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Cars As A Barrier For Esl Students?

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the CARS section of the MCAT has been seen as the one section that correlates with academic success in medical school. However, in order for this section to measure logic and reasoning skills, the test taker must be highly proficient in english (esp due to long and excessivly obtuse writing styles seen on this exam). It seems strange that the writing in the CARS section is reflective of literary/artistic writing, rather than scientific writing (which is significantly easier to understand as it is more of a technical document).

Do you think that the way that CARS is now is unfairly impacting immigrant populations who may have learned english at a later age? Do you think that ability to comprehend complex literary text is an important skill in a physician and, as such, heavy emphasis on CARS scores in the Canadian system is justified?

 

I personally did well on CARS without a lot of difficulty and didnt think much of it untill talking to a number of friends about their experiences and struggles. It does seem strange to me that we test students on their ability to follow along and answer questions regarding things like the viewpoints of old philosophers or artforms (that are writting in a style typical of the 1800s that we do not see today).

 

What are your thoughts?

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From what I understand, that section of the MCAT is most highly correlated with fewer lawsuits towards physicians compared to the other sections. It's not about what's actually in the test, but rather the skills one gains or has to do well on it. Inferring information, sifting through unnecessary information to find pertinent information, etc. When dealing with patients, you are going to have to somehow find a way to sift through their verbal story to find what you need, and apparently CARS correlates with that as well as proper communication. So I can see why it's important. If the research supports it, I can see why med schools would.

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From what I understand, that section of the MCAT is most highly correlated with fewer lawsuits towards physicians compared to the other sections. It's not about what's actually in the test, but rather the skills one gains or has to do well on it. Inferring information, sifting through unnecessary information to find pertinent information, etc. When dealing with patients, you are going to have to somehow find a way to sift through their verbal story to find what you need, and apparently CARS correlates with that as well as proper communication. So I can see why it's important. If the research supports it, I can see why med schools would.

I understand including it from this perspective, I just think it could be improved to be more relevant? I know a number of people that are otherwise very good at sifting through information but struggle with cars because of the style of writing/obscure language used. 

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the CARS section of the MCAT has been seen as the one section that correlates with academic success in medical school. However, in order for this section to measure logic and reasoning skills, the test taker must be highly proficient in english (esp due to long and excessivly obtuse writing styles seen on this exam). It seems strange that the writing in the CARS section is reflective of literary/artistic writing, rather than scientific writing (which is significantly easier to understand as it is more of a technical document).

Do you think that the way that CARS is now is unfairly impacting immigrant populations who may have learned english at a later age? Do you think that ability to comprehend complex literary text is an important skill in a physician and, as such, heavy emphasis on CARS scores in the Canadian system is justified?

 

I personally did well on CARS without a lot of difficulty and didnt think much of it untill talking to a number of friends about their experiences and struggles. It does seem strange to me that we test students on their ability to follow along and answer questions regarding things like the viewpoints of old philosophers or artforms (that are writting in a style typical of the 1800s that we do not see today).

 

What are your thoughts?

 

There's undoubtedly a negative effect on ESL groups due to the CARS section. However, I don't think that's entirely a bad thing. Understanding subtext in the language of communication in medicine is important. There may not be a lot of literary analysis in medicine, but there are plenty of equally obtuse writing styles that physicians need to understand reasonably well to do their jobs effectively. If someone's ability in English prevents them from understanding the intricacies of written communication in English, I think there's some merit in screening those individuals out.

 

Put simply, I do think that the CARS section reduces ESL individuals' chances, but I'm not sure that it does so unfairly.

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As an ESL person myself, I think that I can see both sides of the discussion as having some merit. I understand that we have to prove that we are capable of using the English language in its full capacity simply because human discussions that involve a power imbalance (doctor-patient), a chance of manipulation (lying) and incomplete or incorrect disclosure require a cautious speaker and listener (if not necessarily a perfectly fluent speaker).

