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Medical school applicants are up in arms over the Association of American Medical Colleges' (AAMC) approach to rescheduling test sessions for the Medical College Admissions Test (MCAT) during the COVID-19 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. It also added an additional 3 days from June through the end of September to the testing schedule.

On May 7, the AAMC opened up its MCAT scheduling system for applicants who needed to reschedule or make their initial testing appointment. However, the system wasn't prepared to handle the 62,000 people -- rather than the usual 10,000 to 12,000 -- who were trying to get on to schedule their exams, and it crashed, Gabrielle Campbell, AAMC's chief services officer, said at a virtual press briefing on May 8.

"In the first 2 minutes we had more people ready to go than we've ever experienced before, so we had to step back and revamp the system, which took a couple of hours," Campbell said. She asserted that all 62,000 people were accommodated and everyone got an appointment.

But that's not what many applicants said they experienced. "I unfortunately did not get the time I needed so I decided to just cancel the exam and hope for a better exam experience next cycle," one applicant . "What do you say to students who waited 5-7 hours to register and did not get their desired test date, time or place?" .

Communication Problems

One applicant who asked to remain anonymous was disappointed with the way the association communicated about what time the system would open on May 7. Attempts to request priority registration for those who had exams canceled, or tiered priority based on an applicant's time zone, were refused. After many comments on Twitter, the AAMC said the system would open between 6 a.m. and noon. It eventually opened at around 8 a.m. "and immediately crashed," the applicant said.

After the crash, the only communication from AAMC was a tweet every few hours saying "Thanks for your patience; we're working on it," the applicant continued. Then, "at 2:30, with no warning the system was suddenly back online. I got back on at 2:32 and waited 2 hours ... and I had to take a date that was not what I wanted."

The lack of communication has been a big problem, according to , of Boulder, Colorado, who runs a business advising medical school applicants. "There was just silence from AAMC about what's going on," he said in a phone interview. For students who had previously registered for an exam on one of the canceled dates, "The day before, they finally sent emails to students, saying 'Here's your new test time, if you don't like it, you can reschedule with everyone else,'" Gray said.

"So there was really a lack of communication right off the bat," he continued. "Students were freaking out." For example, some students whose test date was May 29 -- a day that wasn't originally canceled -- were telling Gray that when they logged into the system it was telling them their new test date was Sept. 30. "There was no communication from AAMC until the next day, when they sent out a tweet saying, 'We had to cancel the May 29th date.' It was just a communication nightmare. That's my biggest beef."

Getting Accommodations a Challenge

Why didn't the AAMC tell applicants exactly when the site would open? Because they were still testing it, said Karen Mitchell, PhD, senior director of the MCAT program. Although AAMC staff had done some tests the weekend before, "we anticipated there would be a heavy load and wanted to get up on the morning of the 7th and try out the systems one more time in production," she said in a phone interview. "We were in there testing everything out in a production environment.... We didn't know how long that was going to take, so we didn't announce a specific time."

The experience for some disabled applicants who need special testing accommodations has been especially frustrating. "Getting accommodations is a really, really tough process -- I started it in 2018 and have been doing it for 2 years," said a second applicant who also requested anonymity. "I submitted it in 2019 -- it took a while to get the paperwork together," the second applicant said. "It almost felt like a medical school application; that's how much work went into it." This person has "combined" ADHD, "and I've been in two car accidents and I have light sensitivity, so I get migraines." The applicant's request was for a separate room, short testing periods with frequent breaks, and extended time; they were approved for some accommodations but still have not had a time assigned to them.

Mitchell said the accommodations process usually works well if the tests are being scheduled over weeks and months, "but when we tried to condense it into 2 or 3 days, this system became overwhelmed," she said. "We're working now with Pearson VUE [the testing administration firm with which AAMC contracts] to try to help students waiting to get their exams scheduled this year and find a better way to do it moving forward."

On Friday, AAMC posted a on its website for students whose accommodations have been approved to fill out and explain where and when they want to test. Once they fill out that form, they will receive an email from the schedulers within 2 days with more information about their appointment, Mitchell said.

The AAMC attempted to address some of the applicants' concerns in a "Pre-Med Forum" on May 14; video of the forum was shared with 乌鸦传媒. "I sincerely apologize for how incredibly frustrating last Thursday must have been for many of you," Campbell told participants. "The pre-med experience is anxiety-producing enough without that, so I sincerely apologize."

Is In-Person Testing a Good Idea?

The scheduling snafu is not the only issue applicants have with the MCAT exam. For example, AAMC is allowing exactly 5 hours and 45 minutes per test -- the thrice-daily sittings are at 6:30 a.m., 12:15 p.m., and 6:00 p.m. -- but it is also saying that the testing rooms will undergo "" before and after each sitting. "Technically, on their short time frame, there's not time to sanitize the desks or anything," the first applicant said.

Although that appears to be true, with test-takers staggering their arrivals and departures, "and because test centers are only 50% full at most, they've got time to do all the cleaning they need to do," Mitchell asserted. 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. There also will be social distancing while standing in line as well as during breaks, Mitchell said.

Another issue is the lunch period was shortened from 30 minutes to 10 minutes. "This is my first time taking the MCAT, but people who have taken it before say that it takes 7 minutes to sign in and out of the room," so a 10-minute break isn't very helpful, the first applicant said.

"Our assumptions are that the students who start at 6:30 a.m. will eat after they finish, and students who start at 12:15 p.m. will eat before they start," Mitchell said, although students will be encouraged to bring food and drink and put them in their assigned locker for consumption during the lunch break or the test's two other optional breaks. And since applicants will be taking staggered breaks depending on when they finish a particular test section, it should take less time to sign out, especially given that there will be fewer test-takers at each sitting due to social distancing requirements, she said.

Some applicants who fear for their health and that of their families are wondering whether the exam needs to be given in-person at all, noting that many other organizations are doing online testing instead. At the Pre-Med Forum, Mitchell said that she knew some other medical education programs were administering exams online, but that "one thing that's different about the MCAT is 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."

In addition, Mitchell said during the interview, students taking tests online "have different kinds of hardware, software, and Internet connections," which can be problematic during so long of a test. She cited news articles about students taking online Advanced Placement exams due to computer glitches. "There's just a lot of complications you don't think of when you're trying to work online. So we're worried about there not being opportunities for students in rural communities and the economically disadvantaged to take the exam and do well," she said. The possibility of students trying to get an "unfair advantage" -- i.e., cheat -- was another concern.

Pre-med student Alexandre Bourcier started a seeking more transparency from AAMC on testing accommodations, free study materials for students whose exams were canceled, and representation from pre-med students within AAMC. The petition, which the AAMC has not yet responded to, has 750 supporters.

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