Scholastic Aptitude Test

The College Board's Scholastic Aptitude Test is the most commonly used undergraduate admissions test for selective public and private colleges. As such, it is the “gateway” examination for most students interested in pursuing health professions careers. SAT I verbal and math scores range from 200 to 800, with a standard deviation of 111 to 112. As shown in Figure 2-1, whites achieve, on average, the highest scores on both scales, with a mean SAT verbal score of 526 and a mean SAT math score of 528. African American test-takers score nearly a full standard deviation unit lower than whites on the SAT verbal and math scales (standardized difference² [SD] = .83 and .92, respectively), while Hispanics score about three-fifths of a standard deviation unit lower than whites on both scales. Asian American test-takers perform nearly identically to whites on the SAT math scale, but about one-quarter standard deviation unit lower than whites on the SAT verbal scale (Camara and Schmidt, 1999).

Graduate Record Examination

The Graduate Record Examination Verbal, Quantitative, and Analytic scales range from 200 to 800, with a standard deviation of 108 for the Verbal scale and 127 for both the Quantitative and Analytic scales. The GRE is commonly used for admission to selective graduate (e.g., Ph.D.) programs in a range of academic fields, including most “scientist-practitioner” clinical psychology programs (many programs typically also require applicants to take a subject-area examination). Group differences in performance on the GRE are displayed in Figure 2-2. As with the SAT, white testtakers typically score higher than other racial and ethnic groups, with the exception of the GRE Quantitative, where Asian Americans score nearly a half-standard deviation unit (SD = .46) higher than whites. African Americans score, on average, one full standard deviation unit below whites on all three scales, while Hispanic test-takers score approximately half to three-fifths of a standard deviation unit below whites on all scales (ranging from .46 on the Quantitative scale to .62 on the Analytical scale; Camara and Schmidt, 1999).

Medical College Admissions Test

The Medical College Admissions Test Verbal Reasoning, Physical Sciences, and Biological Sciences scales range from 1 to 15, with a standard deviation of 2.4 for all scales in 1998 (Camara and Schmidt, 1999). Group differences in performance on the MCAT are displayed in Figure 2-3. As is the case with the GRE and SAT, African American and Hispanic test-takers score lower than whites and Asian Americans, who tend to perform at similar levels on this test. African American and Hispanic test-takers score approximately 1 full standard deviation unit lower than white test-takers on all three scales; this difference ranges from .96 to 1.08 on all scales for African Americans and from .88 to 1.00 on all scales for Hispanics. Asian American test-takers score .29 of a standard deviation unit lower than whites on the Verbal Reasoning scale, perform slightly higher on the Physical Sciences (.21) scale, and score equivalently on the Biological Sciences scale (Camara and Schmidt, 1999).

Pre-College Influences on Educational Preparation

In the United States, educational opportunities are unevenly distributed by race and ethnicity. Racial and ethnic minority students are far more likely than white students to attend majority-minority schools, even when the former group of students is from middle- and upper-income families (Orfield, 2001). For example, more than 70 percent of African American students and 76 percent of Latino children attend schools that are majority non-white (American Sociological Association, 2003). Such schools tend to be characterized by fewer academic and financial resources, fewer credentialed teachers, fewer advanced placement courses, and higher dropout rates, even when in similar neighborhoods as predominantly white schools (American Sociological Association, 2003). Students in higher-income, predominantly white schools, in contrast, are exposed to more rigorous coursework, take more courses, and have greater exposure to college preparatory and advanced placement coursework (Camara and Schmidt, 1999). Such students are also more likely to take test preparation courses outside of regular coursework. Even among racial and ethnic minority students who attend integrated schools, segregation within schools in common; African American and other URM students are more likely to be “tracked” into vocational or lower-level academic programs, which offer little or no college preparatory content (Camara and Schmidt, 1999).

