCAT Scores in Predicting Students' Performance and Progress in Medical School: Results From a Multisite Study.

PURPOSE: This is the first multisite investigation of the validity of scores from the current version of the Medical College Admission Test (MCAT) in clerkship and licensure contexts. It examined the predictive validity of MCAT scores and undergraduate grade point averages (UGPAs) for performance in preclerkship and clerkship courses and on the United States Medical Licensing Examination Step 1 and Step 2 Clinical Knowledge examinations. It also studied students' progress in medical school. METHOD: Researchers examined data from 17 U.S. and Canadian MD-granting medical schools for 2016 and 2017 entrants who volunteered for the research and applied with scores from the current MCAT exam. They also examined data for all U.S. medical schools for 2016 and 2017 entrants to regular-MD programs who applied with scores from the current exam. Researchers conducted linear and logistic regression analyses to determine whether MCAT total scores added value beyond UGPAs in predicting medical students' performance and progress. Importantly, they examined the comparability of prediction by sex, race and ethnicity, and socioeconomic status. RESULTS: Researchers reported medium to large correlations between MCAT total scores and medical student outcomes. Correlations between total UGPAs and medical student outcomes were similar but slightly lower. When MCAT scores and UGPAs were used together, they predicted student performance and progress better than either alone. Despite differences in average MCAT scores and UGPAs between students who self-identified as White or Asian and those from underrepresented racial and ethnic groups, predictive validity results were comparable. The same was true for students from different socioeconomic backgrounds, and for males and females. CONCLUSIONS: These data demonstrate that MCAT scores add value to the prediction of medical student performance and progress and that applicants from different backgrounds who enter medical school with similar ranges of MCAT scores and UGPAs perform similarly in the curriculum.

Patient Perspectives on the Risk-Based NLST Outcomes Tool for Lung Cancer Screening.

Researchers at the NCI have developed the Risk-Based NLST Outcomes Tool (RNOT), an online tool that calculates risk of lung cancer diagnosis and death with and without lung cancer screening, and false-positive risk estimates. This tool has the potential to facilitate shared decision making for screening. The objective of this study was to examine how current heavy and former smokers understand and respond to personalized risk estimates from the RNOT. Individuals who were eligible for lung cancer screening and were visiting Walter Reed National Military Medical Center were invited to participate in a semi-structured interview to assess their experiences with and perceptions of the RNOT. Results were analyzed using template analysis. Participants found their risk of lung cancer death to be lower than anticipated and were confused by changes in risk for lung cancer diagnosis with and without screening. Most participants indicated that the RNOT would be helpful in making screening decisions, despite reporting that there was no maximum risk for a false positive that would lead them to forgo lung cancer screening. Participants provided actionable needs and recommendations to optimize this tool. Risk-based screening tools may enhance shared decision making. The RNOT is being updated to incorporate these findings.

Atraumatic forearm swelling in a patient with poorly controlled asthma.

We present a case of sarcoidosis presenting as unilateral forearm swelling. A 65-year-old male with a long history of asthma presented with unexplained left forearm and hand swelling. Over many years, chest imaging had been devoid of adenopathy or parenchymal findings suspicious for sarcoid, until after the extremity findings emerged. The patient was diagnosed based on subcutaneous, dermal and mediastinal lymph node histopathology. Sarcoid presenting with isolated extremity findings prior to more typical pulmonary manifestations is rare even for cutaneous or soft tissue sarcoid, highlighting the need to maintain a high index of suspicion for sarcoidosis.

Cardiac MRI for Patients with Increased Cardiometabolic Risk.

Cardiac MRI (CMR) has rich potential for future cardiovascular screening even though not approved clinically for routine screening for cardiovascular disease among patients with increased cardiometabolic risk. Patients with increased cardiometabolic risk include those with abnormal blood pressure, body mass, cholesterol level, or fasting glucose level, which may be related to dietary and exercise habits. However, CMR does accurately evaluate cardiac structure and function. CMR allows for effective tissue characterization with a variety of sequences that provide unique insights as to fibrosis, infiltration, inflammation, edema, presence of fat, strain, and other potential pathologic features that influence future cardiovascular risk. Ongoing epidemiologic and clinical research may demonstrate clinical benefit leading to increased future use. © RSNA, 2021.

