Holistic review--shaping the medical profession one applicant at a time.

n engl j med 368;17 nejm.org april 25, 2013 1565 as the core of medical education.1 Admissions committees at U.S. medical schools have, for the past century, focused their attention largely on predictors of success in the foundational science curriculum, relying heavily on academic performance in the biologic and physical sciences and scores on the Medical College Admission Test (MCAT) in selecting applicants for medical school. Abundant data support the contention that performance in the medical school science curriculum and on the U.S. Medical Licensing Examination (USMLE) Step 1 are predicted by performance on the MCAT and in the undergraduate science coursework required of medical school applicants.2 Key aspects of behavior, character, and performance that are essential for the practice of medicine, however, cannot be predicted from these measures. In addition, performance on standardized tests and in undergraduate sciences is influenced by myriad social, demographic, and economic factors that limit the utility of these measures in large segments of the potential applicant pool for medical school. Over the past decade, individual medical schools, supported by the Association of American Medical Colleges (AAMC), have been working to expand the frame of reference for evaluating applicants for medical school. These efforts have come together under the “holistic review” rubric endorsed by the U.S. Supreme Court in 2003: “highly individualized, holistic review of each applicant’s file, giving serious consideration to all the ways an applicant might contribute to a diverse educational environment.” Under such an approach, a school “seriously considers each ‘applicant’s promise of making a notable contribution to the class by way of a particular strength, attainment, or characteristic — e.g., an unusual intellectual achievement, employment experience, nonacademic performance, or personal background.’ ”3 The AAMC Holistic Review Project has defined holistic review in medical school admissions as “a flexible, individualized way of assessing an applicant’s capabilities by which balanced consideration is given to experiences, attributes, and academic metrics . . . and, when considered in combination, how the individual might contribute value as a medical student and future physician.” 4 Holistic Review — Shaping the Medical Profession One Applicant at a Time