Mastering the Medical College Admission Test (MCAT): A Comprehensive Guide for Aspiring Medical Students

The Medical College Admission Test (MCAT) is a standardized medical admission test that is a key prerequisite for students applying to medical school. It specifically focuses on a student’s skills and knowledge, including problem solving, critical thinking and comprehension of a range of scientific concepts. Because of the importance of this medical college admission test, the American Medical Association provides resources to help students better prepare for the MCAT. These include study tips, information on the medical admission process and much more. This article aims to provide a structured approach to MCAT preparation, covering essential strategies, resources, and tips to help students succeed.

Understanding the MCAT

The MCAT is a comprehensive examination designed to assess a student's readiness for the rigors of medical school. Since its initial development in 1928, the MCAT has gone through six revisions, the most recent being in 2015. In each revision, the internal qualities of the test have drastically increased to assess the readiness of students for the rigors of medical school education. The latest version includes sections that test an applicant’s understanding of the importance of population health and cultural competency in attempts to reduce the health care disparities in medicine.

MCAT Sections

The MCAT consists of four sections:

Chemical and Physical Foundations of Biological Systems (CPFBS)
Biological and Biochemical Foundations of Living Systems (BBFL)
Psychological, Social, and Biological Foundations of Behavior (PSBFB)
Critical Analysis and Reasoning Skills (CARS)

The current version of the test clocks in at approximately 7 h and 33 min, it is beneficial for a student to work up to devoting 8 h per day for studying to simulate the real test duration. The MCAT tests a student’s endurance; therefore, it is important for an examinee to build up stamina, step-by-step, during the preparation period.

Addressing the Physician Shortage and MCAT Preparation

By 2030, it is estimated that there will be a shortage of more than one hundred and twenty thousand physicians in the USA. To address this shortage, it is important to enhance pre-medical students’ access to available resources and effectively prepare them for the medical school admission process, especially in rural areas. Often students are not aware of the free or reduced-cost online sources and appropriate strategies available to prepare for the MCAT exam. While most pre-medical students join pre-health clubs to pursue medicine, many are still not aware of the vital resources available through American Association of Medical Colleges (AAMC). For some students, it is unclear how to begin preparing for the MCAT.

Overcoming Barriers for Rural Students

The chronic shortage of doctors and other health care providers is steadily increasing in rural residents over the urban populace. Many rural students are hesitant to spend thousands of dollars on commercially available online courses, while other onsite MCAT preparatory courses are simply not available. Beyond the economic barrier, rural students are often required to travel longer distances to the nearest testing facility and in some cases must book hotels the night before the test day which may have adverse psychological impacts on their performance.

Initial Steps in MCAT Preparation

A major concern for nearly every pre-medical student is where to begin MCAT preparation. Top hits from popular engines are undoubtedly going to be paid advertisements from commercially available preparatory courses rather than low-cost preparatory sources from the AAMC. Prospective applicants should take this into account when looking at the cost/benefit ratio for a commercial course.

Completing Prerequisite Coursework

It is essential to finish required undergraduate science and non-science coursework before registering for the MCAT exam. Traditionally, coursework requirements for MD/DO schools in the nation include at least 1 year of organic chemistry (with labs), general chemistry (with labs), physics (with labs), biology (with labs), English, and some even require calculus or statistics as pre-requisites. Students should still investigate specific pre-requisite coursework requirements for the schools they are interested in applying too, as there is sometimes variation from school to school.

Additional Coursework

Completing additional coursework, which correlates with the AAMC exam content syllabus is an effective strategy. Since the Biological and BBFL section has the most correlation with board scores after medical school, it is especially important to focus on. With biochemistry as a major part of the BBFL and Chemical and Physical Foundations of Biological Sciences (CPFBS) sections, finishing one semester of biochemistry and cell/molecular biology courses would help pre-medical applicants to get a broader understanding of biomolecules, cells, and organs asked about on the test. Additionally, finishing psychology and sociology courses equips students with the knowledge of the social systems and problems associated with psychological, sociocultural, and behavioral issues, which will help on the Psychological, Social, and Biological Foundations of Behavior (PSBFB) section. Taking additional upper-level science courses, writing-intensive courses, post-baccalaureate, or graduate-level courses (immunology, microbiology, pharmacology, and physiology) will further strengthen an applicant’s testing ability.

