Complex Regional Pain Syndrome Medicine

After affirmative action ruling, medical education leaders see silver lining in court endorsement of ‘holistic review’

This post originally appeared on StatNews.

After having a day to read through the Supreme Court’s decision on affirmative action, some medical school and educational leaders are more hopeful that a path exists for them to diversify future classes and the health care workforce as they scramble to understand its impact on the next admissions cycle and the class of 2024.

Several told STAT they saw the court’s ruling as explicitly endorsing the use of “holistic review,” a tool used increasingly by medical, dental, and nursing schools and other institutions to build classes that better reflect the demographics of the nation. For years, medical schools have been seeking to train physicians who better resemble the patients they treat — a key part of the effort to reduce health disparities.


That’s not to say there wasn’t still a lot of criticism of the decision. The American Nurses Association said in a statement Friday its leaders were “appalled” by the ruling and said it “signals the continuation of systemic and structural racism which has inflicted generational discriminatory trauma in terms of lack of access and academic and professional advancement.” The decision would no doubt impact nursing admissions processes, it said.

A wide variety of medical groups, from the American Medical Association to the American Cancer Society, had also decried the decision as undermining both the health of the nation and patient care.

The Association of American Medical Colleges, which represents the nation’s medical schools, has been encouraging the use of holistic review — in which an applicant is evaluated as a whole person, not just by empirical data such as test scores — to help medical schools diversify their classes.


It was also heavily involved in the two affirmative action cases, involving the admissions practices of Harvard and the University of North Carolina, from the beginning. The AAMC submitted an amicus brief to the court with reams of data showing that when physicians are from the same racial and ethnic groups as their patients, health outcomes improve.

One of the co-authors of that brief, AAMC Chief Legal Officer Frank Trinity, told STAT he saw the ruling as “deeply consequential” and “a significant change in law.”

However, after spending most of Thursday analyzing the majority opinion, he said he thought the ruling affirmed the use of holistic review, which can take into account a person’s experiences and racial background. The court said explicitly that nothing in the decision prohibited applicants from addressing their own race or experiences in their applications. “In my opinion, holistic review has received a boost by this decision,” Trinity said. “Admissions officers must treat each individual as an individual — that’s what holistic review is all about.”

The opinion drafted by Chief Justice John Roberts stated: “nothing prohibits universities from considering an applicant’s discussion of how race affected the applicant’s life, so long as that discussion is concretely tied to a quality of character or unique ability that the particular applicant can contribute to the university.”

A number of people who run admissions departments for professional schools said they were still digesting the ruling and could not yet comment specifically on how they would respond, or what changes they would make.

But medical schools posted statements saying they would continue to work to be inclusive in their admissions policies, and Nancy J. Brown, Yale’s dean of medicine, said in a statement that the school would continue the holistic approach to admissions it has employed in its pursuit of “diversity and inclusive excellence.” The school “considers each applicant’s commitment to medicine, maturity, and resilience, as well as measures of academic preparation, such as grades and MCAT scores. This will not change,” the statement said.

Others agreed that there were still paths forward, if admissions officers were willing to do the hard work of changing the status quo of who traditionally gets admitted. “The nice thing about this ruling is that maybe it will start some conversations,” said Mark Henderson, the associate dean of admissions at the University of California, Davis, medical school, which has worked to diversity classes despite a longstanding statewide ban on affirmative action. “There are many things that can be done.”

Others agreed. Ruth Simmons, the first Black president of an Ivy League university, Brown, and now a senior adviser to Harvard’s president, told CBS Morning News, “We’re still able to consider a diversity of factors … so I am not given to seeing this as being as detrimental as many.”

Asha Rangappa, a lawyer and assistant dean of admissions at Yale’s Jackson School of Global Affairs, tweeted that she thought the ruling would have less impact than others predict because it allowed more latitude for subjective admissions decisions.

“It seems to me that in making more explicit *how* a students’ background impacts experience/perspective, schools will have a much easier time DEFENDING why race mattered in admitting that person…and test scores, etc. become less of the comparison point,” she wrote.

Trinity said many medical schools would be waiting for guidance from the Department of Education on the court ruling. That guidance is expected within 45 days. In the meantime, Education Secretary Miguel Cardona urged higher education leaders to continue to strive to diversify their campuses and said in a statement: “Our commitment to educational opportunity for all Americans is unshaken.”

Trinity said the AAMC would continue to support member medical schools as they think through how the decision will affect their selection of the medical students entering school in 2024. In the meantime, he said he feared the impact the ruling may have on people from groups that have not been well-represented in medicine who are deciding whether or not they want to be physicians.

“What we’re most concerned about is the negative narrative. We have prospective students from different backgrounds that might feel discouraged,” he said.

“To the middle schoolers out there who are good at chemistry and may do well in medicine, we want you to aim high,” he said. “We need your talents and drive more than ever.”

This post originally appeared on StatNews.