It's T minus four days until exam day, and Travis Driscoll is practically living at his desk.
"Each day, I'm easily here for five hours," he says. "I haven't done much of anything else but studying for the last two months."
Driscoll is one of 13,000 medical school applicants across the U.S. taking the new Medical College Admissions Test, or MCAT. He's got stacks of science books on his desk to help him prepare, and a rainbow of biochemistry charts pasted to the walls: glycolysis, citric acid cycle, electron transport chain, mitosis, meiosis and DNA replication.
He also has a thick prep book on psychology and sociology -– new ground for this year's MCAT takers.
The test has been thoroughly revamped and is now three hours longer. It takes 7 1/2 hours to complete, including breaks, and covers four new subjects, including a combined section on psychology and sociology, that account for a quarter of the overall score.
Driscoll, who works in a San Francisco theater, focused on biomedical engineering in college. So for him, the new psychology/sociology section is the one he's most nervous about.
"It's at the end of the test, which makes it more difficult because you're pretty tired by then," he says. "And it's the thing I had the least experience with."
Bringing Test Up to Date
The Association of American Medical Colleges, which administers the MCAT, wants to make sure the doctors of tomorrow are better prepared to care for an increasingly diverse patient population in a rapidly changing health care system. Administrators say the exam changes are necessary to bring it up to date with how medicine is practiced, and with all the scientific discoveries that have been made since the test was last revised, more than 20 years ago.
Research on genetics, and the social factors that affect health, in particular, have advanced significantly.
"Whether or not someone becomes ill has a lot to do with the society in which they live," says Catherine Lucey, vice dean of education at University of California, San Francisco School of Medicine and a member of the committee that will assess the new MCAT.
For example, she says, we now know a lot more about what happens to children who are exposed to violence before they turn 5.
"If they live in a violent neighborhood, if they hear gunshots all the time, if they themselves are the victims of interpersonal violence or child abuse," Lucey says, "they are much more likely to develop diabetes, high blood pressure, obesity, and many other chronic conditions, because of their social environment."
How those conditions are treated has also evolved. Doctors know how to treat acute infection now. But managing chronic disease has become a much bigger part of medical care, and doctors need to develop different skills and a different kind of relationship with the patient. Doctors need to build trust, Lucey says, to understand how patients think and make decisions, in order to convince them to exercise more and change their diet.
"My ability as a physician to affect that patient's health is not only dependent on medical knowledge, in terms of what drug should I give this individual, but on my ability to support this patient in the decisions they're making on a daily basis," she says.
Attracting New Type of Student
While the test prep industry adapted quickly to the new MCAT, enrollment in prep courses at the Princeton Review and Kaplan is only starting to pick up.
The real rush was last fall, when students flocked to take the old test, says Krissi Taylor Leslie, tutoring director at the Princeton Review in Northern California.
There was a recognition among students "that was my chance at the 'easier' test and now I'm up against this beast," Leslie says.
She says the new social sciences section is already attracting a different kind of student to consider med school.
"It entices certain students to come in and consider this test when they might not have otherwise," she says. "For instance, an increase in the number of English majors, of psychology majors."
And philosophy majors, like Ari Fischer. He started thinking about a career in medicine the summer after his junior year, when his grandfather was diagnosed with cancer.
"And that's when I was first shown, hands on, what physicians do every day," he says.
He started taking medical ethics classes -– one was called "Life and Death" -– where he read works about immortality, the meaning of death and the meaning of life in the face of death.
Fischer says he can imagine drawing on this knowledge one day if he has a patient facing tough end-of-life decisions.
"There's always a scientific view, then there's the theological views, or philosophical views. Knowing what other disciplines believe is going on at the same time, I think that could really help me in a daily practice of medicine," Fischer says. "What a cool way to take my degree in philosophy and turn it into a helpful, practical skill."
Fischer took the MCAT on the first testing date for the new exam in April, and just got his full score back on Tuesday. He did best on the social sciences section and the verbal, analytic reasoning. Overall, he landed in the 87th percentile.
"Perhaps Harvard will think I'm lacking in my MCAT score," he says. "For myself, I did well enough."
Altogether, he's applying to 38 schools. He says he's willing to go anywhere that will take a humanities major like him.
"All I've ever wanted out of the MCAT really is a score that's good enough to not get me kicked out of the pile when it comes to admissions decisions," he says. "Any school that that gives me a shot, I'm going to be thrilled."