Timing and Registration

Choosing the right time to take the MCAT can be just as important as the time spent preparing and studying for the exam. Under normal circumstances, it is best to register to take the MCAT in the calendar year prior to when a student is planning to enter medical school. This coincides with the beginning of the medical school application cycle, which starts in May and runs until October-January for most MD schools, and May until January-April for most DO schools. Applicants should aim to be prepared to submit their application as early in the cycle as possible. Paying approximately $315.00 fee (the fee is subject to change in the future) to register for the test can be one of the best motivating factors to start serious MCAT preparation. While students can schedule the test up to 6-8 months in advance, it is unclear as to the exact amount of time required for MCAT test preparation.

Effective Study Strategies

With the current version of the test clocking in at approximately 7 h and 33 min, it is beneficial for a student to work up to devoting 8 h per day for studying to simulate the real test duration. The MCAT tests a student’s endurance; therefore, it is important for an examinee to build up stamina, step-by-step, during the preparation period. Many students devoting time to MCAT preparation must also juggle concurrent enrollment in coursework at school, work responsibilities, research commitments, family and social obligations, volunteer, and other extracurricular activities.

Planning and Time Management

One strategy many students follow, after selecting a start date, is to plan to accelerate time devoted to study as the exam date approaches to ease into the rigorous study schedule and prevent burnout. Planning should begin by brainstorming the available resources and suggested strategies to use those resources. Create a list of problem areas such as pre-requisite courses remaining, cost and availability of preparatory materials, amount of time available each day, and the time remaining until test day.

Active Study Habits

Once students can identify the available resources and strategies, they will need to implement them into their active study plan rather than through passive activities (such as watching videos). Examples for active study habits include the following: creating summary notes at the end of each section, building an MCAT content vocabulary, applying the concepts into real-life scenarios, making flashcards, teaching back the concepts learned to peer students, practicing multiple-choice questions in the passages by using section banks, practicing interpreting data (including figures and graphs), identifying hypotheses, and creating compare-and-contrast charts and concept maps. Rural students can easily apply these active learning strategies into their study plan while preparing for the MCAT.

Utilizing Resources

Applying the content into these active strategies by using official practice questions allows test takers to gauge their understanding and application of the concepts studied. Commercial preparatory courses motivate their students mostly due to the amount of money invested into the course, but proper planning and time management can allow motivated applicants (including rural students) to use the many reliable free or low-cost resources available, with a similar result. Khan Academy’s MCAT Collection is a great starting point with 1100 videos and approximately 3000 practice questions covering all categories of the exam, with the added benefit of being open access. The AAMC is another resource for an examinee on a budget. Low-cost “Official MCAT Prep” bundles from AAMC are also very popular among the pre-medical communities. Since the AAMC decides the actual content on the MCAT, their official practice materials are especially well informed.

Creating a Personalized Study Plan

It is important to create a personalized and specific study plan. The plan should account for their use of time until exam day, identifying the amount of time needed to study each day and remembering to allot time for normal responsibilities, including school, work, eating, sleeping, and resting. Students should identify their strongest subjects and plan to devote more time to areas where they are weakest. Once identified, students should find additional tools for weak areas and skills. The personalized study plan will become a living document. Although vast changes should not occur, it is essential to fine-tune the study plan based on improvements made as a student learns and grows over the weeks and months of preparation. Learning to self-motivate through a personal study plan and to be accountable to that plan will allow students to achieve their desired MCAT scores.

