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WASHINGTON -- The Association of American Medical Colleges (AAMC) continues to find itself in hot water with medical school applicants over its policies regarding the rescheduling of the Medical College Admission Test (MCAT) and other facets of the application process.

"I've been trying to take this test since March, and I've been rescheduled, as of yesterday, five times -- cancelled last minute," one applicant said on the hosted by Maylyn Martinez, MD, of the University of Chicago Hospital Medicine Section. In addition, "it's become apparent that they'll say something to us and the outcome will not be consistent with what we were told," the applicant said. For example, "they consistently say there is no delay on application verification, which is not true."

The applicant is a member of a 55-person group known as Students for Ethical Admissions (SEA), which has posted a outlining a number of problems with applying to medical school in the wake of COVID-19.

The MCAT itself

Due to the pandemic, AAMC had to cancel MCATs scheduled for March, April, and most of May. To make up for that loss in testing time, the association reformatted the exam, shortening it from 7 hours and 30 minutes to 5 hours and 45 minutes, and began making tests available three times on each scheduled day, rather than once per day. AAMC also added an additional 3 days from June through the end of September to the testing schedule.

In addition to using social distancing to reduce COVID-19 risk, AAMC officials said the organization and Pearson VUE, the contractor that runs the testing centers, is also putting specific sanitation measures in place. Disinfecting techniques that will be used include cleaning each workstation -- including the keyboard, mouse, and headphones -- after every use, disinfecting the signature pad applicants will use, and cleaning the high-touch points and communal surfaces such as door handles and lockers at least hourly. Facial tissue, hand sanitizer, soap, and paper towels will be available, and applicants and staff will be required to wear masks.

But SEA said that wasn't good enough. By continuing to require the MCAT to be taken in-person, rather than online, "students are risking their health and safety in order to take the MCAT," the group said. SEA has started a #WaiveTheMCAT campaign on Twitter to try to get schools to consider applicants who haven't taken the exam; Stanford University's medical school has already said for its applicants during the 2021 application cycle.

As mentioned in a May 18 story in 番茄社区app, the AAMC maintained that the test cannot be given virtually because in the MCAT, "the scientific content is often communicated in words but also complex graphs, charts, figures and equations, and accurate and high-resolution displays of that kind of information is really critical to students being able to show how well they can demonstrate their knowledge and skills on the exam, so center-based testing really is a better solution for the MCAT exam than online administration," said Karen Mitchell, PhD, senior director of the MCAT program.

The AAMC's stance on in-person testing remained the same in an posted June 29 on its website, and also in emailed comments to 番茄社区app. "We considered if and how we could implement remote testing and concluded that it is not a viable option, as it will not allow us to protect the integrity of the exam and ensure fairness and equity for everyone," Gabrielle Campbell, the AAMC's chief services officer, said in the email.

"It was a tough choice to make, but we still think it was the right one. Online, remote testing will require a significant number of proctors and further advances in software that monitors examinees," she continued. "We have also been concerned about the potential for connectivity and technological problems, which have occurred with other major standardized tests this year, according to news reports. And we also must keep in mind the examinees who do not have stable internet access or a quiet place to take the test at home for several hours."

Regarding applicants such as the person on the podcast whose exams keep getting cancelled, "several states eased restrictions on social distancing in the second half of June, and our testing partner Pearson VUE opened up additional seats in their scheduling system in those jurisdictions, which followed local laws but did not meet the AAMC's requirements on social distancing," Campbell said. "When we learned of this we immediately worked with our testing partner to re-establish the AAMC's social distancing requirements for scheduling, and to ensure this issue won't come up again."

"Unfortunately, we learned of the system issue shortly before examinees were set to take their June 27-28 exams," she said. "Approximately 200 examinees were affected for that weekend, and approximately 600 additional examinees who were scheduled to test between now and September also had to be rescheduled. We know this was frustrating for the affected examinees, especially since they found out with so little time before their scheduled exams. However, we made this decision in the best interests of protecting the health and safety of all examinees scheduled to test on those dates."

Students who have taken the MCAT say that many of the sanitation requirements aren't being followed at the testing sites. One applicant who took the exam last month said on the podcast that "the hand scanner and eyeglass checker were never sanitized between uses ... The employee told me that once I got in there I could take my mask off -- I didn't, but others did -- and none of the desks or keyboards were cleaned at all, and the lockers were not cleaned, and there was no sanitation other than a little container of half-empty hand sanitizer."

Campbell said the AAMC "continues to monitor reports of health and safety issues at testing centers. We want to know about these issues and any concerns. We want to ensure that best practices are in place and followed so that even isolated instances don't happen at all."

For its part, Pearson VUE says its priority "is the health and safety of test-takers and our employees," according to an email from company spokesman Scott Overland. "Across all of our test centers we have strict sanitization protocols that include the cleaning of testing stations and high touch points between every user. Our teams take these sanitizing protocols very seriously. If we receive any claims that cleaning procedures were not followed, we will investigate immediately."

Accommodations for students who need them

The group asserted that AAMC is in violation of the Americans With Disabilities Act (ADA), which says that students with disabilities are entitled to measures that will "level the playing field" when they are compared with non-disabled students. "The U.S. government is clear that high-stakes testing companies, such as the AAMC, should permit these accommodations without hesitation. AAMC's process, however, takes anywhere from 60 to 90 days, can cost thousands of dollars, and appears to be rarely successful for the student."