Optimizing routine screening for cardiac sarcoidosis through use of commonly available studies.

BACKGROUND: Sarcoidosis is a multisystem granulomatous disorder with unclear etiology. Morbidity and mortality vary based on organ involvement, with cardiac sarcoidosis (CS) associated with higher mortality; despite this, CS remains underdiagnosed. The Heart Rhythm Society (HRS) expert consensus statement recommends screening sarcoidosis patients for CS utilizing a symptom screen, EKG, and echocardiogram (TTE), while the American Thoracic Society (ATS) guideline recommends only EKG and symptom screening. These recommendations, however, are based on limited data with recommendations for further studies. RESEARCH QUESTION: The purpose is to evaluate the prevalence of abnormal screening tests in patients with sarcoidosis and the correlation of these tests with the subsequent diagnosis of CS. A specific emphasis was placed on evaluating the sensitivity of the recommendations versus the sensitivity of a modified criteria. STUDY DESIGN: and Methods: This study retrospectively evaluated a database of prospectively enrolled patients from a tertiary military academic center. All patients who underwent imaging with cardiac MRI and/or FDG-PET were identified. These results were correlated with screening studies (symptom screen, EKG, TTE, and ambulatory rhythm monitoring (ARM)) and used to calculate sensitivity, specificity, and positive and negative predictive values for each test. Using a clinical diagnosis of CS as the reference standard, the sensitivity and specificity of the HRS criteria were calculated and compared to a modified screening rubric developed a priori, consisting of minor changes to the criteria and the addition of ARM. RESULTS: This study evaluated 114 patients with sarcoidosis with 132 advanced imaging events, leading to a diagnosis of CS in 36 patients. Utilizing HRS screening recommendations, the sensitivity for CS was 63.9%, while the modified criteria increased sensitivity to 94.4%. INTERPRETATION: This study suggests that the HRS guidelines lack sensitivity to effectively screen for CS and that a modified screening model which includes ARM may be more effective.

Do Interviews Influence Admission Decisions? An Empirical Analysis From an Institution.

INTRODUCTION: The admission interview is regarded as one of the most significant moments in the process of applying to medical school, but there is limited empirical evidence that supports this claim. Previous analyses have offered what is largely anecdotal evidence of the interview's importance while also suggesting that there is ample opportunity for ethnic and gender bias to impact interview scores. We also asked what medical schools can learn from comparing the attributes of matriculants and those applicants who rejected offers of acceptance. MATERIALS AND METHODS: This study investigated the association between interview performance and admission committee decisions for applicants applying to the School of Medicine of the USU. The study cohort included all candidates who were invited for an on-site interview at the USU in 2014, 2015, and 2016 (n = 1825). RESULTS: Seventeen percent of the variance of the outcome variables-admission committee decisions to accept, place on the alternate list, or reject an applicant-can be explained by considering interview scores alone. Applicant age, race, ethnicity, and gender did not significantly impact interview overall ratings. Matriculants to the USU had similar interview ratings and distribution of gender, race, and ethnicity when compared to those applicants who rejected offers of acceptance. Matriculants were more likely to have previous military experience. CONCLUSION: Our analysis provides some justification for the importance of the interview in the admission process. Applicant demographics (age, race, gender, and ethnicity) were not associated with interview scores. Differences between matriculants to the USU and those who rejected offers of acceptance are small, indicating that the USU continues to build a class body that excels in both cognitive and noncognitive domains.

A Quadricuspid Aortic Valve as Seen by Cardiac Magnetic Resonance Imaging.

