The Supreme Court's decision to reverse the long-standing precedent on race-conscious college admissions may drastically change how medical schools evaluate candidates. Although it's still too soon to assess the extent of such changes or the impact on underrepresented students, some admissions experts and medical students suggest that well-written essays can boost students' odds of standing out.
Tyra-Lee Brett, a premed student at the University of South Florida and premedical trustee of the American Medical Student Association, told Medscape Medical News that students traditionally underrepresented in medicine — such as first-generation or low-income students, people of color, and immigrants — often have to compete with candidates who have more money and connections along with high test scores. Brett expects that underrepresented students will face additional challenges to admission without affirmative action policies.
Still, Brett believes students can use personal essays to embrace their lived experiences and demonstrate the distinct perspectives they would bring to a medical school class.
"Coming from South Africa and living through the Cape Town water crisis, I've had experiences that have nothing to do with patients and medical care, but they do show cultural competency, maturity, and people skills," Brett said, adding that she will highlight her experiences and the traits that resulted when she applies to medical programs soon.
"You want to show committees what it taught you, how you evolved, and [how you] will be a better physician."
Colleges are updating essay prompts to learn more about students' defining moments. For example, Harvard College, one of the schools the Supreme Court ruling addressed, now requires applicants to answer new essay prompts, according to The Chronicle of Higher Education. The prompts include: "Harvard has long recognized the importance of enrolling a diverse student body. How will the life experiences that shape who you are today enable you to contribute to Harvard?"
In its ruling, the Supreme Court said that an applicant's personal experiences should carry the most weight in admissions decisions and that "nothing in this opinion should be construed as prohibiting universities from considering an applicant's discussion of how race affected his or her life, be it through discrimination, inspiration, or otherwise."
The Biden Administration also urged higher education institutions to "give serious consideration to the adversities students have overcome," such as a student's finances and "personal experience of hardships or discrimination, including racial discrimination the student may have faced. In doing so, colleges and universities can fully value aspiring students who demonstrate resilience and determination in the face of deep challenges."
How Are Students Responding?
Students on Reddit's premed community shared their frustration with essay prompts and their reluctance to divulge sensitive personal details.
"I feel like everyone's secondaries are either overcoming bullying, moving to a new place as an immigrant, health issue of yourself or a loved one, or a drug overdose or death of a friend. Mine is one of these…how [do] I even stand out," according to Reddit user Cold_King_4661. Other people posting said it felt "uncomfortable" and "invasive" to answer the prompts and likened it to a race for "who can dump the most trauma the fastest."
In another thread, a Redditor who goes by Snekyplant feared admissions committees might label an applicant "whiny" for discussing how they handled sexism in the workplace.
Wahaaj Farah, a premed student at Boston University, told Medscape that allowing students to open up about the events that have shaped their character and motivation to become a doctor can help students — particularly first-generation and students of color — express their potential beyond a GPA.
Farah plans to write about how a nearly fatal childhood illness and the treatment he and his parents received as immigrants from Somalia spurred his interest in medicine.
"Medical professionals didn't take my symptoms seriously, leading to later complications. The incident solidified my determination to offer compassionate care, guidance, and respect to patients," he said.
Underrepresented students may feel pressure to focus on their trauma, according to Hanna Stotland, JD, a Chicago-based attorney and independent admissions consultant who helps students with their medical school applications. She told Medscape that school counselors and advisors should support them in writing about their experiences to showcase the "distinctive insight" gained from those interactions.
Third-year Tufts University medical student Madeline Valverde told Medscape that when she applied to medical school, she was comfortable talking about the socioeconomic struggles and challenges of growing up with immigrant parents.
"I knew I was applying as a disadvantaged applicant, but I didn't see that as a detriment. My story is intertwined with my mission, vision, and goals for medicine and demonstrates the barriers I have overcome, so I chose to disclose those difficult circumstances," she said.
Colleges Make Adjustments
As they await federal guidance following the high court's decision, college leaders should continue pushing for racial equity in admissions, Catherine Lhamon, assistant secretary in the Department of Education's Office for Civil Rights, said at a recent affirmative action summit, according to Inside Higher Ed.
Some schools may reevaluate the fairness of legacy preferences following the AMA's lead in opposing the controversial policy that typically favors wealthier children of alums and donors.
Regardless, medical schools will continue to use "holistic" admissions practices to create a complete picture of the candidate's abilities and character, says Geoffrey H. Young, PhD, senior director of transforming healthcare workforce at the Association of American Medical Colleges (AAMC).
Medical schools design holistic reviews around their missions and "each prospective student's full capabilities and experiences," Young told Medscape. He added that admissions committees may consider factors such as whether a student speaks multiple languages and is willing to work with vulnerable populations or study health inequities.
The holistic reviews help to boost diversity, even in the case of race-neutral admissions, he said.
Beginning with the 2024 medical school application cycle, AAMC will replace the self-reported "disadvantaged status" question with an optional essay prompt for "Other Impactful Experiences." The essay aims to provide a "snapshot of applicants' lived experiences" and additional context about personal challenges related to demographics such as religion, finances, or living situations.
The University of California at Davis School of Medicine showed that it could increase the diversity of its students after affirmative action was banned at the state's public universities in 1996. Half of the school's medical class of 2026 are people of color belonging to groups typically underrepresented in medicine, the school reports.
Like other medical schools, UC Davis uses a holistic review process that evaluates a student's grades, test scores, and experiences, said Shadi Aminololama-Shakeri, MD, professor and chair of the school of medicine's admissions committee. The school's "distance traveled" metric, part of the AAMC's holistic review framework, considers socioeconomic factors such as family income, parents' education level, and if the student grew up in a medically underserved community, she told Medscape.
"We believe the ability to overcome such obstacles reflects grit, resilience, commitment, and the ability to connect with patients from all walks of life — important qualities needed for the medical workforce in California and elsewhere."
At Duke University School of Medicine, "holistic review" incorporates multiple essays and mini-interview sessions to learn about students instead of a traditional interview, which tends to be longer. Interviewers only know the student's name to minimize bias and evaluate traits not easily measured by standardized tests, such as cultural competency, emotional intelligence, and the ability to navigate difficult situations, the school reports.
According to its annual diversity report last year, the school has steadily enrolled more women, Black, and Hispanic students but has not substantially increased representation among Asian students and other minority groups.
Brett, the University of South Florida premed student, believes further educational changes are needed to achieve greater diversity in medical schools.
"Research and shadowing opportunities for underrepresented students are almost impossible to get and occur at rates much lower than for those in a majority category," she said, citing findings from an ongoing national AMSA study she's leading to evaluate barriers to med school application.
Improvements should begin at the undergraduate level, she said, with colleges increasing minority student access to mentors, advisors, and extracurricular activities. Then, by the time students apply to medical school, there might be a smaller gap between underrepresented groups and wealthier students, she said.
Steph Weber is a Midwest-based freelance journalist specializing in healthcare and law.