Up@dawn 2.0

Saturday, September 6, 2014

Bioethics and the MCAT

It's coming, and with it new emphasis on bioethical issues. We won't be teaching to the test, in our course; but the test will now reflect greater attention to critical thinking and the "heart and soul" issues that are our course's focus. 

MCAT 2015 FAQs... What's on the MCAT 2015?... Psychological, social, and biological foundations of behavior section


Pre-Med's New Priorities: Heart and Soul...
"...what’s really exciting is not that taking this class will get these kids into medical school, but that it will help them become better physicians... The goal is to improve the medical admissions process to find the people who you and I would want as our doctors. Being a good doctor isn’t just about understanding science, it’s about understanding people.
The adoption of the new test, which will be first administered in 2015, is part of a decade-long effort by medical educators to restore a bit of good old-fashioned healing and bedside patient skills into a profession that has come to be dominated by technology and laboratory testing. More medical schools are requiring students to take classes on interviewing and communication techniques. To help create a more holistic admissions process, one that goes beyond scientific knowledge, admissions committees are presenting candidates with ethical dilemmas to see if their people skills match their A+ in organic chemistry.
...the Association of American Medical Colleges began three years ago to redesign the MCAT, surveying thousands of medical school faculty members and students to come up with a test tailored to the needs and desires of the 21st century. In addition to more emphasis on humanistic skills, the new test had to take into account important new values in medicine like diversity, with greater focus on health care for the underserved, Dr. McGaghie said.
As a result, there will be questions about gender and cultural influences on expression, poverty and social mobility, as well as how people process emotion and stress. Such subjects are “the building blocks medical students need in order to learn about the ways in which cognitive and perceptual processes influence their understanding of health and illness,” explains the preview guide to the new MCAT.
“I used to think of medicine as very methodical: you get the symptoms, find the diagnoses and treat,” she said. “Now it has made me think beyond pathology and biochemistry to the person. It’s made me think, ‘How will I communicate with them?’ ”
Professor Hale at Oklahoma said that, with a far larger component of pre-meds in his class, he had fielded new types of questions. “When pre-meds approach an ethics class, at first it’s: just tell me what to do to be ethical,” he said. “They’ll come saying they’ve been put in the class by an adviser, but then discover it’s relevant.”
...“I know what society needs and what patients want. They want a doctor who is technically competent but who also understands who they are. How to get there is more complicated.” 
POP QUIZ

The New MCAT

In February, the Association of American Medical Colleges approved an overhaul of the MCAT, due in 2015. New sections will stress the psychological and social dimensions of medicine (the samples below have been edited for length). 

QUESTIONS 1-4 Psychological, Social and Biological Foundations of Behavior

Psychologists have identified two forms of bias: explicit and implicit. Explicit bias is a conscious preference, whereas implicit bias is unconscious. Research on racial disparities in treatments for heart attacks has found that blacks are significantly less likely than whites to receive thrombolytic therapy (the administration of drugs to break up or dissolve blood clots). A study investigated the relationship between physicians’ implicit and explicit biases. Participants received a vignette describing a 50-year-old male with heart attack symptoms. Half the vignettes included a photo of a black patient; the other half a photo of a white patient. After participants indicated whether they would refer the patient for thrombolytic therapy, their preferences for blacks and whites were measured using a five-point Likert scale. Next, participants completed an Implicit Association Task (I.A.T.), which measured their response time to valenced words (words with good or bad connotations) that were presented with images of black and white individuals. No effect was found for levels of explicit bias and the likelihood of providing thrombolytic therapy. Figure 1 summarizes the findings related to implicit bias.
Diagram

QUESTIONS

1Which concept is the focus of this study?

  1. Fundamental attribution error
  2. Elaboration likelihood model
  3. Modern prejudice
  4. Self-serving bias
Move your mouse over this block for the correct answer.C

2Which of the following explanations describes why the amygdala would most likely be activated by the use of the I.A.T. in this study? The amygdala is important for:

  1. learning
  2. fear
  3. anxiety
  4. value judgments
Move your mouse over this block for the correct answer.B

3How would a social identity theorist most likely explain the results summarized in Figure 1?