At the same time, however, I do see how a concern may rightfully be raised about the degree of unnecessary complication and obtuseness of the texts in the MCAT. I mean, the test is supposed to be a measure of performance not only subject-wise, but cognitively as well. It basically has disguised elements of an IQ test in there. As such, it will necessarily be biased toward anglophone thinking and linguistic structure, since it's pretty much all that you read in the test. I did notice, for example, that more than half of the material I ended up reading for practice, and most of the test itself, involved texts about American history or another country's history as written by an anglophone. Very few were ever translations. I suppose that one really needs to be extremely well-versed in literary English in order to read some of these older texts well, despite the fact that I am pretty certain that reading an obsolete or unrepresentatively complex form of a language does not directly correlate with ability to understand the day-to-day uses of that language (which is why even native speakers of a language do not have to be well-versed in Shakespeare and John Milton to be able to speak and comprehend a variety of complex scenarios in real life).

In conclusion, I still do not think that the test should be adapted for the reasons mentioned above. If anything, the beauty if you will of CARS is that it is so subjective and that it is trying to measure how open to subjectivity and critically thinking a person can be with plain text. Since they can't possibly change the test so that students will be evaluated verbally for comprehension, I doubt that there is a better way to test this cognitive capacity. I actually quite liked studying for CARS. I have an interest for literature and the random information I learned or refreshed while reading passages was actually a good break from dealing with, say, Physical Sciences passages.

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There's undoubtedly a negative effect on ESL groups due to the CARS section. However, I don't think that's entirely a bad thing. Understanding subtext in the language of communication in medicine is important. There may not be a lot of literary analysis in medicine, but there are plenty of equally obtuse writing styles that physicians need to understand reasonably well to do their jobs effectively. If someone's ability in English prevents them from understanding the intricacies of written communication in English, I think there's some merit in screening those individuals out.

 

Put simply, I do think that the CARS section reduces ESL individuals' chances, but I'm not sure that it does so unfairly.

 

I don't think a large proportion of physicians will have to read Thus Spoke Zarathustra or anything along those lines in the context of their work. If one's communication skills or ability to appreciate a situation and deal with it are not on par with what is expected due to some language barrier, the screening out will happen, fairly, at the interview stage.

 

I agree with OP that the texts chosen should probably reflect the nature of the profession you are aspiring to get into. The goal is to see if you can think critically, interpret information, and apply it, right? If the barrier is linguistic, you're not evaluating any of those three. The level of English should simply be similar to what one might see in practice or in the scientific texts that one will necessarily have to read.

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I don't think a large proportion of physicians will have to read Thus Spoke Zarathustra or anything along those lines in the context of their work. If one's communication skills or ability to appreciate a situation and deal with it are not on par with what is expected due to some language barrier, the screening out will happen, fairly, at the interview stage.

 

I agree with OP that the texts chosen should probably reflect the nature of the profession you are aspiring to get into. The goal is to see if you can think critically, interpret information, and apply it, right? If the barrier is linguistic, you're not evaluating any of those three. The level of English should simply be similar to what one might see in practice or in the scientific texts that one will necessarily have to read.

 

It's not just scientific texts that need to be interpreted in medicine. Written communications from patients, other physicians, other healthcare practitioners, legal offices, businesses, the government, and yes, researchers, are common. While ideally these communications would be at a level understandable with, say, high school-level English, they frequently aren't. 

 

Keep in mind that the ability to interpret scientific writing is already done in the other sections of the MCAT. Those sections test more of the "nature of the profession" information. The CARS section is meant to evaluate ability to interpret a wider breadth of information, much of which will be intentionally non-familiar, because medicine requires interpreting non-familiar sources of information. I agree with you that the goal is to see if you can think critically, interpret information, and apply it. However, lack of competence with a language can cause individuals to misinterpret information or apply it incorrectly. Sure, they might be able to do it better in their primary language, but it's a moot point if they're going to be working in English.

 

I understand the criticism that the texts used are obscure and unfamiliar, but I believe that's a feature, not a bug. CARS is meant to be obscure and unfamiliar, as it's trying to look at communication ability outside a specific context. That why the passages draw on a wide variety of topics - you can't possibly be familiar with the subject matter or linguistic all of it, or even the majority of it, even as a native English speaker. More importantly, you don't need to be familiar with things like Thus Spoke Zarathustra (which, by the way, is apparently an original German text, not an English one) to do well on the CARS section - heck, I hadn't heard of it until your mention of it.