In addition, the group said, "information about the accommodations process is vague and deadlines are not made clear to students. Students are never told the qualifications of the 'expert' who makes a determination on their request, and they are expected to locate academic records dating back decades, at times." 番茄社区app spoke with two applicants who had difficulty getting accommodations, including one who had worked on their accommodations application for months before eventually getting approval.

Campbell said that scheduling students who need accommodations is a "highly individualized process" and admitted there have been problems. "This person-to-person process works well in a typical testing year, which takes place over the course of weeks and months," she said. "But in this very atypical year, this system has faltered. We are taking longer to contact and schedule examinees, and we are taking steps to improve this process for accommodated examinees. We have made some changes that address the most recent issues and have more coming."

Transcript processing

AAMC is planning to transmit completed medical school applications -- some with MCAT scores, some without -- to medical schools starting on Friday. But in order for an application to be "verified" for sending to the schools, it must include the applicant's undergraduate transcript. However, "due to extreme processing delays of transcripts, many students' applications will not be ready for transmission at that time," the SEA said, adding: "Transcript processing times are outrageous. For such a time-sensitive subject, this is unacceptable. Long processing times also lead many students to believe that their transcript was lost. This causes them to send multiple copies, further backing up the system."

One problem with the paper transcripts has been that during the pandemic-related shutdown in Washington, where the AAMC is headquartered, no one checked the post office box to which transcripts were mailed for several weeks, which further contributed to the backup, according to one applicant.

As for electronic transcripts, also called eTranscripts, there is "little to no guidance in terms of what will be accepted and what will not," the group said. "The AAMC has stated that they are accepting more eTranscripts than they usually would due to the pandemic, but the information stops there. Students don't know what types of eTranscripts are accepted."

The AAMC's American Medical College Application Service (AMCAS) "has received more than double the number of transcripts for the 2021 application cycle compared to previous years," Campbell said in response to a question about this issue. "The AAMC has provided additional transcript delivery options for institutions, which resulted in a high number of duplicate transmissions, significantly increasing the number of transcripts for processing. AMCAS has been retrieving transcripts from the post office box since May 18, and mail is delivered from the post office box to the AMCAS team every business day."

Processing times for transcripts "remain within our ," she said.

Communication with AAMC in general has been very difficult, according to the SEA. "When attempting to call and speak with a representative, the queue is often so full that it cannot be joined," the group wrote in its document. "Once queued, students wait hours and frequently experience 'system failures' on AAMC's part. Some students have had representatives hang up on them or tell them that they "will just have to call again and hope someone knows answers." Many callback requests are left completely unanswered."

Campbell said part of the problem is the sheer volume of calls the organization is getting. "From March-June 2020, the AAMC's Services Contact Center handled more than 87,000 calls and emails from premed students, compared to 48,000 calls and emails during the same period in 2019," she said.

"Much of this has been due to the unavoidable MCAT cancellations caused by the pandemic, and due to a high volume of applicants confirming AMCAS transcript receipt," Campbell said. "Emails have increased by 136%. Moreover, the callers have more complex and nuanced questions, so the calls are taking longer as well. The average call duration has gone up 33%. That means that each support specialist can help fewer people per hour because each call takes longer."

In response, "the AAMC has hired and trained more people to staff our Services Contact Center and we are working to improve response and wait times in order to meet rising demand," she said. "Even with more people handling examinee calls and emails, we recognize that we need to do better. We're working to improve our processes so that we can sort and answer examinees' and applicants' questions more quickly."

VITA electronic interview

The AAMC recently debuted the Video Interview Tool for Admissions (VITA), which it describes as a "one-time, one-way video (recorded) interview designed to help medical schools assess applicants' pre-professional competencies important for success in medical school." The tool is designed to assess applicants on "core competencies" such as social skills, cultural competence, teamwork, reliability and dependability, and resilience and adaptability.

"Six questions are presented in text prompts, and applicants record an audio/video response; there is no human interviewer," AAMC explains on its . "You will have 1 minute to read and reflect on each written question and up to 3 minutes to record a response. You may complete all six questions in one sitting, or you may complete any number of questions you choose, as long as all questions are completed by the required medical school deadline."

The SEA group expressed concern about VITA, writing: "A live interview is a two-way conversation. The interviewer can receive verbal as well as nonverbal cues, making it easier to judge a candidate. VITA does not allow for that discussion."

However, Campbell said the VITA tool "was designed to complement the live interview process -- not replace it ... Each participating medical school will determine how and at what stage it will add the AAMC VITA interview into its application review process. One of the primary benefits of the AAMC VITA interview is that it allows schools to refocus their live, virtual interview on mission alignment and devote more time to sharing information with applicants about their schools and city."

Others

In addition, the SEA group criticized the AAMC's communications with applicants -- with important announcements posted on Twitter and phone lines tied up when applicants tried to call with questions.

The group also expressed frustration with the documentation requirements for the MCAT Fee Assistance Program. Among the complaints: that the AAMC requires financial information about applicants' parents, even for those who are financially independent and estranged. Also, the SEA objected to the program's weighting of applicants' existing debt, such as from undergraduate student loans.

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