To a great extent, school-based inequities reflect patterns of racial housing segregation and inequities among localities in school funding (American Sociological Association, 2003). African American and Hispanic students, particularly those in inner-city and rural communities, are more likely to live in neighborhoods characterized by high poverty rates and few local resources for schools. Not surprisingly, average per-pupil expenditures for these schools are in some cases one-half to two-thirds lower than per-pupil expenditures in some of the wealthiest public school districts, resulting in inequities in teaching resources, teacher pay and qualifications, and physical accommodations (Orfield, 2001). As Camara and Schmidt (1999) note:

The stark differences across [standardized test] assessments and other measures collectively illustrate the inequities minorities have suffered through inadequate academic preparation, poverty, and discrimination; years of tracking into dead-end educational programs; lack of advanced and rigorous courses in inner-city schools, or lack of access to such programs when available; threadbare facilities and overcrowding; teachers in critical need of professional development; less family support and experience in higher education; and low expectation (p. 13).

In addition to inequality of educational opportunities, differences in family influences may be associated with poorer URM academic performance. Bowen and Bok (1998) note that despite their efforts to account statistically for racial and ethnic differences in family socioeconomic background, students' academic performance is likely to be affected by family attributes that are difficult to measure. “College grades,” they write, “may well be less affected by family income and parental education … than they are by the number of books at home, opportunities to travel, better secondary schooling, the nature of the conversation around the dinner table, and more generally, parental involvement in their children's education” (Bowen and Bok, 1998, p. 80). Students from higher socioeconomic backgrounds, more often non-URM students, benefit disproportionately from these influences.

Experiences in Higher Education Institutions and HPEIs

In addition to educational and socioeconomic inequities between United States racial and ethnic groups, the poorer performance of minority students on standardized tests, and their lower academic performance than would be expected on the basis of these tests, may also be traced to experiences of URM students in higher education and HPEI settings. Bowen and Bok (1998) note that these explanations “range from … psychological theories to assertions about discrimination by faculty members, low motivation on the part of [URM] students, special problems of adjusting to predominantly white environments, and poorly conceived institutional policies that at best accept and at worse encourage lower academic aspirations by [URM] students” (Bowen and Bok, 1998, p. 81).

URM students, particularly those that are a visible yet small minority on college and HPEI campuses, may experience academic pressure or feelings of insecurity, and especially so in contexts where URM students have been historically excluded. Pressures to perform as well as non-URM students and manage stress stemming from campus racial tensions have been found to be negatively associated with URM undergraduate students' academic performance, after controlling for standardized test scores and prior academic performance in college (Smedley et al., 1993). Other researchers suggest that peer group influences, particularly within African American peer groups, may cause minority students to be less invested in academic performance and to “experience inordinate ambivalence and affective dissonance in regard to academic effort and success” (Fordham and Ogbu, 1986, p. 177).

Among the most extensively studied social and psychological factors affecting URM academic and test-taking performance is research on “stereotype threat.” Beginning with the work of Claude Steele and colleagues (Steele, 1997; Steele and Aronson, 1995), psychologists have found that African Americans and other groups whose intellectual abilities are stigmatized by widely held societal stereotypes (e.g., women undertaking mathematical problems) may respond to these stereotypes by performing poorly relative to their actual abilities. This tendency, termed stereotype threat, presents an additional emotional and cognitive burden for individuals who are members of the group for which the stereotype might apply. Stereotype threat exerts its influence in the form of performance-disruptive anxiety and apprehension about the possibility of confirming the stereotypes' validity in the eyes of others or for the individual affected by the stereotype. This threat applies to those who are aware of the stereotype and value high academic performance, as is the case for most African American students in higher education settings. African Americans and others affected by stereotype threat need not believe in the stereotype's validity to be affected by their consequences, given the widespread nature of many stereotypes about minority intellectual ability.³ Rather, it is the students' concern about disproving the stereotype that confers anxiety and affects academic performance (Aronson et al., 2001; Steele, 1997; Steele and Aronson, 1995).

