Fairness Begins at the Gate: Why Pakistan’s MDCAT Must Move Beyond Raw Scores

Abstract

Background:
The Medical and Dental College Admission Test (MDCAT) is the primary gatekeeper for entry into medical and dental education in Pakistan. Recent controversies surrounding MDCAT 2023–2024 paper leaks, skewed score distributions, and the use of raw scores across multiple sessions and years have raised serious concerns about fairness, validity, and public trust. Court judgments and parliamentary debates have further highlighted weaknesses in governance and psychometric practice.

Objective:
To critically evaluate the current use of raw scores in MDCAT across multiple test forms and years, compare this approach with international best practices in high-stakes testing, and propose a practical roadmap for psychometrically defensible and ethically robust reform.

Methods:
This narrative review synthesizes evidence from Pakistani legal documents, public notices, and media reports on MDCAT 2022–2024, alongside international standards in educational measurement and technical documentation from major testing agencies (e.g., ETS, NCCAOM, NCBE, AERAs Standards for Educational and Psychological Testing).

Results:
Findings indicate that: (1) MDCAT scores are currently reported and interpreted as raw percentages, while being declared valid for up to three years across cohorts under Section 17 of the PM&DC Act 2022; (2) multiple court proceedings and independent reviews have noted statistical anomalies, including very weak correlations between MDCAT and board marks, unusually high clusters of near-perfect scores, and credible allegations of paper leaks across sessions; and (3) international high-stakes examinations with multiple forms (e.g., MCAT, LSAT, GRE) rely on equating and scaled scores to ensure comparability, as required by professional standards.

Discussion:
Using unadjusted raw scores from non-equated forms in a multi-session, multi-year, high-stakes exam is psychometrically indefensible and ethically problematic. It risks hidden advantage, systemic disadvantage, and erosion of trust. Pakistan can align MDCAT with global best practice by legally mandating equated and scaled scoring, creating an independent National Center for Health Professions Assessment, adopting anchor-item designs and item response theory (IRT), and enhancing transparency.

Conclusion:
Scaling and equating are not statistical luxuries but instruments of justice. For a country where access to competent healthcare can mean life or death, fairness at the very first gate, who is allowed to become a doctor, is an ethical imperative.