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Holistic Review in the Medical School Admissions Process and What It Means for You

SUMMARY: 

Part of the purpose in training medical students is to help them develop further their capacity to share in the pain and suffering of patients, understand what sickness means to them within the context of background and circumstances, and demonstrate a disposition to help. In other words, compassion must be center stage. Thus, students accepted and enrolling in medical school must have a strong foundation in the attributes and experiences that will facilitate the development of that capacity for compassion. The focus on experiences and attributes reveals not only the distance that they have traveled, but also the extent that they have been resilient and dealt with responsibility, accountability, authority, and vulnerability.

By and large, applicants to professional school programs possess wellestablished values and diverse backgrounds along with some life broadening experiences that distinguish them in the admissions process. The stories they bring to the admissions process facilitate identifying a broadly diverse student body. This article presents another way of thinking about the process of selecting students without jeopardizing inclusiveness: Holistic Review. It highlights new perspectives in making admissions decisions. It emphasizes the importance of balancing traditional metrics with experiences and attributes in selecting applicants.

Medical education has an obligation to prepare physicians better to deal with the dilemma of disease and disability that many Americans suffer, especially among our burgeoning minority and immigrant groups. The fact that our society is continuously reshaping itself, becoming increasingly more diverse, multicultural, multiethnic, and globally interconnected, compels us to close the diversity gap. Therefore, the obligation of any health professions school committed to effectively responding to the changing landscape includes assessing itself. Holistic review is such a process that allows a balance between competence and compassion so that one is not attained at the expense of the other.

 

WHAT IS HOLISTIC REVIEW?

Holistic review is fundamentally a process that is aligned with the medical school’s mission, core values, and priorities. It also emphasizes multiple factors in selecting applicants for interviews and admission. The common practice of allowing any single metric to drive the review and selection of applicants for interviews and admission are quickly disappearing. Schools are putting into place holistic review policies and procedures that provide the foundation to consider earnestly the varied ways each applicant may contribute to a diverse educational environment within the context of the school’s goals for classroom learning, clinical practice and medical research and/or innovation. So, within a holistic admissions process what matters within the application that may determine how applicants are selected for interview and admission? Admissions committees across medical schools are incorporating the Association of American Medical Colleges (AAMC) Core Competencies for Entering Medical Students into their admissions processes. By doing so, committees broaden their scope of assessment to include:

  1. Experiences that reveal the path applicants have taken to arrive where they are
  2. The personal and professional characteristics that distinguish them
  3. The interpersonal skills that reveal their ability to interact and communicate effectively
  4. The demographic factors that shaped their experiences and attributes
  5. The intellectual skills needed to adapt to the learning demands of medical education

Thus, successful medical school applicants typically demonstrate the skills and knowledge in key areas to make transparent not only their motives for wanting to study medicine, but qualities essential in their professional, intellectual, and moral growth. Identifying Pre-Professional Competencies and Thinking and Reasoning Competencies (see previous page) are crucial for admissions committees in a holistic review approach and vital for understanding the nature of an applicant’s path toward medicine.

 

HOW IS HOLISTIC REVIEW USED?

 

In general, admissions committees get a sense of the extent to which applicants exercise these competencies in the personal statements, which should disclose the value of experiences in the context of their motivations for the study of medicine. They also examine activities in key areas, such as healthcare and service, to determine their breadth, depth, and/ or continuity. If there is any place in the medical school application that is critical in the review process to assess an applicant’s identity, level of commitment, maturity and motivation, it is in these segments of the application.

A holistic review process not only has at its core a broad, balanced range of criteria to assess applicants, but it also identifies the “deal breakers”, which often reveal underdeveloped motivation, a lack of maturity, integrity and responsibility, and high academic risk. These “deal breakers” will indeed vary from school to school, but more often than not, they are not consistent with the competencies outlined above.

 

WHAT DOES HOLISTIC REVIEW MEAN FOR ME?

The task confronting applicants is to develop the intellectual skills, attributes and experiences that reflect a balance between competence and compassion. Today we are seeing a remarkable emphasis on compassion and empathy. Medical school curricula are also focusing on bioethics, humanities in medicine, and professionalism, which has at its center respect, integrity and an understanding of the human condition. These additions have brought to the forefront the behavioral characteristics of compassionate care.

 

HOW ARE MEDICAL SCHOOLS MEASURING THESE OTHER CAPACITIES?

Some schools are using new approaches to interviewing candidates such as multiple mini-interviews (MMI) which are situational in design requiring that applicants draw from their inter- and intrapersonal traits and experiences to make decisions or judgments. Others have structured into their traditional interviews thought provoking situations followed by critical guiding questions. To complement these approaches, some medical schools are now requiring online tests that assesses noncognitive skills and interpersonal characteristics that medical schools believe are important for successful students.

Therefore, the goal of any student applying to medical school should be about making clear your identity, which is shaped and developed largely because of what you strive to be and achieve. Hence, what we as admissions committees hope to find in your identity is how you have looked inward to discover a sense of uniqueness and looked outward for a sense of community. This sense of uniqueness and community or identity is the acknowledgement that much of what you do in life is about developing character and manifesting that character in community. 

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Mr. Maldonado is the associate dean of admissions and assistant professor of humanities in medicine at the Texas A&M University College of Medicine.