The impact of stereotypes on URM students' test performance has been demonstrated in a number of laboratory studies. Steele and Aronson (1995), for example, administered difficult GRE-type verbal questions to a sample of African American and white Stanford University undergraduates. In one condition, students were told that their performance on the test items was diagnostic of their intellectual abilities, while in another condition, students were told that their performance was nondiagnostic (i.e., the investigators were merely interested in how students solve problems, and their performance was unrelated to ability). After controlling for students' initial skills (as measured by SAT verbal scores), the investigators found that African American students performed significantly worse than their white peers in the “diagnostic” condition, but equaled the performance of whites in the “nondiagnostic” condition. To further assess this phenomenon, the investigators asked students in both the diagnostic and nondiagnostic conditions to complete word fragments, some of which were symbolic of African American stereotypes and self-doubt. African American students in the diagnostic condition, who were expecting to take an ability-diagnostic test, completed more stereotyping word fragments and self-doubt words compared to African American students in the nondiagnostic condition or whites in either condition, indicating that the former group of students were more aware of and concerned about stereotypes of black academic performance. When the same students were asked to list their race on the exam, all of the African Americans in the nondiagnostic condition and whites in both conditions complied, whereas only 25 percent of African American students in the diagnostic condition did so, further indicating anxiety about test performance being viewed as confirming racial stereotypes (Steele, 1997).

What Would Happen to URM Enrollment in Medical Schools Without Race-Conscious Admissions?

Were medical school admissions committees to drop any consideration of race or ethnicity in admissions, URM students would find difficulty gaining admission in U.S. medical schools. Cohen (2003) reports on an exercise, based on data from URM and non-URM applicants to medical schools in 2001, in which researchers used an algorithm to calculate the numbers of students that would gain admission based on undergraduate grades and MCAT scores. This analysis assumes that all other differences between URM and non-URM students are held constant, including industriousness, leadership, or other qualities that medical schools might consider in the admissions process. Using data from all applicants to 119 nonminority medical schools (excluding historically African American and Puerto Rican medical schools), this analysis revealed that only 513 URM students would have gained admission, a figure that is 70 percent lower than the actual number (1,697) of URM students that gained admission in 2001. These 513 students would have constituted approximately 3 percent of all medical students, levels that have not been seen since the early 1960s.

Effect of “Race-Neutral” Admissions on URM Participation in Higher Education in California, Texas, and Florida

In response to public referenda, judicial decisions, and lawsuits challenging affirmative action policies in 1995, 1996, and 1997 (notably, the Fifth District Court of Appeals finding in Hopwood v. University of Texas, and the California Regents decision to ban race or gender-based preferences in admissions), three states—California, Texas, and Florida—developed “race-neutral” undergraduate admissions policies that guaranteed admission to the state university system to applicants who graduated within the top tiers of their high school class. In Texas, the state legislature passed legislation that guaranteed admission to the state institution of choice for applicants who graduated in the top 10 percent of their high school class. Under this plan, qualifying applicants must complete an application for admission and provide standardized admission test scores, but test scores are not considered in admissions decisions. In California, the University of California (UC) Board of Regents approved a plan to confer eligibility for admission to the UC system to the top 12.5 percent of the state's high school graduates, as well the top 4 percent of graduates from each high school. The latter pool of students (termed “eligibility in the local context” [ELC]) includes several hundred students who are at the top of low performing schools and thus would not qualify as being in the top 12.5 percent statewide. The vast majority of students in the top 4 percent of their class also qualify on statewide criteria, however. Because URMs are disproportionately from low performing schools, the ELC program tends to increase the number of URMs eligible for admission. Students who clear the eligibility hurdle are admitted to the University of California, but not necessarily to the campus or major of their choice. Similarly, Florida adopted a “percent plan” admissions policy when the state's governor, in an attempt to preempt a statewide referendum similar to that passed in California, approved a plan to guarantee admission to the University of Florida system to the top 20 percent of the state's high school graduates.