  1. The physician is ethnocentric and places high value on belonging to his racial in-group.
  2. The physician perceives blacks as competing with whites for scarce societal resources.
  3. The physician is a product of prejudiced parents and peers.
  4. The physician is surrounded by inaccurate stereotypes.
Move your mouse over this block for the correct answer.A

4Which conclusion is supported by the findings?

  1. Participants high in implicit bias prescribed thrombolytic therapy for black patients more often than for white patients.
  2. Participants prescribed thrombolytic therapy less than 50 percent of the time for all patients, regardless of their implicit bias levels.
  3. Participants high in implicit bias prescribed thrombolytic therapy for black patients 77 percent of the time.
  4. Participants high in implicit bias prescribed thrombolytic therapy for white patients more often than for black patients.
Move your mouse over this block for the correct answer.D

QUESTIONS 5-9 Critical Analysis and Reasoning Skills

A covenant of confidentiality characterizes physician-patient relationships. But suppose that during a routine medical examination, a prison physician notices that Prisoner A has drugs and paraphernalia. Should the physician report the crime or should confidentiality prevail?
Professional communications between physicians and patients are statutorily protected as confidential. Health professionals have an interest in maintaining confidentiality so patients feel comfortable revealing personal but necessary information. Prisoners do not possess full constitutional rights to privacy but generally retain them in the physician-patient relationship. In fact, respect for confidentiality is particularly important in a prison hospital setting, where patients feel distrust because physicians are often employed by the incarcerating institution. Even then, physicians’ first responsibility is to their patients. Circumstances in which to give privileged information to authorities remains the physician’s decision.
The right to privacy supersedes a duty to report the drugs and paraphernalia as there is no imminent threat to others. In contrast, a weapon harbored by a prisoner represents an imminent threat to others. Thus, upon discovering a sequestered weapon during a routine examination, the physician has a “duty to warn.”
The possibility of discovering contraband reinforces the need for informed consent at several stages. First, patients should be evaluated and treated only after they provide informed consent, unless they are incompetent. Before an X-ray is taken, they should be informed that it can demonstrate metal and other foreign bodies, and their agreement to the procedure obtained. Second, if a weapon is discovered, the patient should be given the opportunity to surrender it to authorities. And if Prisoner A is harboring drugs and a needle, it is the physician’s responsibility to educate about the potential harm of drug use.
— Adapted from “Cases in Bioethics: Selections From the Hastings Center Report,” 1989

QUESTIONS

5Assume that a prison did not have a policy of obtaining informed consent before a diagnostic procedure, and almost all of the inmates refused to be X-rayed. The author’s comments suggest this situation could be evidence that prisoners:

  1. believe that they have a constitutional right to privacy.
  2. are less concerned about their health than are nonprisoners.
  3. distrust physicians employed by the prison.
  4. feel a need to carry weapons for protection.
Move your mouse over this block for the correct answer.C

6Suppose that a prisoner under sedation for a medical procedure inadvertently reveals that a weapon is hidden in his cell. The author of the passage would be most likely to advise the physician to report the incident:

  1. only if the prisoner threatened to use the weapon.
  2. only if the prisoner consented to the report.
  3. only if the prisoner subsequently denied that the weapon existed.
  4. regardless of the patient’s assertions.
Move your mouse over this block for the correct answer.D

7With respect to prisoners, “necessary information” (paragraph 2) probably refers most specifically to a patient’s:

  1. past criminal activities.
  2. use of illegal drugs.
  3. intent to harm others.
  4. psychiatric history.
Move your mouse over this block for the correct answer.B

8Which of the following conclusions about physician confidentiality can be inferred from the passage?

  1. It is more likely to be assumed in a private setting than in a prison.
  2. It is especially important when patients are incompetent to give informed consent.
  3. It is threatened by the use of invasive diagnostic tools such as X-rays.
  4. It is an aspect of a constitutional right that is lost by prisoners.
Move your mouse over this block for the correct answer.A

9Which of the following objections, if valid, most weakens the argument made for the special importance of the physician-patient covenant within prisons?

  1. Prisoners understand that X-rays will detect hidden weapons.
  2. Prisoners assume that physicians are independent of the institution.
  3. Prison officials often question physicians about prisoners.
  4. Prisoners often misunderstand their constitutional rights.
Move your mouse over this block for the correct answer.

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