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New Medical Schools Use Holistic Admissions to Create Diverse Classes That Will Fulfill Diversity-Related Missions, Goals

AAMC Reporter: February 2014

—By Jen Uscher, special to the Reporter

In recent years, a growing number of medical schools have adopted holistic review to increase the diversity of their student body. Several newer medical schools have had success linking holistic admissions to their mission statements in an effort to create more diverse classes. While admissions committees traditionally relied heavily on GPA and Medical College Admissions Test® (MCAT®) scores in selecting applicants, a holistic review gives balanced consideration to an applicant’s life experiences, personal attributes, and academic metrics. Selection criteria are linked to the school’s own unique mission and goals.

Last June, the U.S. Supreme Court issued a long-awaited decision in the Fisher v. University of Texas at Austin case, sending it back to the lower court of appeals for review. The justices left intact the precedent that a college or university can take an applicant’s race into account as one factor among many in a holistic review process, but only when the school can demonstrate it as necessary to achieve its diversity-related educational goals.

“To successfully implement a holistic admissions process, a school needs to first have a clear mission statement. It should be looking for the students who will best help fulfill its mission,” said Henry Sondheimer, M.D., AAMC senior director of medical education projects.

In defining the types of diverse students and graduates who will help carry out its mission, a school might consider a wide range of factors, including race, gender, socioeconomic status, educational background, languages spoken, and geographic origin. Several states prohibit public colleges and universities from using race and ethnicity in evaluating applicants, but those with a holistic admissions approach can look at other factors to attain a diverse mix of students.

“Ultimately, our hope is that as more medical schools use holistic admissions, we’ll create a more diverse physician workforce and one that is better capable of caring for the American public,” Sondheimer said.

Through its Holistic Review Project, launched in 2007, the AAMC is providing support to medical schools that are revamping their admissions processes. The association offers a “Holistic Review in Admissions” workshop designed to help schools develop procedures that are aligned with their diversity interests and institutional mission. The workshop is designed for admissions committee members and other key staff and administrators. So far, a total of 54 institutions have hosted a workshop.

Some newer schools hosted the workshop before they began evaluating applicants for their first entering class. Cooper Medical School of Rowan University, which opened in 2012, is located in Camden, N. J., one of the most impoverished cities in the United States. The school seeks to educate physicians who will practice in the region and create new programs in which students and faculty provide health care services to local residents.

John F. McGeehan, M.D., associate dean for student affairs and admissions at Cooper, said his team knew from the beginning that it wanted a class with diverse backgrounds, cultures, and races, in part because Camden’s population is very diverse.

“Our mission is to train students who are not only knowledgeable and capable but who also want to give back to a challenged urban population. We are looking for people who will consider working long-term in an environment like Camden,” he said.

As part of its holistic review process, the admissions team puts particular focus on an applicant’s personal statement and experiences—looking, for example, at whether the student has volunteered with needy populations. Candidates selected for interviews have a traditional interview session with an admissions committee member and are videotaped interacting with actors posing as patients in two simulated clinical scenarios. This exercise helps the admissions committee assess the applicant’s interpersonal skills.

Central Michigan University College of Medicine in Mt. Pleasant, Mich., which opened in 2013, is another new school that held an AAMC workshop to help develop its holistic admissions process. Joel Lanphear, Ph.D., senior associate dean of educational programs and interim associate dean for student affairs, said the school has a social accountability mandate to improve access to highquality health care in rural and medically underserved areas in middle and northern Michigan.

“We want to engage physicians in leading health care transformation, and we realized we needed to look at a lot more than MCAT scores and GPAs,” he said.

The admissions team decided to give candidates ratings on attributes such as compassion for others, leadership abilities, cultural competence, integrity, and adaptability when evaluating their secondary application materials. The reviewers also give the candidate an overall rating on how well they fit the school’s mission. They look for at least one extensive community service experience or leadership experience—for example, volunteering regularly in a soup kitchen or retirement facility for six months to a year.

