AAMC Reporter: September 2006

Criminal Background Checks for Medical Students Moving Forward

In June, the AAMC Executive Council approved the development of an AAMC-administered national, centralized system for completing and reporting on criminal background checks for applicants accepted to medical school, a system that will be available to all AAMC–member medical schools.

After nearly two years of deliberation, the AAMC, including its Criminal Background Check Advisory Committee, responded to growing public and legislative momentum in favor of criminal background checks for all medical students. Several states already require medical schools to perform criminal background checks on entering students, and the Department of Veterans Affairs mandates that all students who will be involved in patient care at its hospitals have criminal background checks. Approximately one quarter of medical schools have already instituted checking procedures.

While the decision is not without controversy, and discussions on a variety of related issues will continue, many in academic medicine felt it was the right time to take action.

"We believe that establishing this system ourselves, rather than having it imposed on us in an arbitrary manner, is most likely to maximize the benefit to patients and society," said Robert Witzburg, M.D., associate dean and director of admissions at Boston University School of Medicine and chair of the AAMC Group on Student Affairs Committee on Admissions. "Having 125 individual schools develop their own processes would be inefficient, costly, and burdensome both for schools and for applicants, so it makes sense for the AAMC to take this on."

The process for establishing the new system has already begun, with a request for proposals from criminal background check vendors issued this summer. In September, the AAMC will evaluate the proposals, with input from an AAMC committee of medical school admissions officers, health professions advisers, and current medical students. In the summer of 2007, about 10 medical schools — half with criminal background check systems already in place and half new to the process — will assess the chosen system for applicants to the 2008 entering class.

"We'll be assessing things like ease of integration and accuracy of data. Those schools currently conducting checks could compare the results we provide with those they receive from other checks," said Stephen Fitzpatrick, a program director with AMCAS, who will oversee the implementation. If the test goes well, the new system will be available to all interested medical schools in the summer of 2008 for applicants to the 2009 entering class.

The decision, however, is not without its challenges. In addition to numerous technical hurdles, said Robert Sabalis, the AAMC's associate vice president for student affairs and programs, implementing the system will require ongoing discussions with schools as each decides exactly what it wants to do with the information revealed in a background check.

"We're not looking for information about juvenile offenses," Sabalis said. "Only offenses committed as an adult or those for which a juvenile might have been tried as an adult." Aspiring medical students also will need to be educated on the new process, a key reason for including health professions advisers in the implementation advisory committee.

"They will help us vet the questions that are asked in the admissions process and clarify the system for applicants," Sabalis said. "The instructions about what applicants must include in their self-reporting need to be crystal clear."

The advisory committee also recommended schools not take this information into account in the application and admissions process but consider it after making a conditional decision to admit. They can then compare the applicant's self-reported information about criminal history with the background check and decide based on that information whether to extend a final offer of admission.

How will a school decide what it is comfortable with, in terms of a criminal history, and what it is not?

"Individual schools may have different responses to a given history," Witzburg said. "Obviously, people who have committed homicide or are convicted child abusers probably won't get into medical school, but other circumstances may be open to interpretation. One medical school might say a single DUI is too much, but another might see a single offense five years previously, with no evidence of a pattern, as a youthful indiscretion that warrants a second chance."

Admissions officers also worry that the criminal background check process may unfairly target members of underserved minority populations.

"The criminal justice system in America is not race or status blind. The criminal history of someone from a minority background may be different than the history of someone with exactly the same behaviors but from a different racial background or economic status," Witzburg said. "Individuals already facing barriers in access to the medical profession will now face yet another one. Medical schools must be very conscious of this issue."

That's not the only problem leaders in academic medicine foresee. "I would be concerned that medical school applicants could be so worried about having a record that it would inhibit them from taking actions that might be expected of doctors, or potential doctors, in the protection of human rights and other acts of conscience," said Mark C. Henry, M.D., chair of emergency medicine at the State University of New York-Stony Brook School of Medicine.

For example, Henry said, what if a pre-med student wanted to participate in a protest for civil rights or against a war? "Arrests have resulted from protests like these. If future physicians are inhibited from participating in the discourse out of fear of personal consequence to their ability to practice, that would not be good for society," Henry said.

In response to such concerns, criminal background checks and their implementation are scheduled to top the agenda at a 2007 AAMC professional development conference for admissions officers. The committee on admissions is also preparing a criminal background check "best practices" guidelines document.

"We recognize that the criminal background check is a potentially intrusive, invasive, costly process," Witzburg said. "And there's no clear indication that this will improve the safety of our patients or the quality of our doctors. Nevertheless, self-policing is a defining characteristic of a profession; this has been demanded of us, and so we're going to do our best."

AMCAS instructions will also have to be revised and clarified. The current system asks only about felony convictions; it will have to be expanded to include questions about misdemeanor convictions and, potentially, expunged records.

"We don't want this to come as a shock to the applicants," said Fitzpatrick. "By communicating effectively with all of our constituents, we hope that it can be done with as little stress as possible."

Read the Report of the AAMC Criminal Background Check Advisory Committee (PDF, 12 pages)

— By Gina Shaw, Special to the Reporter

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