Conservative critics of these plans have charged that percent plans are merely affirmative action plans under a different name, given that the plans' proponents argue that the plans will maintain racial and ethnic diversity while eliminating the explicit consideration of race and ethnicity in the admissions process. In addition, these critics charge, guaranteeing admission to even the narrowest top percentage of high school graduates threatens to weaken state university admission standards, and that because of the relatively poorer academic resources of majority-minority high schools, even top minority graduates who gain admission will be poorly prepared for the academic rigors of selective state universities (Horn and Flores, 2003). Progressive advocates are similarly dismayed by percentage plans. They charge that the plans are perversely dependent upon racial segregation in high schools (given that the racial and ethnic diversity that the plans' proponents expect depends largely on the assumption that top graduates of majority-minority high schools will matriculate within the state university system); that the plans are likely to miss many high-achieving minority applicants who do not graduate within the top percentage of “automatic” admits; that a guarantee of admission only within state systems does not prevent the possibility that minority admits will be “clustered” in lower tiered schools within state systems; and that, for purposes of enhancing student diversity in public institutions, such plans are an inadequate substitute for the explicit consideration of applicants' race and ethnicity (Horn and Flores, 2003).

Several major studies have been conducted to evaluate the impact of percentage plans on undergraduate student diversity in the three states (Tienda et al., 2003; Horn and Flores, 2003; Marin and Lee, 2003). Each concludes that while most students eligible for admission to state universities under the percentage plans would also have been admitted under previous admissions policies, percent plans have largely failed to restore minority enrollments to levels seen prior to the ban on the consideration of applicants' race or ethnicity imposed in each state (Horn and Flores, 2003).

Texas' “Top 10 Percent” Plan

Marta Tienda and colleagues (Tienda et al., 2003) evaluated trends in admission and enrollment of African American and Latino students at the University of Texas' flagship public institutions, the University of Texas (UT) and Texas A&M University (A&M), before and after implementation of the “Top 10 Percent” plan, and found that while some minority students who graduated among the top 10 percent of their high school class gained admission to UT and A&M under this plan (students who might previously have been rejected because of low standardized test scores or poor essays) the plan has resulted in lower minority admissions and matriculation rates for African American and Latino students than during the pre-Hopwood era. Post-Hopwood, for example, African American students constituted only 2.4 percent of enrollees at A&M, a decline from 3.7 percent prior to the ruling. Hispanic student representation similarly declined, from 12.6 percent pre-Hopwood to 9.2 percent following the ruling. Similar, but less striking trends were observed at UT, where African American and Hispanic students declined from nearly 20 percent prior to the Hopwood ruling to less than 17 percent of the undergraduate population post-Hopwood. More importantly, the probability of admission to the two flagship institutions for Asian American and white students increased following implementation of the “Top 10 percent” plan, while this probability declined for African American and Hispanic students (see Figure 2-4). Tienda and colleagues note that while the decline in URM representation at Texas' flagship institutions was not as dramatic as some critics had predicted (due in large part to the heavy weight placed on high school grades and class rank in UT undergraduate admissions prior to the Hopwood decision), the decline is particularly disturbing given the fact that Texas' “minority” population will soon become a demographic majority (Tienda et al., 2003).

FIGURE 2-4

Probability of admission pre- and post-Hopwood by race and Hispanic origin: Texas public flagship. SOURCE: Tienda et al., 2003.

University of California

As with the Texas percent plan, the UC admissions plan guarantees admission to the state system to the states' top high school graduates but differs from the Texas plan in that eligible applicants are not guaranteed admission to the campus of their choice. While data are incomplete because of California's relatively recent (1999) move toward a “percent” admissions plan, preliminary data indicate that minority admission and matriculation in the UC system has declined and that this decline was sharpest shortly after the California Regents' decision to eliminate the consideration of race and ethnicity in admissions. As shown in Figure 2-5, both African American and Hispanic freshman admissions dropped significantly from 1995, when African Americans and Hispanics represented 4.4 percent and 15.8 percent of freshman admissions, respectively, to 1998, when African American admissions fell to 3.2 percent, while Hispanic admissions fell to 12.9 percent of the freshman class (Horn and Flores, 2003). By 2001 URM representation among freshmen in the UC system increased slightly to 3.4 percent African American and 14.6 percent Hispanic students, but these percentages are still below the levels attained prior to the Regents' decision. The decline in URM representation was more profound at the state's flagship institutions, the University of California at Los Angeles and the University of California at Berkeley. African American freshman admissions offers at UC Berkeley declined from 7.3 percent in 1995 to 3.2 percent in 1998 and 4.1 percent in 2001, and from 6.7 percent in 1995 to 3.3. percent in 2001 at UCLA. Similarly, Hispanic freshman admissions offers declined from 1995 (18.5 percent and 20.1 percent at Berkeley and UCLA, respectively) to 2001 (12.5 percent at Berkeley and 12.7 percent at UCLA), with these percentages dwindling to under half their 1995 levels in 1998 at both campuses (Horn and Flores, 2003).