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Enhancing Reading Comprehension for the CARS Section

Reading comprehension is an important skill that is required to achieve desired scores in each of the sections, especially in the CARS section. This section tests an examinees’ comprehension, analysis, and reasoning skills by asking them to critically analyze material in each of the nine reading passages. The content for this session is generally taken from ethics, philosophy, studies of diverse cultures, literature, population health, psychology, social sciences, and humanities. Scores in CARS were lower compared with all other sections when comparing scores of 239,681 test takers from data released by AAMC in 2018. This was especially apparent in students with English as a second language or international students who immigrated to the USA. Even native English speakers have difficulty with this section often due to the short amount of time allotted for each passage.

Improving Reading Skills

Examinees will need to quickly read and process information, comprehend the questions, and draw conclusions from the specific topics in the passages. Since reading skills are critical later in medical school performance, cultivating this skill before and during the MCAT preparation period is essential for pre-medical students. Processing information while reading is a skill which can take years to develop. The best way to strengthen this skill is by simply reading as much as possible. While preparing for the MCAT, one should read a variety of forms of literature including news articles, books, and novels with a wide range of topics in both fiction and non-fiction categories. Additionally, reading the occasional scientific journal article will help students learn how to break down dense topics and learn new vocabulary.

Avoiding Digital Distractions

Students from the current generation tend to favor digital media accessed from smartphones and tablets in the form of video or animation. This is often clouded by distracting notifications from friends, social media, and other apps, which impede their ability to process complex arguments and memory recall. Even the mere presence of a cell phone can negatively affect cognitive functioning during demanding tasks. As such, students should focus on strengthening their reading skills in an environment comparable with the testing conditions. There are a variety of resources available online, such as Read me or Spreeder, which can help struggling students to enhance their reading skills.

Practicing with MCAT-Style Passages

While reading books and articles is important, it is paramount to practice reading passages similar in length and content to the ones seen on the MCAT. Unlike the other sections of the MCAT, the answers for the CARS section are solely based on the passage. While reading these practice passages, examinees are expected to decipher the subtle clues based on vocabulary, sentence structure, and content, much like a physician would discover the clues of a disease. Topics for the CARS section can vary widely from science to music theory, and examinees should remember that the answers are based solely on the passage.

Shelf Exams During Medical School

The third year of medical school is a very exciting time. In this post, we’ll break down what shelf exams are, when they take place, and how to best prepare. Note that many details of shelf exams vary by school. Shelf exams are designed to evaluate your medical knowledge as well as your ability to apply that knowledge practically. Shelf exams are licensed by the National Board of Medical Examiners (NBME), the same organization that designs the USMLE Step exams. The exams are called “shelf exams” because they consist of “shelved” (expired) USMLE Step 1 and Step 2 CK questions from old exams. For example, the shelf exam for internal medicine will include questions about the various body systems, so expect to be asked questions about heart failure, diabetes, cancer, liver disease, and so on. Shelf exams cover a broad range of medical topics, and they’re widely considered difficult due to the massive amount of knowledge students are required to memorize and understand.

Core Clinical Rotations

There are 7 core clinical rotations: internal medicine, family medicine, general surgery, neurology, pediatrics, OB/GYN, and psychiatry. While not typical, some schools may require additional core rotations, such as emergency medicine, radiology, or anesthesiology. Each shelf exam is one-to-one with the rotation itself, so scheduling is super specific to the medical school. Depending on your school, you may be able to decide the order of rotations, or you may not. Core rotations typically last 6-12 weeks.

Scheduling and Timing of Shelf Exams

Unlike Step 1 and Step 2, where you can choose the day, you can’t necessarily choose the date of your shelf exam. This poses a challenge to students who do not plan ahead or adequately prepare, as you can’t delay your test. That said, some schools use a pass/fail system, so your exact grade may not matter as much. In either case, you do not want to do poorly or fail any of your shelf exams. Neurology, as you would expect, is all about the brain, so shelf questions about the subject will be extremely narrow compared to internal or family medicine, where you could face questions about neurology but also those about cancer, GI bleeds, and other family medicine-esque things. How your shelf exams are spaced out depends on your rotation schedule, which may or may not be up to you, depending on your school’s process. The tests themselves usually occur on the last day of your clerkship, but the exact timing depends on the medical school. Scheduling is straightforward. Unlike Step 1 and Step 2, shelf exams are standardized for you. Everyone takes them on the same day through the same proctoring. You also don’t have to worry about finding a date or going to a test center; however, this depends on your school’s resources.

