Session 117

Today, we cover Passage 9, the last of the CARS section which is going to be relevant to your future as a doctor because it’s about medical school and the education that takes place there. And once again, Clara from Blueprint MCAT (formerly Next Step Test Prep) joins us as we break it down for you. Next week, stay tuned for some Biochemistry questions!

Meanwhile, listen to our other podcasts on the MedEd Media Network so you can hopefully get all the resources you need to help you along this path to becoming a physician. Also, we’ve got a treat for you! Check out The MCAT CARS Podcast with Jack Westin.

[02:22] Passage 9

At a medical school graduation ceremony, a young graduate offered thanks to professors and other healthcare professionals for the lessons about the competent and humane care of patients and for exemplifying the highest level of professional and ethical behavior. But she also thanked other unnamed faculty members for unintentional lessons on how not to behave towards colleagues, patients, and their families. Remarkably, no one who attended the ceremony, and was later questioned, seemed uneasy about the allegation. This may be an indication that a lack of professionalism is tolerated and perhaps even expected in medical schools.

It would be overly simplistic to suggest that within that particular medical school or even within all medical schools, a few bad apples are responsible for such behavior. Rather, this graduate’s experience reflects a hidden curriculum (i.e. information learned from the organizational environment taught by example by faculty and other professionals). It illustrates a deep-rooted culture of disrespect and dysfunction that is pervasive throughout our healthcare system. Professional behavior is easily defined. It is intention or action that fosters trustworthy relationships.

Unprofessional behavior takes many forms. As the graduate elaborated behavior she witnessed included disrespectful patient care such as performing medical procedures against the will of patients who are fully capable of decision-making, withholding diagnostic information from patients, speaking to patients disrespectfully, and allowing medical students and unprepared residents to care for patients with insufficient supervision. It included expressions of racism, sexism, and homophobia directed toward students, residents, nurses and other physicians.

In most institutions, there’s a gap between the official version of medical aims, putting patients at the center of their endeavors, and the actual culture of the institution, which is maintaining a medical hierarchy. This conflict between ideal and real environment lease a cynicism as medical professionals begin to accept ethically and professionally dubious practices as culturally acceptable and as manifestations in medical practice. Moreover, increased workloads, diminished resources, and burgeoning demands on health care workers all lead toward the creation of an environment characterized by increased commercialism and decreased compassion. Such dysfunction has implications far beyond the medical school experience that leads to increased cost, medical errors, and preventable adverse outcomes.

Healthcare institutions have taken steps to address the unprofessional and unethical behavior. While the methods are varied, each is created an institutional code for professional behavior, a structure for anonymous reporting and training for institutional leaders and dealing with issues regarding professionalism. Expanding such measures would send an even stronger message about the priority of ethical, professional behavior. The task ahead involves exposing the hidden curriculum of healthcare professionals in order to change the underlying culture of our institutions, thus fostering a revolutionary change in the way medicine is taught and practiced.

[05:46] Question 48

The author suggests that the notion that “a few bad apples” are responsible for unprofessional behavior in medical schools is flawed because it:

• (A) Overlooks the possibility that many faculty members behave unprofessionally.
• (B) Only addresses the behavior of faculty members but not other healthcare professionals.
• (C) Leaves medical students with little recourse for reporting such behavior.
• (D) Fails to recognize that the problem of unprofessional behavior is systemic.

Clara’s Insights:

The correct answer here is D because when you go back to the passage, you get the idea of what the author is saying. And it’s actually clear enough that we predict the right answer and D matches perfectly. The only one that might be a bit tempting is A. You can get caught up in the phrase “a few” because it’s not a few and it’s actually many, But that’s not what the passage is saying, which means it’s part of the organizational structure. So it’s systemic. Plus, it involves people other than just faculty members.

[08:49] Question 49

Which of the following is an example of a hidden curriculum as described in the passage?

• (A) A medical student learns suturing by watching the procedure rather than by reading about it.
• (B) An apprentice electrician spends time assisting and learning from experienced electricians.
• (C) An office worker observes that managers overlook harassment of clerical staff.
• (D) Medical residents choose a specialty based on avoiding a stressful hostile work environment.

Clara’s Insights:

The correct answer here is C since this matches with the definition they give of a hidden curriculum in the passage. Sometimes, people are tempted by A or D because they’re about medical students or residents. But while it matches the topic, it’s not analogous in terms of the situation.

Also, A and B are similar to each other, in fact, identical so there’s no way you can distinguish A from B. So both have to be wrong.

[11:52] Question 50

The author’s characterization of the gap in medicine suggests that there is a disconnect between:

• (A) An institution’s stated goal versus its actual priorities.
• (B) What patients expect from medical care versus what they actually receive.
• (C) The idea of practicing medicine versus the day-to-day reality of it.
• (D) The experience of medical school versus the experience of healthcare work.

Clara’s Insights:

The correct answer here is A. You may tend to think of B, C, D based on our own knowledge but they just don’t match what the passage is saying. The passage makes it easy for us by talking about this gap directly. So you can go right back to the passage and find it.

[13:22] Question 52

The author implies that the dysfunctional and unprofessional atmosphere described may have which of the following results?

• (A) It ultimately impacts the quality of medical care patients receive.
• (B) It discourages promising students from pursuing a medical career.
• (C) It fosters dysfunction in other non medical fields.
• (D) It projects an unflattering picture of the business of healthcare.

Clara’s Insights:

The correct answer here is A. This is somehow an easy passage. It’s also a good exercise to be good at your time management skills. Otherwise, you might just miss all these questions if you ran out of time.

[15:50] Length of Passages

On the actual MCAT, passages can vary pretty significantly. Most CARS passages fall between 500 and 600 words. And it’s a pretty noticeable difference. For this podcast, we shortened the CARS passages a little bit. But you can definitely see some variations on the actual exams, in fact, a lot more than the sciences.

Ultimately, Clara’s takeaway for students with regard to the CARS section is to remember that CARS answer choices really are going to be direct. Most of the questions that you might have missed in the questions here were because you were thinking too much. But in reality, there’s another choice that’s really directly stated. So if you catch yourself doing a lot of speculating, then hold up. See if there’s a more direct answer elsewhere in the passage.

[17:45] Blueprint MCAT (formerly Next Step Test Prep)

Check out Blueprint MCAT (formerly Next Step Test Prep) full-length practice tests, second best to the AAMC test prep of course. Use the promo code MCATPOD to save some money on their offerings.

Links:

Blueprint MCAT (formerly Next Step Test Prep)

MedEd Media Network

The MCAT CARS Podcast