<p>With regard to lilypod who must have posted right as I started writing the other reply. Holistic admissions would actually allow a school to create a more diverse student body when it comes to personality as it would allow them to use personality as a factor while a “purely merit based” admissions process would have to ignore it.</p>
<p>Anything can be “taken too far,” and that is not a reason to not do it. I would assume that protecting the brand of the school is ultimately important enough that if holistic admissions began generating incompetent physicians it would be abandoned so that the school doesn’t lose standing.</p>
<p>My point with the two outlier examples of Hassan and Kermit Gosnell is this: I’m sure they didn’t enter medical school as the monsters they became. They were no doubt eager to be compassionate, caring, and all the rest of it. They obviously changed. </p>
<p>Personalities change over time. We’ve all seen it in people we know. The ability to absorb knowledge and call it up when needed does not. </p>
<p>So the interviews and all the personality screening may not be as valuable in finding excellence in medicine as the MCAT/GPA. When I am really sick, I don’t care whether my doctor overcame hardship or isn’t someone I would hang out with socially or not. I want the right diagnoses and the right cure. I don’t want him to hold my hand while blowing the treatment.</p>
<p>Not privilege talking ( which by the way, as an applicant years back I would have been one of those who would have potentially benefitted from a holistic application process as a double minority, low income etc…).My point is that I know of many classmates who were in med school and never intended to practice medicine, but rather wanted to be actively involved with research, continue on to get a master of public health etc. They may not have “passed” the typical personality profile test so to speak. Some of these very bright folks did not have the best people skills so to speak, nonetheless have been very productive for the benefit of society at large</p>
<p>I believe Hassan should have been fired 2 years before he started shooting people. His reviews were really bad and pointed out many psychological issues but military was grossly negligent in being politically correct.</p>
<p>Wait, Nidal Hassan was a monster? Beware the government hack who trolls these boards looking for politically insensitive statements that don’t jive with the administration’s agenda. (Sarcasm)</p>
<p>and there have been many individuals with lower GPA/MCAT scores than your socially inept classmates who were equally if not more beneficial to society thanks to their ability to attend med school. What is your point?</p>
<p>TatinG,</p>
<p>The Mount Sinai Humanities and Medicine program has showed that without using the MCAT at all, they have not seen a decline in the quality of physicians accepted. Several BS/MD programs have no MCAT requirement or MCAT minimums that would severely disadvantage an applicant if they were going the traditional route. As I said in my previous post: no school wants to be known as the school that produces bad doctors. Surely these programs would have been abandoned if they consistently produced the awful doctors that you and others seem to be convinced that they do?</p>
<p>There are social skills and there are communication skills. You don’t need to be “the most interesting man in the world” but if you can’t communicate well enough to counsel a patient or take a history or consult with another physician it doesn’t matter how much you know or how innovative you are, you’re going to be a poor physician.</p>
<p>“Bad doctors” is also a highly subjective phrase. It would be interesting to see if there were a correlation between MCAT/GPA and Step 1 and successful malpractice suits. I don’t know any other measure of “bad doctor” once they are licensed. Such a survey would have to be adjusted for specialty, location and other factors. But it would be interesting. When I practiced med mal defense ages ago, there were certain med schools (who will be nameless) that seemed to recur on the resumes of our ‘best’ that is repeat clients, those who were sued over and over.</p>
<p>I’ve worked with doctors for a long time. They are a bright group–I’m sure they all passed their tests with flying colors. (Well, most anyways.)
After that, things become more muddy. You have a huge complicated problem–you want the specialist to fix you. Hopefully someone else will pat your hand.
Chronic problems to be managed–that good caring bedside manner will make you better (the placebo effect is alive and well). Some people really do have “the touch”.</p>
<p>I’ve known all types–the caring, the money-hungry, the incompetent, the saints.
Right now I’d settle for someone who speaks the same language I do.</p>
<p>This thread went through a lot of rabbit holes. For my own sake I want to recap what I heard. Please feel free to correct, if my understanding is incorrect. </p>
<p>Here is what I heard about holistic review from the supporters of that process:</p>
<p>Definition:</p>
<p>It is an admissions philosophy that gives concrete pre-determined weightages to subjective criteria (ethnicity, background, hardships, expressed interests in certain fields with demonstrability etc.) and applies them along with objective criteria like grades, test scores, research etc., in making decisions.</p>
<p>Assumptions:
[ul]
[<em>]Documentation of subjective criteria provided as part of an application and information gathered during interview process is not only sufficient, but also reliable.
[</em>]Applicants are always honest and ethical in providing subjective information.
[li]ADCOMs have excellent abilities at assessing the subjective criteria based on the extra curricular activities, essays, interviews and other subjective aspects of an application.[/li][/ul]</p>
<p>Benefits:
[ul]
[<em>]Increases heterogeneity in class rooms and also increases cooperativeness amongst the students.
[</em>]Increases the number of rural physicians. Rural physician contracts used my some medical schools are inferior to holistic reviews in this regard, since they are not enforceable.
[<em>]In some states, holistic review increased the alignment of doctor demographics with patient demographics. That process is still incomplete because the alignment is not complete yet and continuing with holistic review process will get those states there eventually.
[</em>]Not every applicant with great GPA and MCAT scores make great doctors. Holistic review can not only catch those high achievers who could potentially become bad doctors, but also can find not so high achievers who can become great doctors.
[<em>]Improves the ethical behavior of doctors.
[</em>]Improves the bedside manners of doctors.
