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The Medical College Admission Test (MCAT) has undergone several revisions for content and validity since its inception. With another comprehensive review pending, this study examines changes in the predictive validity of the MCAT's three recent versions.Study participants were 7,859 matriculants in 36 classes entering Jefferson Medical College between 1970 and 2005; 1,728 took the pre-1978 version of the MCAT; 3,032 took the 1978–1991 version, and 3,099 took the post-1991 version. MCAT subtest scores were the predictors, and performance in medical school, attrition, scores on the medical licensing examinations, and ratings of clinical competence in the first year of residency were the criterion measures.No significant improvement in validity coefficients was observed for performance in medical school or residency. Validity coefficients for all three versions of the MCAT in predicting Part I/Step 1 remained stable (in the mid-0.40s, P < .01). A systematic decline was observed in the validity coefficients of the MCAT versions in predicting Part II/Step 2. It started at 0.47 for the pre-1978 version, decreased to between 0.42 and 0.40 for the 1978–1991 versions, and to 0.37 for the post-1991 version. Validity coefficients for the MCAT versions in predicting Part III/Step 3 remained near 0.30. These were generally larger for women than men.Although the findings support the short- and long-term predictive validity of the MCAT, opportunities to strengthen it remain. Subsequent revisions should increase the test's ability to predict performance on United States Medical Licensing Examination Step 2 and must minimize the differential validity for gender.