AAMC Reporter: July 2009

Schools Implement Student Background Checks

The AAMC's new criminal background check system is now available to all medical schools, but school officials must first tackle complicated policy questions before ever screening a student.

The check system became available in May to all schools for the 2010 student application cycle. Each background check, conducted by Pennsylvania-based screening service Certiphi Screening Inc., searches records for felonies, misdemeanors, and dishonorable military discharges. How the school responds when one of these events, or "hits," comes up for a given applicant is up to each school. General guidelines do exist, but there are no firm standards or requirements. Seventy-nine schools currently participate in the new AAMC check system.

For 2009, the background check system has revealed seven felonies, 382 misdemeanors, and 67 other-than-honorable military discharges. Overall, medical school admissions leaders indicated that the numbers are fairly low.

"The good news is that we hold these students to a high standard, but they seem to hold themselves to an even higher standard," said Clara A. Callahan, M.D., who as dean of students and admissions at Philadelphia's Jefferson Medical College of Thomas Jefferson University said "nothing significant" has turned up since the school began conducting background checks.

That is not to say that the checks have not caught anything. Henry Sondheimer, M.D., AAMC's senior director of student affairs and student programs, said the system, which the AAMC first explored in 2005 after suggestions from hospitals and state legislatures concerned about patient safety, is doing its job.

"Have schools not matriculated students they accepted because of background checks? The answer is absolutely yes," Sondheimer said. "For example, schools have seen more alcohol-related events than they had anticipated."

AAMC officials emphasized that when a school rescinds an offer, it is typically not done solely on the contents of the background check reports, but rather on a variety of factors, including whether a discrepancy exists between the background check results and what a student selfreports in an application. The background check system is generally used as a confirmation tool for the information a student provides in an application.

There is no definitive list of institutional policies, but a cross-section of established and emerging programs reveals some similarities and differences. Overall, schools have displayed a willingness to accept-with certain conditions-students whose infractions were relatively minor.

"We would not automatically withdraw our offer if a hit came up," said Wayne M. Samuelson, M.D., senior associate dean at the University of Utah School of Medicine, which has been conducting its own checks since 2002 and has not uncovered any felonies in that time. "We do reserve the right to institute certain actions, and we try to have those actions be consistent with what we would do for house staff."

Samuelson said probation and counseling are common measures for lesser infractions.

A Mississippi state law passed in 2004 requires all health care professions schools in the state, including the University of Mississippi School of Medicine, to fingerprint applicants. Mississippi now conducts both fingerprint checks and the AAMC background checks. Steven T. Case, Ph.D., M.S., the school's associate dean for admissions, estimates that about 3 percent of applicants get a "hit" of any kind. When a "hit" does turn up, the school takes one of three actions: allowing the acceptance offer to stand if the incident is minor and isolated, rescinding the acceptance entirely, or ordering the student to enter a counseling program or monitoring regimen such as random drug testing.

"What has become a concern is a pattern of behavior that may not be classified as violent per se, but could still be considered worrisome," said Case, who added that the school so far has rescinded three letters of acceptance. "Usually, this pattern means a record of substance abuse, or a failure to self-disclose an incident, which we say is tantamount to applicant falsification."

Most schools assemble a committee of faculty and administrators to evaluate infractions on a case-by-case basis. At Mississippi, a council comprised of associate deans in the school's offices of admissions, multicultural affairs, student affairs, academic affairs, graduate medical education, and veteran affairs evaluates the applications.

According to Geoffrey H. Young, Ph.D., M.A., associate dean of admissions at the Medical College of Georgia School of Medicine, which is still developing its background check policies, each school has different leadership structures, meaning the committee makeup can vary.

"The role of a student affairs dean and an academic affairs dean can be different at different schools," Young said. "You have to understand the differences in knowledge at each institution, and who is responsible for what."

Regional politics can also shape policies.

"Being a state institution, it's important how people will view our policies," Young said. "It's important to remember who you are serving, and to understand your climate and how people might react to a policy like this if there's a hit."

So far, self-reported applicant data has shown that white students accounted for 53 percent of all applicants and 72 percent of all misdemeanor reports; black and Hispanic students comprised 4 percent and 5 percent of selfreported misdemeanors, respectively. Medical school officials are closely monitoring the issue.

"What happens if there is a disparity between certain populations?" Young said. "We have to continually look at the data."

Despite a relatively low number of problems with student backgrounds, officials said the checks were still worthwhile.

"I think the checks are probably worth doing, even though we haven't uncovered many problems," Callahan said. "It is such a huge investment to go to medical school. If there's a problem, they shouldn't come into med school or be sent to clinical sites."

The check system typically begins in January of the applicant's matriculation year; exceptions to the timeline are made for early-decision applications.

—By Scott Harris