Holistic Medical School Admissions
5-7 Minute Read
Authors: Cheryl Brewster, EdD, MA and Judy Bolstad-Hanrahan, JD, MA
Purpose
To provide clinician educators with an understanding of holistic medical school admissions and familiarize them with limitations on criteria used in medical school admissions processes.
Learning Objectives
Recall the three kinds of applicants that holistic review helps identify; and
Describe why some groups of people see the use of certain personality traits by Harvard College’s admissions process as rooted in Asian stereotypes.
Holistic review in medical school admissions is an intentional process often used to identify qualified students who have been historically under-represented in medicine, whose unique life experiences will contribute to the medical school class and future physician workforce, and whose goals and values align with the school.(1) While holistic admissions procedures continue to use numerical scores for various aspects of an admissions packet, it’s clear that there’s more to an applicant than an overall GPA, a science GPA, and MCAT scores. Holistic procedures enable and encourage admissions committees to contextualize the various aspects of an application with information about the applicant’s personal history. For example, the reason an applicant took a break as an undergraduate might give context to the gap.
Holistic review is not just about race and ethnicity, it is inclusive of a student’s lived experience during their journey into the field and a broad range of personal characteristics. A holistic review process might, for example, take into consideration whether or not an applicant had to work to help support their household through undergraduate education or if they are a first-generation college attendee. It might also consider any of a broad range of personal characteristics, including gender, sexual orientation, religion, age, or ability. These myriad experiences and attributes, along with metrics, are how we will create a diverse class of students who will competently manage the healthcare needs of our ever changing society, in particular the populations of Southern and rural Nevada.
Nearly all allopathic medical schools in the United States and Canada claim to use some form of holistic review.(2) Many uses are modeled after the Association of American Medical College’s (AAMC) Experiences-Attributes-Metrics Model (pictured). AAMC qualifies the use of race or ethnicity in holistic admissions with the disclaimer that procedures must be consistent with federal and state law.(1)
The current state of race-conscious admission practices in higher education is under review by the US Supreme Court in a pair of cases looking at admissions procedures at University of North Carolina and Harvard College.(3) The cases seek to overturn Grutter v. Bollinger (4), a 2003 case upholding the consideration of race/ethnicity as part of a highly individualized admissions process if it also considers the many other meaningful aspects of diversity. Automatic numerical boosts to an applicant because of their race or ethnicity (5) and racial quotas (6) are, however, unconstitutional.
In the current Harvard case, the plaintiffs argue that Harvard systematically assigns Asian American students lower “Personal Ratings” based on assessments of the applicants’ leadership, self-confidence, like-ability, and kindness. Plaintiffs contend the lower personal ratings are tied to stereotypes of Asian American students as “shy, passive, perpetual foreigners, and model minorities who are interested only in math and science.”(4) The focus on self-confidence, they argue, is meant to weed out “shy” Asian applicants, the focus on leadership to weed out “passive” Asian applicants, and the focus on like-ability to weed out “boring” “math focused” and “unidimensional” Asian applicants. Plaintiffs believe Harvard’s attention to these aspects of “personality” is intentional and meant to maintain a consistent number of Asian students; while, they argue, Asian students, who en masse have higher GPAs and test scores, should account for a larger percentage of the incoming class.
Harvard argues that an applicant’s race or ethnicity considered among the various other aspects of an applicant’s personal, academic, and extracurricular record is necessary to select students who do not merely excel academically, but who have a diversity of experience, viewpoint, and interests. The number of qualified applicants that Harvard receives, they argue, is too numerous to rely on grades and test scores alone to compose an incoming class. While arguing that their holistic admissions process does not rely on racial stereotypes, Harvard has instituted training to ensure that interviewers do not rely on racialized stereotypes when assigning personal ratings. Oral arguments in these consolidated cases was heard on October 31, 2022.(7) Based on the current make-up of the Supreme Court, many believe that the court will strike down the use of race and ethnicity in higher education admissions.(8) The Roseman University College of Medicine considering this possibility as we develop admissions criteria and many other schools will need to revise their admissions procedures if the Court rules against race-conscious admissions.
Considerations
The process of developing and/or revising admissions criteria will only be successful if it is deliberate, mission focused, and addresses the needs of the local community. We encourage you to spend some time thinking about the healthcare needs of Nevada, especially its underserved populations, and how admissions criteria can be utilized to help close healthcare gaps.
Also, consider your own pre-medical school experiences, what experiences made a positive impact on how you practice medicine and connect with patients and colleagues? How could an admissions procedure capture such experiences?
At least one school has focused on admission and scholarships for the descendants of slaves previous owned by the University as described in this story out of WGBH in Boston.■
References
AAMC. Holistic review. www.aamc.org. Accessed April 20, 2022. https://www.aamc.org/services/member-capacity-building/holistic-review
AAMC. Aspiring Docs: Holistic review in medical school admissions. AAMC.ORG. Accessed May 3, 2022. https://students-residents.aamc.org/choosing-medical-career/holistic-review-medical-school-admissions
SCOTUSblog. Students for Fair Admissions Inc. v. President & Fellows of Harvard College. Accessed April 20, 2022. https://www.scotusblog.com/case-files/cases/students-for-fair-admissions-inc-v-president-fellows-of-harvard-college/
Grutter v. Bollinger. U.S. 539, 306 (US 2003).
Gratz v. Bollinger. U.S. 539, 244 (U.S. 2003).
Regents of Univ. of California v. Bakke. U.S. 438, 265 (U.S. 1978).
Howe A. Court will hear challenges to affirmative action at Harvard and University of North Carolina. SCOTUSblog. Published January 24, 2022. Accessed April 20, 2022. https://www.scotusblog.com/2022/01/court-will-hear-challenges-to-affirmative-action-at-harvard-and-university-of-north-carolina/
Howe A. Affirmative action appears in jeopardy after marathon arguments. SCOTUSblog. Published October 31, 2022. Accessed November 22, 2022. https://www.scotusblog.com/2022/10/affirmative-action-appears-in-jeopardy-after-marathon-arguments/