In its June 24, 2013 decision in Fisher v. University of Texas at Austin, the Supreme Court addressed the issue of race and higher education admissions. This decision has significant implications for medical school admissions. The Court affirmed the benefits of diversity in an admissions process, but reversed the lower court’s findings that the University followed a proper admissions process that incorporated race as a factor in admissions. In particular, the Court asked whether there were other ways to ensure a diverse student body short of using race as a key factor. The Court did not suggest what might be an acceptable approach, but did suggest that applicants should be judged as individuals and that an applicant’s race or ethnicity should not be “the defining feature of his or her application.”
These guidelines reminded me of recommendations in a recent article by Witzburg and Sondheimer on Holistic Review, in which the authors outline an approach that would appear to meet the current Supreme Court’s guidelines. This Holistic Review of an applicant has been an effective way to increase diversity because it looks beyond the MCAT scores and college grades to focus more on the intellectual and personal characteristics that should be considered in the admission process.
I realize that the Holistic approach is not easy. It requires a careful reading of an application, a probing interview, and scrutiny of letters of recommendation, grades and test scores. In the current admissions environment, where applicants far exceed spaces in medical school, it may be difficult to find the time to review each application in this way. The process also benefits from a diverse admissions committee itself. Time commitments from admissions committee members are significant, and yet I have seen faculty all over the country make these commitments without complaint because they recognize the important role of student selection in the development of a future workforce that will be able to address health disparities.
Diversity has benefits that go beyond individual patients and providers. Academic Medicine published an article by Mark Nivet that describes how diversity can provide a core source of creative energy for an institution. He explains how the concept of diversity has evolved, starting at the periphery of an institution and then becoming part of the fabric of everyday function. He argues that full integration of diversity will help institutions achieve excellence. I recommend this article as an excellent overview of this complex area, and as a way to provide context to the Supreme Court decision.
Of course, context for diversity, appears all around us on a daily basis. I recently had the opportunity to teach some newly admitted medical students. As we went around the room and introduced ourselves I was surprised to hear stories about military service, childhood experience in a developing country, life in a refugee camp, travel away from family and loved ones to pursue education, parenting, poverty, adversity, and resilience. I know that these students will bring their life experiences, empathy, and intelligence to the encounters with their patients, and we will all be the better for it.
In our upcoming December issue of Academic Medicine we will present a Commentary by Rosenbaum et al on the Fisher v. University of Texas decision. This article will be available online prior to print in late October. I encourage you to read our article when it becomes available, and I also ask that you maintain the momentum toward a diverse and fair admissions process. I look forward to your thoughts and reactions to the Fisher decision and our article when it appears.