RACHEL BUNN: Hello and welcome to “Ask an Expert.” I'm producer Rachel Bunn. This week we asked our social media followers and community members for questions about holistic review. If you'd like us to answer your question in a future episode, follow us at AAMCToday on Twitter and Instagram, or join our community at communities.aamc.org and keep a lookout for our ask.
AMY ADDAMS: I'm Amy Addams. I'm the director of student affairs alignment and holistic review here at the AAMC. And what that means is that I work with and support people across the medical education continuum, both to critically examine and revise their admissions and selection processes towards broader access, equity, and mission alignment and also to create and sustain supportive and inclusive cultures and environments.
BUNN: Yeah. So, talking about holistic review, what is holistic review exactly, and why is this part of our work here at the AAMC?
ADDAMS: Yeah, so that's a, that's a great question. And I think sometimes there's, there's a lot of confusion about what holistic review actually is and what it isn't. But for the AAMC, how we define holistic review is that it's a mission-aligned admissions and selection process or selection process that considers the whole applicant in their context. So, it's really thinking about those applicants' experiences, attributes, their academic metrics or academic readiness, but it's also the context in what they, which they grew up, what did they have access to, what didn't they have access to, and what did they do with what they had. But then it's also thinking about the applicant in the school's context.
So really thinking about the institutional mission and goals, thinking about those curricular expectations as well as the learning and psychosocial support structures and services that the school has as well as their patient populations and their community needs. And it's really bringing all of those together and thinking about what's needed and sought in a class or a cohort to achieve that mission and meet those identified patient, community, and other needs. You know, I think it's important to the AAMC if our mission is to lead and serve academic medicine to improve the health of people everywhere, holistic review and admissions and selection is, it's right, it's selecting and developing our future physician workforce. So, it's really thinking about — thinking critically for each of our institutions: What do I need to be looking for and selecting for when I come to compose my student body when I think about composing my residency cohorts? Like what is actually going to help me, my institution, meet those needs?
BUNN: Yeah. So, we've been talking a lot about one element related to this here on the podcast, and that's race-conscious admissions. And could you just give us a little bit more information on that and how that works within the context of holistic review?
ADDAMS: Yeah, that's a really great question. And a lot of times holistic review and race-conscious admissions are linked in the news stories and how we're hearing people talk about these things. And there certainly is a relationship, but race-conscious admissions is not inherently a necessary part of a holistic review framework. And actually, when we first started developing the AAMC’s framework, we kept it intentionally universal, nonprescriptive, and adaptable so that it wasn't inherently race-conscious or race-based, but really dependent on the institution, their context, whatever state laws or federal laws they were operating under. And we're still committed to that, even as we are revisiting and revising our framework, both in light of, certainly, the Supreme Court decision earlier this summer, Students for Fair Admissions, but also in recognition of how holistic review has evolved in the field. Like our admissions officers are doing some extraordinary things, but also because of changes in medical education, whether it's, you know, curricular redesigns, a more intentional move towards competency or outcomes-based medical education, a greater focus on equity, and assessment and learning environments. But we're still keeping that connection, that commitment to ensuring that whatever the AAMC puts out as our holistic review framework is universal and adaptable for any school. And we actually, well, I'll encourage folks first to listen to the podcast right before this, where you have somebody like Dr. Mark Henderson at UC Davis, who is talking about the great work that his school has done in an environment where they couldn't consider race for many, many, many years. Which I think for me, just, you know, is great practical evidence that while there might be a connection between holistic review and race-conscious admissions, holistic review does not depend on any sort of race-conscious policies.
But one of the things coming out of this Supreme Court decision is, right, that you have to look beyond the surface. We can't just look at race as a category and use that categorical you know, kind of focus on race. We have to go deeper and really think about what the applicant's lived experience with race or ethnicity is. How did it help — how did that lived experience help — shape and inform them and their goals, their approach, their perspectives, why they want to be a doctor, and what they'll bring? And that's a powerful but important difference in how we might've been thinking about race and using race and admissions before this. It means that our schools and our programs are thinking about different essay questions that they can be asking to really elicit the information that they're seeking while, you know, obviously wanting to, you know, staying within the confines of what’s allowed. It's having, it's providing that, you know — if I, I think about silver linings. It's trying to find something good in this, this decision that was disappointing for, for many reasons. But that it does kind of provide that impetus to really think deeply about who you are as a school, what it is you're truly trying to accomplish, what it is you're truly seeking in your applicants, and how you'll find that and assess that in an equitable way. So, it's that opportunity to go back and examine what you're communicating about yourself and then how you're folding that into your admissions or selection process. And to look at what it is, look at your criteria, look at your processes. Is everything you're seeking necessary — everything that you say is required —necessary? Or are there cases where things might be unintentionally, unnecessarily exclusionary for certain populations or people who have not had access to certain things? And so it's really, it's a lot of work, and it's a lot of work with limited resources amidst competing priorities and pressures. But we really do believe that ultimately it will get institutions, and perhaps even more importantly, our applicants and our medical students and those aspiring applicants to a better place with each other and ultimately for our patients and, you know, our communities.