We report a case of a 35-year-old active duty male with a rare quadricuspid aortic valve identified via transthoracic echocardiography following the detection of an incidental grade I/VI diastolic murmur. Further characterization of the anatomical findings and aortic valve flow dynamics were evaluated with cardiac magnetic resonance imaging. Accurate assessment of the various valve morphologies is essential, as it guides surgical treatment options to correct the defect. Our case highlights the complimentary role of cardiac magnetic resonance imaging in defining the anatomy and functional consequences of a quadricuspid aortic valve.

Lung function abnormalities among service members returning from Iraq or Afghanistan with respiratory complaints.

BACKGROUND: Service members deploying to Afghanistan (OEF) and Iraq (OIF) often return with respiratory symptoms. We sought to determine prevalence of lung function abnormalities following OEF/OIF. METHODS: We identified OEF/OIF patients who had unexplained respiratory symptoms evaluated using lung function testing. Lung function data were summarized and analyzed for associations with demographic and deployment characteristics. RESULTS: We found 267 patients with unexplained cough or dyspnea, lung function testing and a history of OEF/OIF deployment. All patients had basic spirometry performed and 82 had diffusion capacity for carbon dioxide (DLCO) measured. The median (IQR) number of deployments and total days deployed were 1 (1-2) and 352.0 (209-583), respectively. There were 83 (36.6%) patients with abnormal spirometry, 53 (63.9%) of whom had an abnormal FEV1/FVC. Only one (1.2%) patient had an abnormal DLCO adjusted for alveolar volume. Of 104 patients who had post bronchodilator (BD) testing performed, six (5.8%) had a positive response by ATS criteria. We found no relationships between lung function and time in theater, deployment location, deployment frequency, or land based-deployment. Dyspnea and enlisted rank were associated with tobacco use and lower FEV1, and cough was associated with total number of deployments. CONCLUSIONS: Service members with respiratory complaints following OEF/OIF have a high prevalence of abnormalities on spirometry. Tobacco use, enlisted rank and total number of deployments were associated with symptoms or spirometric abnormalities.

Sinus venosus atrial septal defect as a cause of palpitations and dyspnea in an adult: a diagnostic imaging challenge.

Sinus venosus atrial septal defects (SV-ASD) have nonspecific clinical presentations and represent a diagnostic imaging challenge. Transthoracic echocardiography (TTE) remains the initial diagnostic imaging modality. However, detection rates have been as low as 12%. Transesophageal echocardiography (TEE) improves diagnostic accuracy though it may not detect commonly associated partial anomalous pulmonary venous return (PAPVR). Cardiac magnetic resonance (CMR) imaging provides a noninvasive, highly sensitive and specific imaging modality of SV-ASD. We describe a case of an adult male with exercise-induced, paroxysmal supraventricular tachycardia who presented with palpitations and dyspnea. Despite nondiagnostic imaging results on TTE, CMR proved to be instrumental in visualizing a hemodynamically significant SV-ASD with PAPVR that ultimately led to surgical correction.

Computed tomography angiography of thoracic aortic aneurysms.

Thoracic aortic aneurysms (TAAs) can be life-threatening but often remain undiagnosed until a complication occurs or the disease is discovered incidentally on imaging studies performed for other purposes. Multidetector-row computed tomography angiography has emerged as a useful modality for aortic imaging and allows a comprehensive evaluation of TAAs in terms of their morphology, extent, amount of thrombus, relationship to adjacent structures, and signs of acute or impending rupture. This article reviews the normal anatomy of the thoracic aorta, etiology of TAAs, and the spectrum of their imaging appearance. Technical considerations for performing and interpreting multidetector-row computed tomography angiography of the thoracic aorta will be presented along with the role this modality plays in identifying the various complications associated with TAAs.

Colonic perforation during screening CT colonography using automated CO2 insufflation in an asymptomatic adult.

CT colonography has become a potential alternative technique to optical colonoscopy for the detection of colorectal polyps and cancer. While considered safer than optical colonoscopy, CT colonography is not without risk. We report a case of colonic perforation during CT colonography using automated CO(2) insufflation and present procedural changes to help minimize the adverse effects of perforation when it occurs.