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Of course, I agree with you. And again, none of those texts will be as dense and convoluted as philosophical work or some 17th century critique of some obscure painting. You absolutely need to communicate effectively in English and understand it well in order to practice. There are several ESL people I know with whom communication is never an issue. You would simply not know English was not their first language if it wasn't for their accent....or their CARS score (or worse, not writing the MCAT because of CARS).

 

Thus Spoke Zarathustra is indeed originally German. I don't know how much I can say about my MCAT experience, but I only mentioned that because there were some complex philosophical works in there, which goes way beyond what anyone needs to be a physician. 

 

It's not just scientific texts that need to be interpreted in medicine. Written communications from patients, other physicians, other healthcare practitioners, legal offices, businesses, the government, and yes, researchers, are common. While ideally these communications would be at a level understandable with, say, high school-level English, they frequently aren't. 

 

Keep in mind that the ability to interpret scientific writing is already done in the other sections of the MCAT. Those sections test more of the "nature of the profession" information. The CARS section is meant to evaluate ability to interpret a wider breadth of information, much of which will be intentionally non-familiar, because medicine requires interpreting non-familiar sources of information. I agree with you that the goal is to see if you can think critically, interpret information, and apply it. However, lack of competence with a language can cause individuals to misinterpret information or apply it incorrectly. Sure, they might be able to do it better in their primary language, but it's a moot point if they're going to be working in English.

 

I understand the criticism that the texts used are obscure and unfamiliar, but I believe that's a feature, not a bug. CARS is meant to be obscure and unfamiliar, as it's trying to look at communication ability outside a specific context. That why the passages draw on a wide variety of topics - you can't possibly be familiar with the subject matter or linguistic all of it, or even the majority of it, even as a native English speaker. More importantly, you don't need to be familiar with things like Thus Spoke Zarathustra (which, by the way, is apparently an original German text, not an English one) to do well on the CARS section - heck, I hadn't heard of it until your mention of it.

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TL;DR:

  1. CARS is a challenge for all pre-meds, not just ESL students. The way the pre-meds grew up studying is probably the biggest reason for doing poorly on CARS, not being ESL. CARS passages is not dependent on how well one memorizes and regurgitates like our previous academic evaluations.
  2. Having CARS passages scientific in nature makes it useless. The other 3 sections of the MCAT are all scientific and lets pre-meds shine in their scientific strengths. Having literary/philosophical passages allows the assessment of test takers and how they adapt to new/complex information under pressure, and levels out the playing field for all pre-meds.
  3. Skills assessed by CARS is fundamental in the decision making and communication of those decision in any field of medicine.

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I know this may be a contentious opinion, but I don't think being ESL is as big of a factor in determining CARS score as people make it out to be. If anything, I think it's an excuse to say that students who are pre-med and ESL's are disadvantaged by the CARS. We have to remember that CARS is known to be hard for ALL pre-meds, and not just those who are ESL.

I think there's a more common reason for doing poorly on CARS than how fluent you are in English. I'd like to suggest that doing poorly on CARS has more to do with the pre-med mentality and the way they grew up studying, regardless of their first language. Let me elaborate/clarify.

Most pre-meds are so skilled at reading scientific textbooks or lecture notes and understanding all the intricacies and minute details. But CARS is not testing one's ability to absorb details or facts. It's testing one's ability to get a general consensus of what was written and understand the perspective of the author who wrote it. 

As pre-meds, many of us did not train to read a chapter of a textbook and ask ourselves, "What was the author's attitude and feelings towards photosynthesis?" or "If I could summarize this chapter on photosynthesis in one sentence, what was the author trying to tell the reader?" These questions are those often asked by philosophy/liberal arts/language majors. So it is normal for many pre-meds to lack the skills to understanding these passages to answer the questions, even if it was written about science.