[/ul]</p>
<p>I will summarize the concerns of the folks who are skeptical of this process (including me) in another post.</p>
<p>Gee. That seems like a fair and impartial recap. </p>
<p>I’m too old and tired to get in these discussions anymore. This ain’t exactly Selma. </p>
<p>My advice to those willing to listen: Spend your limited time learning the system that is in place. However important you think it is to change the “unfair” system, it is not likely to change in time for you or your applicant. If you just like to howl at moon or have unlimited time, bay away. Howling is fun! </p>
<p>But if you want to get into medical school today, listen to the pros that have been there done that. Recently. </p>
<p>And btw. Count me, parent of the “whitest” kid on cc, in favor of the “failed social experiment”. </p>
<p>My kid could no more come up with an overcoming adversity essay then she could come up with a why she’s interested in the “primary care mission” of a school. In the latter instance she refused to apply to those 2 state schools. Just wouldn’t write it. In the former (iirc) I believe her essay started with an admission that she had advantages, not dis-advantages or far more advantages than dis-advantages. Or somesuch. It was not an easy essay for her to write. Not the high point of her app. lol</p>
<p>Apparently didn’t hurt her much at some schools.</p>
<p>Research is not an objective criteria by any means. It is largely evaluated by the LOR from the PI and the interview with the student. Nothing objective about those.</p>
<p>Quite frankly, the use of anything other than GPA/MCAT is holistic admissions to me. The difference is just what factors receive how much weight. I’m not really trying to discuss how much weight should be put into any given subjective factor, just whether or not subjective factors should be included. All of you “non holistic types” want to make sure patient care isn’t compromised and repeatedly stressed the importance of GPA/MCAT as the most valuable tool in ensuring the “smartest” people wind up in med school.</p>
OK. I’ll strike that from the list of objective criteria.
That’s what confuses me about your position. All colleges, to some extent or the other, already consider other factors in the existing admissions process. However, the “holistic review” is presented as a reform to the existing process. I am not sure whether you are supporting the current process or the new and improved one. You could be supporting the concept, and could be saying “the more the merrier” </p>
<p>“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 assessment 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.”</p>
<p>Note is says institution specific. I think this is critical to the process. Every school has a “brand” of physician which will affect what gets weighed and how much. There should not only be elements of heterogeneity within medical school but across medical schools.</p>
<p>Holistic review does not in and of itself attempt to increase the number of rural physicians UNLESS that is a goal of the specific to that institution. (It is at our state med school(s), but that’s not necessarily true for every institution that uses holistic review. The school’s mission statement also includes a goal of increasing the ethnic and cultural diversity of the state’s physicians. Again not all schools will have this as their goal.)</p>
<p>Holistic review does not purport to “weed out” high achieving, but “bad” future doctors or improve physician bedside manners (which indeed can be taught). </p>
<p>It does acknowledge that a high GPA/MCAT are not the the only indicators for future success as a physician. </p>
<p>Holistic review uses a broader, less mechanistic set of institution-specific criteria to evaluate each student on an individual basis. </p>
<p>Science knowledge and aptitude are valued, but so are communication skills, resilience in the face of adversity and the ability to surmount personal, societal and cultural challenges.</p>
Post #10 claims a correlation between holistic reviews and increase in the number of rural doctors. Post #17 alludes to the superiority of holistic reviews over contracts on the grounds that contracts are not enforceable. Posts #21 concedes that there are enforceable contracts, but still alludes to the superiority of holistic review in that regard. Post# 43 acknowledges the existence of contracts with monitory penalties, but stops short of acknowledging that they could be as effective as holistic reviews. At no point in any of the above posts, I saw any thing mentioned to convey that this benefit of holistic review may not apply to all medical schools and/or states. </p>
<p>
Post #29 gives an example of how a kid with 3.9/40, who could have become a bad doctor for his lack of community service, was successfully “weeded out” three times over by a state medical school with it’s holistic review.</p>
<p>
The connection between resilience in overcoming personal adversity/challenges and fundamental skills of a doctor is extremely far fetched, if not outlandish.</p>
<p>correlation does not equal causation. I do support the notion that some schools need to specifically target people for primary care/underserved but I certainly didn’t say all schools need to do it. I do think all schools need to look beyond GPA/MCAT.</p>
<p>I personally do think holistic review is meant to catch smart people who would be bad doctors.</p>
<p>From the stories I hear from my former MD classmates about their experiences on the wards, resilience is absolutely critical to their success. Whether it be to abuse from patients and physicians or from simply watching multiple people die in front of you every day.</p>
<p>Resilience is also critical in scientific research where the saying/joke is that it’s 90% failure and 10% luck.</p>
<p>Btw, in germany they did see an effect of resilience on work engagement:</p>
<p>Work. 2013 Mar 26. [Epub ahead of print]
Exploring the impact of resilience, self-efficacy, optimism and organizational resources on work engagement.
Mache S, Vitzthum K, Wanke E, Klapp BF, Groneberg DA.</p>
<p>In the states:
Fam Pract Manag. 2013 Jan;20(1):25-30.
Physician resilience and burnout: can you make the switch?
Nedrow A, Steckler NA, Hardman J.</p>
<p>Acad Med. 2013 Mar;88(3):301-3. doi: 10.1097/ACM.0b013e318280cff0.
Physician resilience: what it means, why it matters, and how to promote it.
Epstein RM, Krasner MS.</p>
<p>Acad Med. 2013 Mar;88(3):382-9. doi: 10.1097/ACM.0b013e318281696b.
If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians.
Zwack J, Schweitzer J.</p>
<p>There are 125 other articles that come up for “physician resilience” on PubMed although i’ll admit some of them appear to actually be about patient resilience.</p>
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