Statistical criteria for setting thresholds in medical school admissions.

In 2001, Dr Jordan Cohen, President of the AAMC, called for medical schools to consider using an Medical College Admission Test (MCAT) threshold to eliminate high-risk applicants from consideration and then to use non-academic qualifications for further consideration. This approach would seem to be consistent with the recent Supreme Court ruling on the University of Michigan admissions cases. Research to support a threshold approach has been reported in many different ways, making comparability problematic. This study examines an assortment of statistical indices that have been used to determine thresholds in undergraduate science grade point average (USGPA) and MCAT sub-scores and total sum and compares them in terms of their sensitivity and specificity for determining Medical Licensing Exam (USMLE Step 1) first time failure. Data for medical school entering classes of 1992-1998 (N=752) from a large Midwestern medical school are used to determine the set of statistics that provide the most useful information for this purpose. The results support plots of risk differences, odds-ratios, sensitivity and specificity for setting cut-scores.