<p>Interesting discussion of the use of holistic review for medical school applicants at BU. Holistic review considers the achievements of each applicant in context of their life experiences. </p>
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A holistic review process therefore emphasizes attributes, including learning ability, that are associated with excellence in physicians. Applicants are evaluated according to criteria that are institution-specific, mission-driven, broad-based, and applied consistently across the entire applicant pool at a given school. Holistic review does not abandon the as- sessment of aptitude in science. Rather, it places such measures in the broader context of the applicant’s life experiences, with a particular focus on adversities overcome, challenges faced, advantages and opportunities encountered, and the applicant’s demonstrated resilience in the face of difficult circumstances.
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<p>D1 and I discussed this article at length this morning. She attends a school that uses a holistic evaluation process nearly identical to the one described in the article.</p>
<p>She says that her observations match those of this study. She characterized her classmates as very cooperative and supportive of one another, and as more open-minded, and more ethnically and culturally diverse (~35% URMs) than students she has met from other schools.</p>
I am not sure how much of that is attributable to the holistic application review process. It probably has more to do with the competition (or the lack there off, in this case) amongst them for scarce resources. In medical schools, unlike at most undergrad schools, they are not competing against each other to get those coveted A grades. Therefore they behave in a civilized manner with each other. Often times, competition brings out the worst out of us.</p>
<p>I used to attribute a lot of human behavior to this mysterious thing called “civilization”. And life taught me that, put in difficult situations, even the so called civilized behave in very uncivilized ways. </p>
<p>I used to live in the deep south where life was more leisurely, people would greet each other and don’t push and shove each other while waiting in a line. Then I moved to NJ in mid 90’s. I am used to it now, but it was a cultural shock then. I commute by an extremely busy commuter train service to my work. I hear fights breaking out almost everyday because of folks pushing each other while trying to grab one of those coveted seats. PATH trains - forget about it They push each other so hard that I am actually concerned about the safety of the weaklings.</p>
<p>I just wanted to make one more comment on holistic reviews. Schools’ primary goal with holistic reviews, I believe, is to achieve a certain level of heterogeneity with their student populations. That heterogeneity can be based on whole lot of things ranging from cultural to socio-economic. In that sense, most schools have been doing the holistic reviews for a while. They are just tinkering at the edges again, now.</p>
<p>I remember you calling WUStL a “score whore” on another thread. Without doing this holistic thing, they all would end up being score whores and certainly the top schools would be flooded with Asian kids (no offense intended, and no I am not perpetuating a stereotype). I am not saying whether it is a good thing or a bad thing, as that can be argued until the cows come home.</p>
<p>I think that holistic review for medical school sets a new low bar for standards. In my medical school class, almost 20% could not graduate in 4 years, primarily because they could not pass the boards. You could have guessed from day 1 who those students would be- they are the same ones who got extra tutoring sessions (that we were not allowed to attend). If you can’t deal with the tough pre med work, then you are likely not cut out for medical school. Becoming a doctor is a very rigorous path (although residency training is becoming so much easier with work hour limits), and we are setting this country up for failure by taking unqualified students. I’d rather have an aloof doctor who knows how to take care of me than a hand holder who has no clue to manage a patient. Obviously, it would be nice to have a compassionate physician who knows patient care, but this is not something you find all the time.</p>
Isn’t that dangerous? I certainly don’t want to put my life in the hands of a doctor who got through the back door that this holistic review thing can potentially end up being. In health professions, objectivity can not take back seat to anything else, because in the end peoples’ lives are riding on the quality of these professionals.</p>
<p>I’ve been a Cardiologist for 13 years, and I have met only 5 primary care physicians in a large metropolitan area that I would trust to take care of me. Almost all of the primary care physicians are of the mindset that they need to send patients to consultants for every single problem, no matter how trivial. Restricting training hours exposes residents to less disease pathology and how to deal with complex issues- in addition they develop a “work shift” mentality.</p>
<p>Accord the NEJM study, BU’s GPA/MCAT stayed the same or rose slightly higher.</p>
<p>At D1’s school (another holistic review school) the MCAT/GPA average is low (3.6/28) but the school does not accept OOS students so the selection pool is limited. (Low population state) However, the school’s Step 1 average is at or just slightly below the national mean and the average for STEP 2 is close to ~1 SD above the national mean. </p>
<p>And kal, our “doomed social experiment” has been going on for 15+ years. It’s working. The state has seen an increase in the number of URM doctors practicing in the state. (Still doesn’t match the population demongraphics, but we’re getting closer.) And a significant number of graduates do return after residency to practice here. Including practicing in rural, underserved communities.</p>
<p>IWBB, It goes back to who you call as a “good” doctor to a large extant, doesn’t it?. On that one, I am with PsychoDad10. A doc with great bed side manners is a bonus, but I would rather have a doctor who gets his diagnosis right, albeit a cranky one. Here is a mystery to me - why do folks put so much value on sweet talking (a.k.a. good bedside manners) when it comes to physicians? I can get my sweet talking urges taken care of for a lot less cost elsewhere.</p>
<p>The hole in the holistic review (pun intended) is that, the hole process is way too subjective. Who is responsible for managing the reviewer biases and interpretational mistakes? Also, anybody who thinks that they can figure out who will be good doctor by reading a couple of essays on the application and a half hour interview, should also believe in arranged marriages. The problem is, when an arranged marriage goes wrong only the couple suffers, OTOH if the holistic reviews go wrong we as a people suffer.</p>