The Importance of Shelf Exams

Not all medical schools take a student’s shelf exam score into account when grading their clerkships, such as in true Pass/Fail programs. That said, the grade may factor into your acceptance at a residency program through communication of your composite rotation performance in your Dean’s Letter. Just like the order of your rotations, the weight of your shelf exams is specific to each school. For some schools, up to 80% of your clerkship grade is based on the shelf exam, whereas 20% is based on your evaluations. Each school also determines cutoffs. For some schools, 80% is a pass, and 90% is a high pass. For others, a C is a pass, and so on. This means you will need to adjust your study strategies based on the medical school you’re attending. Every school is different. If the results of your shelf exams will play a significant role in your grade, you will need to prioritize your studying. The key to your success is understanding exactly how you will be evaluated, and the best place to start is the syllabus or medical student handbook. The syllabus will break down how you will be graded, what’s expected of you, and other details specific to the rotation.

Maintaining Study Habits During Rotations

Although MS3 means you’re about to spend most of your time in a clinical setting, keeping effective and consistent study habits is still essential to your success. You will need to continue refining your study strategies, as you will be under even more stringent time constraints. Some of the rotations, especially the big ones like internal medicine, are extremely time-consuming. You’ll likely be working 12 to 14-hour days with little time off. That said, you will likely know your schedule at least a couple of weeks in advance, so start early and be proactive.

Tips for Shelf Exam Preparation

Plan ahead. Design a consistent study routine and stick to it. For best results, begin studying for your upcoming shelf before your rotation begins. This will give you the foundational knowledge needed to succeed in your rotation and impress your superiors. Studying can be done either in the morning before you start or at night when you get back, depending on your current rotation schedule. Remember: It’s easy to tell yourself you’ll study when you get home, but after an impossibly long and challenging day, studying will likely be the last thing you want to do. Your time will be very limited during your rotations, so it’s imperative that you utilize every spare moment. And don’t save it just for the hospital. If you’re on a bus or waiting in line at the grocery store, use that time to run through a few flashcards. We can’t emphasize this enough-your time will be very limited, so you’ll have to use it wisely.

Focus on High-Yield Information

To succeed, you’ll have to go all in on a study smarter, not harder approach. Focus on high-yield information. For example, if you recently completed USMLE Step 1, there’s a good chance you put in a whole lot of study hours learning the material you needed to pass. In this case, practice questions (especially from question banks that come with explanations) are higher yield, as you’ll be able to evaluate your current knowledge and find out where the gaps are. You don’t need to keep studying what you already know. While it may be satisfying to get the answer right over and over again, this isn’t a good use of your time. Modulate your studying based on your objectives. What you should focus on will be different for everyone, and again, it depends on your school’s process. Balance content review with questions. Additionally, how you study can have a huge impact on your results. It’s not about the amount of time you put in; it’s about how well you perform in the end. Some study methods are more effective than others.