 

Now some poster above me wrote that the CARS passages should be then scientific in nature, because it's for pre-MED students, not pre-LAW/philosophy/liberal arts. I disagree. This is why:

  1. There are more than ample opportunities on the other 3 sections of the MCAT, for test takers to be anal-retentive, OCD, and fixated on facts and figures of diverse scientific topics (psych, socio, physics, chemistry, biochemistry, orgo, biology, physiology, genetics). Making CARS passages all scientific in nature would make it redundant. This is probably why they decided to remove all scientific passages in the new MCAT. Also, having all CARS passages not scientific in nature evens out the playing field. 
  2. Medicine is a beast, filled with so much information. While there is a significant scientific aspect of it, it requires a lot of the thinking and judgement that CARS assesses. As medical students you will not only be asked to perform detailed medical examinations, but also interpret what the findings mean for the patient over all. Saying that the patient has high blood pressure, moddling of the knees, and absent breath sounds in the lower lobes doesn't mean anything to the patient until you summarize all that information in a meaningful way. As residents you will be given tons of lab values and complicated medical history then asked to decide the next course of treatment for a critically ill patient. You have be proficient at what details are pertinent and which ones are useless for the decision making at hand. To assess a pre-meds ability requires testing for these skills using a different medium. That is where CARS passages that assesses logical arguments become important.

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1 - Agree that this is a huge contributing factor to ppl doing poorly on CARS.

2 - I think you are referring to me. I did not say that. I said the level of English should reflect what one might see in their professional practice. There is some irony here.

3 - Evidence?

 

Sorry in advance if I didn't read your post fully and misunderstood some things you said but I just want to dispel the notion that the MCAT (except for CARS) is a test of regurgitation and fixation of facts and figures. This is inaccurate, at least especially in the new one. It does require "thinking and judgment" that CARS also assesses. 

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Communication is a huge part of medicine. I think a lot of the schools use CARS partially as an English proficiency test. I'm guessing that's at least part of the reason Mac only requires that part of the MCAT.

 

That is not the purpose of CARS though... https://students-residents.aamc.org/applying-medical-school/article/mcat-2015-cars-overview/ 

Some schools have English proficiency tests on top of having high CARS cutoffs. CARS is not a good way to test your communication skills directly since you just don't communicate on it

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Yeah, I can say first hand that schools will still want to one to prove that they speak English in bureaucratic means (aka taking a $300 IELTS test). As said by some others, English skills are essential to a medical professional, and such skills don't just come naturally to native speakers (let alone non-native learners). Would it be harder for a non-native to master these skills in another language? Sure. Do they still have to because they are applying for an Anglophone program with strict language requirements? Unavoidably.

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CARS "has been developed specifically to measure the analysis and reasoning skills you will need to be successful in medical school."

 

Communication isn't the central assessment for CARS, it's reasoning. So if the point of this assessment is being 'lost in translation' (literally) on ESL students, due to the selection of passages, doesn't really seem that fair

 

This can be a very useful test to examine critical thinking skills, but the selection of passages they use seems like it can defs be a limitation for ESL students

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CARS "has been developed specifically to measure the analysis and reasoning skills you will need to be successful in medical school."

 

Communication isn't the central assessment for CARS, it's reasoning. So if the point of this assessment is being 'lost in translation' (literally) on ESL students, due to the selection of passages, doesn't really seem that fair

 

This can be a very useful test to examine critical thinking skills, but the selection of passages they use seems like it can defs be a limitation for ESL students

This was exactly my point in the beginning. In order for it to measure what it is supposed to measure, these students must meet a baseline level of english competency. I don't think that the level that that baseline is set at is reasonable for a large population of med school hopefuls. I feel like they could accomplish their goals of examining critical reasoning with more straightforward language.

 

It's like in the SAT when reading scores appeared to be associated with SES. It wasn't that low SES students were any less competent in reading comprehension... it was that they were testing word definitions that they would have never reasonably been exposed to. While a high SES child may know that Regatta is a yacht race... the majority of low SES students would have no idea. 

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CARS "has been developed specifically to measure the analysis and reasoning skills you will need to be successful in medical school."

 

Communication isn't the central assessment for CARS, it's reasoning. So if the point of this assessment is being 'lost in translation' (literally) on ESL students, due to the selection of passages, doesn't really seem that fair

 

This can be a very useful test to examine critical thinking skills, but the selection of passages they use seems like it can defs be a limitation for ESL students

 

Again, CARS is testing of critical thinking and reasoning skills, but in the context of the English language, because it is a test for students intending on studying (and presumably practicing) medicine using English. Having good critical thinking skills, but only in a different language, or only with relatively simple English isn't much help when you'll need to be able to critically think about problems presented in higher-level English.