FIGURE 2-5

University of California system-wide Fall state resident freshman admissions offers, by race/ethnicity, 1995–2001. SOURCE: UC Office of the President, Student Academic Services, OA&SA, REG004/006, January 2002, http://www.ucop.edu.news.studstaff.html. (more...)

In light of these data, Horn and Flores (2003) conclude that “ … in all three states, the gap between the racial distribution of college-freshman-age population and that of the applications, admissions, and enrollments to the states' university systems and to their premier campuses is substantial and has grown even as the states have become more diverse…. [I]n California in particular, proportional representation of applied, admitted, and enrolled blacks and Hispanics on the flagship campuses has decreased since the end of race-conscious policies” (p. 50).

Demographic Characteristics of Admissions Committees

Little empirical research sheds light on the demographic composition of admissions committees for health professions education programs. Anecdotal evidence suggests that the vast majority of health professions training programs tend to appoint senior faculty (who tend to be predominantly white and male) to admissions committees and occasionally include representation from one or more students. Rarely are communities affected by admissions decisions, including members of communities served by teaching hospitals and community-based training institutions, represented on admissions committees.

Kondo and Judd (2000), in one of the few empirical studies of the demographic composition of admissions committees, surveyed deans or directors of admission at 85 U.S. medical schools to assess the presence of women and racial and ethnic minorities on medical school admissions committees. The results confirmed many of the anecdotal observations noted above: medical school admissions committees were largely male (the overall ratio of men to women was 1.77 to 1.0) and predominantly white (on average, 16 percent of committee members were from URM groups, only half of the URM members were physicians, and over half of the schools surveyed reported that their admissions committees had no or only one URM physician). While 74 percent of committees had at least one medical student representative, medical students constituted only 15 percent of total admissions committee members. In addition, over nine of ten admissions committees operated on a volunteer basis (Kondo and Judd, 2000).

These data suggest that admissions committees have a great deal of room for improvement with regard to representation of diverse groups. This is not to suggest that racial and ethnic minorities or women should be expected to advocate for URM candidates, or that admissions committees should be “stacked” with individuals who might be more sympathetic to URM applicants. Rather, it suggests that admissions committees can improve on their ability to incorporate the perspectives of diverse groups that contribute to the educational experience on health professions education campuses. Racial and ethnic minority members of admissions committees might be better able to understand and contextualize the life circumstances and experiences of URM applicants and help other admissions committee members to understand a URM applicant's abilities. Furthermore, racial and ethnic minority members of admissions committees may be well-positioned to assess URM applicants' academic and nonacademic accomplishments, and commitment to service in racial and ethnic minority communities.

Unfortunately, because of the lack of URM faculty in many health professions training programs, the few that are present are often “pulled” in many directions and pressed into service on admissions committees and other important institutional committees. Kondo and Judd's (2000) finding that service on the vast majority of medical school admissions committees is voluntary suggests that few rewards (e.g., consideration of committee service during promotion review) are provided for those faculty who serve in this capacity. And because minority faculty often face additional demands such as mentoring and recruiting URM students, service on institutional committees can present additional pressures that compete with teaching, research, and other work important for promotion. Service on important institutional committees, such as admissions committees, should be more appropriately rewarded to encourage the participation of URM faculty and staff.