In addition, select applicants are invited to participate in a “multiple mini-interview” process in which they rotate through 10 short, scenario-based interview stations. Each student discusses a scenario with the interviewer related to a theme such as ethical decision-making, critical thinking skills, or communication skills. The interviewer gives the applicant a score from one to 10, writes comments on his or her performance, and answers yes or no to the question, would you want this student as your future physician?

“Establishing a holistic review process may require more resources for training and staff time in the beginning, but the information you get about your applicants is so much richer that it’s worth the extra effort,” Lanphear said.

At the University of California, Davis, School of Medicine (UC Davis) in Sacramento, Calif., the admissions office had used holistic review for about a decade before opting to hold an AAMC workshop in 2012. During the workshop, the admissions team decided it could look at a larger pool of applicants if it eliminated some prerequisite requirements. As a result, the school no longer requires one year of math for applicants and accepts a wider range of science courses. Instead, it offers more academic support for students after they are accepted. For example, a newly launched Office of Student Learning and Educational Resources helps students with test-taking strategies and provides study aids and other resources.

“We’ve found that many students who might have had less preparation or fewer educational opportunities can thrive here because of the support services we provide,” said Lee Jones, M.D., associate dean for student affairs and clinical professor of psychiatry and behavioral sciences at UC Davis.

Jones advises other medical schools that are adopting a holistic admissions process to determine where students will need support—including academic support, wellness programs, and help navigating financial aid—and to get those services in place. “That’s an integral part of bringing in a more diverse class,” Jones said.

Sondheimer pointed out that establishing a holistic admissions process can be labor-intensive and costly. A holistic review process typically involves assigning various scores to applicants—for instance, on their interview performance and on the number and quality of their experiences in areas like community service and research. Schools do not rely on numbers alone in making their final selections. Sondheimer noted that the schools that have been successful with holistic review have had strong leadership support.

Steven T. Case, Ph.D., professor of biochemistry and associate dean for admissions at the University of Mississippi School of Medicine, said his team meets and discusses how each applicant would contribute to the diversity of the class and add to the educational experience for everyone. “We have never found a formula or algorithm for that, so we talk about it,” he said.

Case noted that the school defines diversity in multiple dimensions. “If an applicant comes from a rural area or from a socioeconomically disadvantaged background, they may be better able to relate to patients who come from those backgrounds. And they could enhance the academic excellence of our school by bringing their perspective to class discussions and clinical experiences,” he said.

Research shows that medical students feel they reap educational benefits from having a diverse group of classmates. A 2013 AAMC study found that students in the most racially diverse medical school graduating classes report the highest levels of agreement that they have learned from others who are different from themselves.

Medical schools are gathering data to evaluate whether their holistic admissions approaches are achieving the desired outcomes. McGeehan and Jones said their schools are tracking where students complete their residencies and where they practice medicine throughout their careers. Many admissions officers also want to find out which variables taken into account during the admissions process predict how a student will perform on the United States Medical Licensing Examination Step 1, in their clinical year and as a physician.

Some schools may be concerned that adopting holistic review and accepting some applicants with lower MCAT exam scores could decrease their standing in national surveys such as U.S. News & World Report’s rankings of medical schools. But those fears may be unfounded since most admissions committees are choosing from a pool with a lot of qualified applicants.

“Using a holistic approach to admissions, we’ve been able to select students who have GPAs and MCAT scores that are well above our minimum requirements and have a high level of commitment to our mission,” Lanphear said.

McGeehan agreed that admissions officers can build a class that is well prepared for the rigors of medical school using holistic review. “We can find people who are good test takers and who are really good at the bedside,” he said. “And if you can have both, why not look for both?”

February 2014 Home

“Establishing a holistic review process may require more resources for training and staff time in the beginning, but the information you get about your applicants is so much richer that it’s worth the effort.”

—Joel Lanphear, Ph.D.