 

Taking directly from the AAMC's page - "[CARS] includes passages and questions that test your ability to understand what you read.You may find this section to be unique in several ways, though, because it has been developed specifically to measure the analysis and reasoning skills you will need to be successful in medical school."

 

Yes, it's an analysis and reasoning skills test, but it's intentionally put in the context of a reading comprehension format. Whether a test taker is a native English speaker or not, poor reading comprehension in English will be a detriment on CARS and this is by design.

 

This was exactly my point in the beginning. In order for it to measure what it is supposed to measure, these students must meet a baseline level of english competency. I don't think that the level that that baseline is set at is reasonable for a large population of med school hopefuls. I feel like they could accomplish their goals of examining critical reasoning with more straightforward language.

 

It's like in the SAT when reading scores appeared to be associated with SES. It wasn't that low SES students were any less competent in reading comprehension... it was that they were testing word definitions that they would have never reasonably been exposed to. While a high SES child may know that Regatta is a yacht race... the majority of low SES students would have no idea. 

 

The difference between CARS and the SAT word definitions testing is that CARS isn't a test of content, while word definitions, by their very nature, are. You can know absolutely nothing about the material a CARS passage is about and get a perfect score. On the flip side, you can be an expert in a CARS passage's subject matter and fail it entirely.

 

I think it's worth noting that the whole MCAT is a critical thinking assessment, not just CARS. The other sections incorporate subject-specific knowledge into that critical thinking. On those sections memorizing the subject matter is necessary to do well, but it's not sufficient - solid critical thinking skills are still necessary. However, because there's far more to medicine than the sciences or social sciences that underpin those other sections, CARS is used to test ability to reason in novel circumstances, where expertise doesn't matter.

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Again, CARS is testing of critical thinking and reasoning skills, but in the context of the English language, because it is a test for students intending on studying (and presumably practicing) medicine using English. Having good critical thinking skills, but only in a different language, or only with relatively simple English isn't much help when you'll need to be able to critically think about problems presented in higher-level English.

 

It's been my experience that there's no automatic 'carry over' from studying and applying critical reasoning skills in one language to a different language (but I wasn't very good at the second language).  It seems to improve with time, sure.  In some situations, though, it could still make sense to consider applicants or candidates with such attributes if for example there's a large non-English speaking patient population.    

Edited by calcan

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1 - Agree that this is a huge contributing factor to ppl doing poorly on CARS.

2 - I think you are referring to me. I did not say that. I said the level of English should reflect what one might see in their professional practice. There is some irony here.

3 - Evidence?

 

Sorry in advance if I didn't read your post fully and misunderstood some things you said but I just want to dispel the notion that the MCAT (except for CARS) is a test of regurgitation and fixation of facts and figures. This is inaccurate, at least especially in the new one. It does require "thinking and judgment" that CARS also assesses. 

 

http://journals.lww.com/academicmedicine/pages/articleviewer.aspx?year=2010&issue=06000&article=00020&type=Fulltext#P92

 

"Also, the Reading Skills (in Group 2) and Verbal Reasoning (in Group 3) scores predicted Part III/Step 3 scores as well as, or better than, other MCAT subtests. These findings are further supported by the magnitude of the standardized regression coefficients for the aforementioned groups. This pattern of findings is consistent with the previous report that verbal skills are better than science scores in predicting measures of clinical competence in medical school.6 This might be due to the heavy load of verbal skills required in clinical performance in the context of the patient–physician relationship."

 

https://www.researchgate.net/publication/26882690_Do_MCAT_verbal_and_MCAT_writing_scores_correlate_with_performance_on_a_third-year_OSCE

 

"There was a statistically significant association between both the MCAT verbal (r=0.134; P<.005) and MCAT writ- ing sample (r=0.115; P<.02) scores and performance on the FM-OSCE. There was no association between applicant interview scores (r= 0.064, P=NS), MCAT biological science (r=.044, P=NS), MCAT physical science (r=0.068; P=NS) scores and FM-OSCE scores (Table 1)."

 

So that's what I found through 10 minutes of googling. I'm sure there are key studies and better evidence that schools like McMaster and Calgary use to support their use/emphasis of VR/CARS.

 

*This evidence is a far cry from the RCTs we see in cardiology*

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