Training of Admissions Committee Members

Another important component of fundamental change in the admission process involves training of admissions committee members. Several examples of innovative training programs are described below, including national training efforts of the Association of American Medical Colleges (AAMC). Common attributes of admissions committee training programs include skills and knowledge development in areas such as:

• How to assess qualitative attributes of applicants;
• How to interpret the academic and standardized test performance of URM students, whose performance may be influenced by a range of factors, such as poor prior academic training and psychosocial factors (e.g., stereotype threat);
• How to assess the academic and nonacademic achievements of URM students, whose life circumstances and experiences may differ from non-URM students; and
• Interviewing skills, to identify ways to better elicit and manage information from applicants.

These skills and areas of knowledge are increasingly important for admissions committee members, who, as a result of the Supreme Court decision in the Grutter v. Bollinger case, may be asked to provide comprehensive reviews of applicants' files and reduce dependence upon standardized test data as a means of winnowing applications.

AAMC Expanded Minority Admissions Exercise

In 1970, the AAMC began exploring new approaches to medical school admissions that consider strategies to balance applicants' “noncognitive” qualities with other traditional predictors of medical school performance (e.g., MCAT scores, undergraduate science curriculum, and grades) in an effort to increase minority admissions. Beginning with the Simulated Minority Admissions Exercise in 1970, AAMC developed a program of case studies and training for medical school admissions officers that is designed to enhance these officers' understanding of the importance of “noncognitive” factors (such as altruism, leadership, commitment to service, and empathy), to foster an appreciation of cultural diversity in medical training, and to model interviewing skills (Cleveland, 2003). In its current iteration, the Expanded Minority Admissions Exercise (EMAE) uses case studies of actual medical school applicants and videotaped admissions interviews to help admissions officials compare their assessment of applicants and with applicants' actual admissions outcomes. Workshops are held at 28 medical schools and emphasize such strategies as:

• Reconceptualizing the initial review of applicant files to assess whether applicants have the academic skills to succeed in medical school (as assessed by MCAT scores and grades), while considering other relevant factors, such as educational and socioeconomic barriers that applicants have overcome;
• Evaluating candidates' skills and experiences, if they meet basic academic requirements in the initial review, such as clinical and health-care experiences, volunteer activities, research experiences, work activities, and leadership; and
• Better assessing applicants' personal qualities in the admissions interview.

A new edition of EMAE will focus on helping admissions committee members to evaluate personal characteristics more effectively and efficiently, to understand how admissions processes relate to the development of medical students' cultural competency and care-giving skills, and to develop a greater appreciation of the different forms of “intelligence” (e.g., analytic, creative, and practice intelligence) that applicants may possess (Cleveland, 2003).

The Texas A&M Medical School Experience

Prior to the Supreme Court ruling in Grutter v. Bollinger, the decision by the U.S. Fifth Circuit Court in the Hopwood v. University of Texas suit created a mandate that all public higher education institutions in Texas (as well as other states in the Fifth Circuit) abandon the consideration of applicants' race or ethnicity in the admissions process. In response, the Texas A&M Medical School, like other institutions in the state, attempted to develop a “race-neutral” admissions process that would allow the institution to continue to admit and enroll URM students. As a first step, the admissions committee considered the Health Sciences Center and College of Medicine's (COM) mission and institutional goals to reassess the admissions process and, in particular, reconsider the weights placed on applicants' MCAT scores, academic records, and personal and experiential qualities. The COM's mission and institutional goals “became the philosophy by which the admissions committee guided and directed the admissions process” (Maldonado, 2001, p. 314). Texas A&M's new admissions plan called for:

• “A mindfulness of the vision and mission of the institution in assessing and selecting students;
• A more inclusive approach to assessing cognitive abilities;
• A broad-minded scrutiny of applicant's noncognitive characteristics at the pre-interview and interview phases of the evaluation process;
• Enhanced interview techniques;
• Improved protocol for admissions committee deliberations; and
• Frequent self-monitoring” (Maldonado, 2001, p. 314).