Recommended Study Resources

There are a plethora of resources at your fingertips-so many that it can be confusing to know where to begin or which ones are the most effective. Plus, the best study tools can vary from rotation to rotation. But when it comes to study resources, more isn’t better. Commit to something, and stick to it. For primary resources, we recommend the latest AnKing Anki Deck with its shelf-specific tags or Step-Up to Medicine, depending on whether you prefer flashcards or books. If you prefer videos, the Boards & Beyond videos and the White Coat Companion study aid, or OnlineMedEd, are all great resources as well. One of these resources should provide you with enough information. Pre-read some of these resources quickly to understand the general concepts, then dive into the most important element of your studying: questions. Some of the best resources for shelf exams are the question banks from either UWorld or AMBOSS. Schedule at least one block of questions each day. Treat the block like an exam by timing yourself and keeping the questions random. You do not need to complete the entire set of shelf questions from either resource. However, you should strive to do as many as you can. Of course, do not forget the NBME Clinical Mastery Series practice shelf exams. While oftentimes not full-length, these tests provide the most realistic sense of what exam day will look and feel like. Endeavor to understand why you got a question incorrect, and if you answered a question correctly, explain out loud why you didn’t select the other answers. This active recall method forces you to assess other areas of your knowledge; plus, it enhances your ability to eliminate answers during the exam. Use a good reference book, such as Step-Up to Medicine or the Boards & Beyond videos + White Coat Companion, as a secondary resource. If you encounter a case pathology you didn’t master, these will help to fill in any gaps in your knowledge. Lastly, Anki decks are an invaluable on-the-go resource. Create your own Anki flashcards from any questions you miss on UWorld or AMBOSS, and pull this resource out whenever you have a few minutes to spare. To summarize, select a primary resource for content review, preferably an interactive one with active recall built in, and pair it with regular question blocks from either UWorld or AMBOSS. Whichever you choose, stick to it. For additional reference material, use the resources at your disposal, whether that be the Boards & Beyond videos or the AMBOSS database.

Exam Day Strategies

Prioritize a good night’s sleep. Stick to what you know. Exam day is not the time to try something new. This goes for your routines, sleep habits, the food you eat, stimulants, what you wear, exercise, etc. If you consume caffeine, do so strategically and in moderation. Eat a brain-healthy breakfast/lunch, and stick to foods you are familiar with. Give yourself much more time than you think you need. If you need to take the exam in person, leave much earlier than you usually would to account for any emergencies or roadblocks you may encounter on your way. If you’re taking your test online, follow the same principles. Everyone will take the same exam on the same day at the same time under the same conditions. Do not allow others’ uncertainty, nervousness, or use of other resources to deflate your confidence, especially as exam day gets closer. When waiting for your exam to begin, refrain from engaging with others’ nervous energy. Don’t let yourself get stuck on a question early on. Build momentum by taking a quick first pass through the questions. Don’t move through the questions too fast. Keep water handy and remember to take some deep breaths. If you get stuck, sometimes the best thing you can do is take a moment to breathe, recenter, and get your focus back on track. Move on to another question if you have to.

Additional Resources

Do you want to honor each of your clinical rotations, ace your shelf exams, match into the best residency programs, and become the best doctor you can be? Check out our admissions and tutoring services, including tutoring services tailored to shelf exams. If you are approaching or currently in your rotations, check out our comprehensive Clerkship series, which covers everything you need to know for your core rotations. Be successful in the classroom, ace your exams, and excel on the boards with five powerful resources in one proven system. Get Rx Bricks, Qmax (including banks of questions for Step 1 and Step 2 CK), Flash Facts with Study Stream, and Express Videos… This foundational medical material is broken down into small learning units, or "bricks", and organized around basic science topics or clinical concepts. With our user-friendly app, you can efficiently learn, review, and assess your understanding of complex medical content-any time, anywhere. USMLE-Rx was the most important part of my Step 1 preparation. I finally was able to remember all the information to pass the exam. I love the diverse questions and explanations. I think this Qbank is the best one for starting out. Rx is the best Qbank available! The question bank really challenged my depth of knowledge. Every brick has objectives, flash card questions, and practice questions. For more than 30 years, USMLE-Rx has been a leader in providing tools for medical education. But we are more than just another study tool. We are a community of medical professionals and students working together to elevate the future of medicine. The Rx Bricks Podcast is a podcast for medical students preparing for the USMLE step 1 and step 2, designed to assist students on their journey through medical school. Every week, we air a new episode based on an important basic science topic or clinical concept. Try Rx360+ for five full days without paying a dime, and keep your free access to over 150 bricks even after your trial ends. This includes the entire collections of General Microbiology and Cellular and Molecular Biology (aka Biochem).

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