David discusses the 15-15-1 Theory

In my glorious two-plus decades on this planet, I have been many things: scholar, playwright and, most recently, emo-blogger extraordinaire. Today, I add intellectual revolutionary to that storied list as I unveil a strategy that will forever alter the landscape of medical school admissions.

Just kidding. The following is more of a thought experiment. Nonetheless, ladies, gentleman, our #1 fan (that’s you, Julia), maybe even Kevin (but probably not Kevin), I present to you the 15-15-1 Theory:

As many of you know, the journey to medical school is filled with hurdles. One must do well in school and have a decent complement of extracurricular activities and/or research experiences to make the cut at many schools. On top of all that is the MCAT, perhaps the greatest, most-feared obstacle of all. The MCAT, in a nutshell, is comprised of three main multiple-choice sections – Biological Sciences, Physical Sciences, and Verbal Reasoning – each scored on a 15-point scale. There is also a short essay section that students generally believe carries less weight in admissions decisions. According to the American Association of Medical Colleges (AAMC), the group that administers the exam, the national average for applicants in 2007 was 27.8, while the average for matriculating students was 30.8.

According to conventional wisdom, a strong applicant has both a high MCAT score and a reasonably even distribution of scores among each subsection. A student with a 9-9-9 breakdown, ceteris paribus, is probably more desirable than one with a 15-6-6, as the former score may indicate a more well-rounded student. This rationale makes perfect sense; a strong medical student should be less a genius in only one subject and more a jack-of-all trades who is competent across the board. We’re not doing hardcore physics or PhD-level biochem here.

Yet how would you choose between a 15-15-1 and 10-10-11, again assuming all other primary characteristics are roughly the same? Here, the choice may not be so clear-cut. Let’s assume for a moment the school has no minimum subsection requirement – which may be highly unlikely, but potentially true in extreme circumstances such as this – and thus does not immediately exclude the 15-15-1. In this scenario, which student is likely to become the more competent physician?

Well, the lopsided genius (LG) is probably a lot more intellectually gifted than the jack of all trades (JT). Two perfect scores indicate LG is very bright and most likely hard-working, both desirable traits for a medical student. JT did fine in each section, but a 31, as evidenced above, is objectively average. Since the margin for error diminishes disproportionately as one approaches the higher scores, the difference between 15 and 11 on any given section is actually quite significant,. So, at least for those two subsections, LG is a world ahead.

But what about the third? Is LG a science whiz who struggles mightily in verbal? (That would be bad, since the VR section correlates most strongly with future clinical performance because it best approximates one’s ability to synthesize new, foreign information and make analytical choices without the benefit of tomes of background information and months of fact-cramming. It’s an extremely loose simulation of any clinical situation, sure, but the critical thinking it demands is a crucial asset for any physician.) Well, maybe LG is or isn’t, but looking at that score breakdown, my guess would be he/she was the victim of some unfortunate twist of fate. Perhaps LG mis-bubbled one of the earliest answers and thoroughly messed up the scantron. Maybe there was a scoring error that wasn’t corrected or some other inaccuracy that was no fault of LG’s. Contingent probability would suggest it’s extremely unlikely that someone capable of a 30 in two sections could possibly score 1 on the third. In fact, I imagine it improbable that LG would even get below a 10 if capable of such dual-section wizardry on the previous two.

What if we assume LG is not even capable of half of his typical brilliance, grant him the slight benefit of the doubt that something strange happened during his exam, and give him a 7. Now his conservative 37 is out of shouting distance from JT’s 31. And since these two candidates are more or less equally qualified in other respects, where does that leave them? At the very least, LG would deserve an interview and a chance to explain what happened, whereas JT might not even make that cut.

Admittedly, this is a unique, rather improbable scenario. To the extent that this would ever occur, the solution would likely be for the admissions committee to recommend LG take the test again to confirm his/her brilliance in all three subjects, reapply the next year, and then choose among the top med schools. But that’s just plain boring.

I’ve discussed this randomly with a number of people, most of whom would favor JT. I’m not so sure. As an extension, if it is completely inconceivable that someone with a 1 in any subsection could ever warrant admission, what if you had to choose, right now, who you’d prefer as your doctor in 10 years? That 1 might be a dealbreaker for acceptance, but who is more likely to pan out in the end?

Clearly, the only way to resolve this amazingly profound debate is for me to drop out, change my name to Lopsided Genius, retake the MCAT and get a 15-15-1, and see what happens. Might be unfair though – that name alone is probably worth an interview.