Subsequently, COM admissions officials decided to widen the pool of applicants to be interviewed by carefully analyzing the distribution of academic scores (i.e., a combination of MCAT scores and undergraduate grade point average) of applicants. A top tier of applicants was identified with superior academic scores and were considered “automatic” interviews. These applicants, approximately 20 percent of the applicant pool, tended to be less racially and ethnically diverse, but also were less likely to enroll in the medical school if admitted (less than one in five accepted offers of admission). The admissions committee identified a middle group of applicants whose academic scores were considered acceptable (average MCAT scores and GPA of this group were 26 and 3.45, respectively) and indicative that the applicant could complete the medical school curriculum, if admitted. This middle pool included a broader representation of “underrepresented and disadvantaged” applicants and tended to be more likely to accept offers of admission to the medical school than the top pool of applicants. Finally, the admissions committee identified a pool of applicants that were considered “high-risk” on the basis of academic scores. Applicants in this pool were not considered for interviews unless they self-identified as “disadvantaged” (Maldonado, 2001).

The Stanford University Model

The Stanford University School of Medicine has adopted a model of medical school admissions that reflects the institution's mission, which includes recognition that racial and ethnic diversity in the medical school is essential to achieving the institution's educational goals. This commitment to diversity begins with strong leadership from the university president and others who have articulated clear diversity goals and strongly support diversity as central to the institution's mission (Garcia et al., 2003). The admissions process is driven by the institutional mission and includes:

• Training of admissions committee members, who are taught about the impact of “stereotype threat” on minority test performance and other contextual factors that are important for assessing minority applicants, such as the role of cultural and language barriers, family background, and the educational “distance traveled” (e.g., the impact of prior experiences of prejudice or discrimination, the greater likelihood that minority students must work during college to meet financial obligations);
• A “mission-oriented” file review, which emphasizes assessment of applicants based on the institution's mission statement and goals (e.g., categorizing and ranking applicants' skills and attributes in a manner that reflects the institution's educational goals); and
• Developing partnerships with undergraduate faculty and advising staff of undergraduate colleges to support the admissions process.

Stanford's admissions committee has developed extensive barometers for assessing applicants' qualitative attributes. For example, candidates' success as a role model for others is assessed by looking for evidence that the applicant has participated in activities that are visible and are intended to influence members of the community in a positive manner. Similarly, applicants' commitment to service is assessed by evidence of community involvement, volunteer service, and other activities. Applicants' degree of engagement in these activities is assessed by evidence of participation, particularly over a long period of time; assuming a leadership role; advocacy on behalf of the organization or issue; programmatic innovation; and, perhaps more importantly, evidence that the applicant has left a legacy or lasting impact in the community served.

MCAT data are considered early in the admissions process as an initial “screen” to identify applicants who are not likely to be able to manage the medical school curriculum. A range of scores has been identified as a “qualifying range,” based on the admissions committee's prior experience and knowledge of the curriculum. Applicants who perform at or above the cut-off range are likely to possess the academic skills and background to pass the school's core curricula. When the admissions committee makes final decisions, quantitative variables are not considered as “individual items of great importance” (Garcia et al., 2003), but rather, the committee attempts to answer two questions:

• “How will this candidate contribute to and benefit from the learning climate at [the] institution?; [and]
• Will accepting this candidate be in line with the mission and values of the school?” (Garcia et al., 2003).

Stanford has achieved significant success in recruiting and admitting URM students (over 20 percent of the medical students in 2002–2003 were African American, Hispanic, or Native American). Of these, nearly three in five (57 percent) are involved in scholarly research through the institution's Medical Scholars Program, a rate that is comparable to participation in research among Stanford's non-URM students. Stanford's success with URM students is providing longer-term benefits: follow-up data reveal that 18 percent of the school's URM graduates have a full-time career in academic medicine (Garcia et al., 2003).

The institution supports its admissions efforts by extending academic and social support to URM students and assesses its progress in attracting and retaining URM students. The Early Matriculation Program (EMP), in particular, offers URM and non-URM students a summer premedical curriculum that provides an early introduction to the culture of the medical school, builds student confidence and leadership skills, and promotes scholarship. Follow-up data reveal that EMP participants have a slightly higher than average rate of receipt of Stanford Medical Student Scholar awards, have a lower rate of attrition, and have published at slightly higher levels (22 percent, or nearly one in four) than other Stanford Medical School students (Garcia et al., 2003).