BUNN: The AAMC also does work related to disability, and I know that you are a part of that. So, can you talk a little bit about what we do relating to disability and then also how this kind of ties into holistic review?
ADDAMS: So, yeah, the work the AAMC is doing related to disability and medicine is emerging and absolutely critical, really divided into two parts. The part that is really focused on how we're training and developing folks, you know, health care workers, particularly physicians and medical students, to better, to be, you know, better equipped to provide culturally responsive, respectful, high-quality care to patients with disabilities. And also, the second kind of strand is really thinking about that meaningful access and inclusion for learners, trainees, and faculty and staff with disabilities. And, you know, as I think about holistic review and disability access and inclusion, which are — holistic review, I've been working on my basically my entire time at the AAMC. So, it's like, it's kind of my professional home in a lot of ways — and I’m newer to working on disability inclusion. But there are some really clear throughlines for me that as soon as I started working on disability inclusion stuff, it was just like, oh, this is so connected to all like the other diversity, equity, and inclusion work that I've done. Because so much of it is really thinking about the individual. It's thinking about what true access really means for talking about meaningful accessibility. What does that mean? What does that look like for individuals? And there's not, you know, there's not just gonna be one answer for that question. It's complex. It's multidimensional because humans are complex and multidimensional. It's really understanding the context of the person and how they move through the world and how that informs them and how that will inform how they, you know, what they're contributing, as you're thinking about peer-to-peer learning, as you're thinking about team environments and team practice, and those opportunities to learn and grow and discover across areas of difference. It's thinking about that whole person and it's going deeper. It's not just thinking about, you know, relying on the assumptions or any single data point to tell us who the person is, but you know, one of the core things in holistic review is going below the surface. It's — there are indicators — there are different data points we extrapolate from them because we're working under time pressures with limited resources, but we know that any single data point will only tell us one thing. Knowing somebody has a disability tells you that somebody has a disability. That's all, right? And that’s how I feel about everything that we’re thinking about in holistic review. Any one thing you learn about the applicant is one thing you learn about the applicant.
And so I feel like, when I think about holistic review and disability inclusion, that both of them really necessitate thinking about that individual and the individual, their context, and the individual in your school's context, and how you can provide the most meaningful and truly supportive and inclusive space and environment for them to not just kind of make it through, not just get accepted, not just graduate, but really thrive.
BUNN: Mm-hmm. We always like to end with a fun question. So, we do have a fun question for you,
and that is: what is your favorite book and why? And I see behind you you have a lot of books, so, maybe it's what is your favorite book today?
ADDAMS: I know. Today at 10:36 a.m. Yeah. I — and this is only some of the books. So I was a literature major. I was a language and literature major. So, you know, this is like an impossible question for me. It really does kind of depend on my mood and that can shift over the time of, time of day or time of year. But there are — so I'm gonna tweak it a little bit, if that's okay, and say that there are authors that I return to over and over again. So, folks like James Baldwin, Chekov, Dostoyevsky, Anna Akhmatova, and Ralph Ellison — people who, every time I read their work, whether it's a poem, or an essay, or a novel, or short story, it opens up something new for me. I discover something new in it and think differently about the world. I think differently about — they make me think differently about language and communication and different ways that we can convey, it's gonna sound really grand, but kind of some of these essential truths.
BUNN: Mm-hmm.
ADDAMS: So that people can really understand and receive them and hear them. And just like all of these are authors who I'll read them and then I just kind of have to stop and process. But they — and most of them tend to be pretty linguistically innovative as well — but they just, they, there's always something new when I go back to them that makes me think about and interact with the world differently.
BUNN: Yeah. That's such a good answer. I say as a reader myself, I was like, I don't even know how, I don't know how I would've put that, but you — that is such a good answer.
ADDAMS: Thank you.
BUNN: So, thank you, Amy, for joining us today on “Ask an Expert.”
ADDAMS: Thank you so much. It's my pleasure.
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