<p>If you read the NEJM article, you see that </p>
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<p>RE: getting the diagnosis right. I’d argue that it’s just as important to educate and communicate effectively with the patient about his diagnosis and prognosis and treatment options as getting the diagnosis right. The patient is not a null object in the health process, but a participatory member. Ask any doctor about what frustrates him most about medicine and you’ll find non-compliant patients near the top of the list. A good deal of medicine is not just about diagnosis, but the management of chronic conditions–and being able to convey to the patient the importance of compliance with treatment protocols is critical.</p>
<p>And on the flip side, if you have had or have lived with someone who has a chronic, debilitating but managable illness, you’ll quickly discover the value of “good bedside manners” and effective patient-doctor communication. A doctor who blows off a patient’s complaints, telling them to “suck it up” and “learn to live with it” is not going to be able to treat that patient effectively and can end up overlooking significant new complications of the original illness.</p>
Why does it matter that the doctor demographics should match with the population demographics? Are you saying that a Caucasian doctor is incapable of diagnosing an African American’s illnesses? Smells very much like a social engineering effort to me.</p>
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And don’t see the connection between holistic reviews and this. If that is a goal, then working in rural areas or in a given state can be made a condition of admission. Quite a few schools do that too.</p>
<p>Here is the problem - the benefits of the holistic review are in the eyes of the beholder. For you it seems like increased cooperativeness in class room, and matching doctor demographics with population demographics are important outcomes of the holistic review. For me, the core competency of a doctor is a lot more important and anything that has the potential to compromise that is worrisome.</p>
<p>I would say that an african american patient is more likely to listen to an african american doctor.</p>
<p>And let’s assume that the quality of GPs is declining as PyschoDad says. I would guess that’s mostly attributable to medical school debt/physician compensation (the smartest docs aren’t going into primary care fields like they used to - not that the actual caliber of medical students is decreasing) and a minor component is the general increase in medical knowledge such that on some level GPs need to constantly turf to specialists out of fear of missing something.</p>
<p>I guess I don’t understand what holistic admissions is because to me anything other than sorting by GPA/MCAT in excel and admitting the top whatever is holistic admissions.</p>
<p>Absolutely not, but different population subgroups can have different responses to treatment/medications, etc., have different predispositions towards certain diseases, present with significantly different symptoms for the same illness. Different cultures have different expectations w/r/t to health and healthcare. Majority culture doctors are not always aware of this and it can have potentially devastating results.</p>
<p>And I think that in our state at least, matching the demographics can be important. We have a significant Native American population. They are justifiably suspicious of “white medicine” because they have been subject to some pretty horrific treatment at the hands of the majority culture. (Including near genocide within the past 5 generations.)</p>
I never questioned the value of good bedside manners, if you read my post more carefully. Seriously, do you think that holistic review figures out who will end up with great bed side manners? That’s why I gave the analogy with arranged marriage. In an arranged marriage also the couple doesn’t question the value of compatibility. They just think that they can figure all that out in a half hour arrangement meeting. The reason why most social engineering efforts fail, is not because they are not well intentioned, but because they are based on false premises and because they tend to ignore side effects.</p>
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And they teach that stuff to all medical students. A doctor from ones one ethnicity should not have a leg up over the others.</p>
<p>Well, lets say that we agree to disagree on this one.</p>
<p>IWBB,
Home run! To me this holistic review thing sounds like a solution in search of a problem.</p>
<p>You can try to do this, but it’s unenforceable.</p>
<p>And to quote Dr. House: Everybody lies.</p>
<p>The best predictor of whether a physician will practice in rural area—is for that the individual to have grown up in a rural area. During the holistic review, this can be taken into account.</p>
<p>Sorry all, had to actually do some stuff in lab (who knew I actually did any work?).</p>
<p>WOWMom is touching on some of the stuff I’m saying. The effect of the tuskeegee experiment still hasn’t worn off. There are women who will only see one gender of OB/GYNs. Whether we like to admit it or not, medicine is not a book science and getting the right diagnosis is not solely dependent on the physician. On a chemistry or physics exam, the amount of information I get to work with isn’t dependent on the mood of the professor that day or based on a snap judgement they make of me when I walk in the room.</p>
<p>Additionally, there are physical skills associated with medicine (physical exam, surgery, scoping, etc) and yet I don’t see anything in the admissions process addressing that?</p>
<p>I’m not trying to say that the current bar is too high or that doctors don’t have to be intelligent. My real point is just that I don’t think these “newer systems” of admissions are necessarily any worse than the current one - which has plenty and plenty of flaws - and in fact these programs have the data to prove it.</p>
<p>There are plenty of smart people who would make awful, awful doctors so why shouldn’t an admissions process reflect that?</p>
<p>EDIT cuz I saw Kal’s post. My final sentence basically gets on this. There are plenty of people who could get GPAs of 4.0 or very high MCATs and that in no way means they would be even remotely successful physicians.</p>
May be not, but you can’t deny that they are smart. You can’t holds that against them. You can replace “physicians” in that quote with the name of any other professional, it would still be valid. Besides, do you think this holistic thing will fix that? No admission process figures out who will be a successful physician, with 100% accuracy. If there is one, and it is proven, lets talk about it. What we are dealing with here is a conjecture, of some social engineers. With regards to the DATA BU purportedly has on their new process (here come the clich</p>
They push each other so hard that I am actually concerned about the safety of the weaklings.</p>