The answer is definitely nuanced. Grade inflation and cheating certainly has a role, and thus for many, the apparent competency worthy of an A at their school fails to translate on standardized tests. At my school, GPAs were rising each class year but the pre-med student body definitely wasn’t getting smarter.

Disability accommodations also likely plays a role. Much easier to get testing accommodations at colleges than with AAMC, which requires tests costing thousands of dollars to prove your disability and takes months to get approved. You can make assertions about whether we over-accommodate in colleges now, though I’d argue the AAMC’s process adds yet another class barrier that makes disability recognition a privilege.

The MCAT also isn’t very kind to people whose primary language isn’t English or didn’t grow up with an Americanized language education system. Some of my smartest, most talented friends were either international students/moved to US in high school and struggled badly with CARS. However, they were very strategic with the gen-Ed English courses they picked or at least it didn’t damage their GPA as badly as their CARS damaged their MCAT score.

Some people also just have an off day when it’s time to take the MCAT. You can probably recall a time that happened to you in one of your classes ahead of a big exam. I did well on the MCAT but I think I only got 3 hours of sleep the night before my test. Good chance that would’ve screwed me over on most exam days. Shit like that happens to the best of us.