Religious discrimination in the selection of medical students: a case study.

• Author: Gunn, Albert E.

In 1978 the Department of Health, Education, and Welfare, responding to congressional concerns,(1) conducted a study to determine whether schools of medicine, nursing, or osteopathy deny admission or otherwise discriminate against any applicant because of the applicant's reluctance, or willingness, to counsel, suggest, recommend, assist, or in any way participate in the performance of abortions or sterilizations contrary to his or her religious beliefs or moral convictions.(2) Surveys were sent to all schools of medicine, nursing, and osteopathy in the United States, asking whether they discriminated against or denied admission to any of the named groups.(3) In addition, any applicant who had suffered such discrimination was asked to contact the surveyors, and any organization aware of incidents of discrimination was asked to describe details of such incidents.(4)

The questionnaire to the professional schools was organized around four areas of inquiry: (1) Does the medical school have a policy or understanding related to abortion or sterilization? (2) Are applicants ever queried about their views on abortion or sterilization? The school was asked to describe such inquiries. (3) What impact do the views expressed by applicants regarding abortion/sterilization have on an applicant's admission? (4) Are there any complaints by applicants concerning admission because of their views on such topics?(5)

One medical school that responded to this survey answered questions 1, 3, and 4 in the negative.6 Regarding the second question, it was stated that one faculty member routinely queried applicants about a hypothetical situation in which a fourteen-year-old unmarried Catholic girl requested an abortion. The applicant was asked to discuss the issues presented by this request from the viewpoint of the primary physician. The medical school stated that the purpose of this inquiry was not to determine a point of view, but to evaluate a capacity to identify relevant issues.(7) Whether the Department of Health, Education, and Welfare made any response to this positive answer or what report they made of it to Congress is not known. This article examines the actual practice of questioning of applicants on abortion and a penumbra of controversial topics in medical school admissions in light of the Department of Health, Education, and Welfare's letter.(8)

Some time after the survey, an opportunity was presented to study the actual admissions process at the school giving the answer described above and to compare it with the information presented to the Department of Health, Education, and Welfare. This particular admissions procedure revolved around a number of factors. College grades (GPA) and the results of the standardized Medical College Admissions Test (MCAT) were considered, particularly in the selection of students to be interviewed by the faculty of the school. Other factors considered included the recommendations submitted by the student's college and the information contained on the application form: questions about the student's demographic data (race, age, birthplace), parents (birthplace, occupation), the high school of graduation, and organizations to which the applicant belonged or other nonacademic activities (church membership was often listed, and some listed anti-abortion activities). in addition, each candidate wrote an essay as part of the application, presenting an account of experiences and motivations leading to the desire to become a physician. On occasion, some applicants mentioned a religious motivation as important in the decision to enter medical school. For medical school acceptance, it was essential that an applicant be selected for an interview. This decision was based largely on an applicant's MCAT and GPA, but some applicants were invited for other reasons. But however an applicant was selected for an interview, it remained a requirement for admission.(9)

The admissions committee was a decisive entity in the selection of applicants for the entering class, although not all applicants accepted necessarily had the approval of the admissions committee. Since the admissions committee made admissions decisions in most cases, it was a goal that each applicant be interviewed by an admissions committee member, who would then be in the best position to discuss an applicant's file and background. A second interviewer was chosen from faculty volunteers not on the admissions committee. At the committee meetings, each committee member had information from the applications to be discussed, including GPA, MCAT, essay, premedical recommendations, and the written report of the admissions committee member and other faculty interviewer.(10)

The admissions committee member who interviewed the applicant would make a presentation of the applicant's file and a recommendation about suitability for acceptance to medical school. Although each member of the committee had all the information related to a particular applicant, the presentation by the admissions committee member was a critical component in the applicant's consideration. The admissions committee member could, and frequently did, emphasize a particular aspect of the applicant's record or the interview and might add further details from the interview not included in the report. The admissions committee member exercised perhaps the most important function in the evaluation of applicants.(11)

After this initial presentation, each committee member in turn assigned a score to the applicant. A secretary recorded these numbers on a worksheet, averaged them, and assigned an overall score to each applicant. The applicants were then rated by scores, the highest scores providing the best chance of acceptance.(12)

With the above background in mind, it is possible to review the comments of committee members and faculty interviewers regarding applicants' views on abortion. The cases described are a sampling of the interview reports in a particular admissions year. They should be considered in the light of the school's answer to the Department of Health, Education, and Welfare that candidates did not suffer discrimination as a result of their views on abortion. They should also be analyzed in the context of a state law governing this medical school, which provided that candidates should not be denied admission because of their views on abortion. The names of candidates have been replaced by numbers, and admission committee members are referenced by letters, which have no relation to the names of the interviewers or committee members. No official minutes were kept of discussions at admissions committee meetings related to applicants, but the chairman of the admissions committee kept a journal with summaries of some discussions. Records of the interviewers' impressions are correlated with actual admissions committee discussions where available.(13)

Medical School Applicants' Views on Abortion

Case 1: Interview

"In discussing various issues related to medicine--especially ethical and moral issues--I felt that her viewpoint was rather narrow or rigid and that she has not thought the issues through very well. She is strongly religious and calls herself a `Christian.' When I asked her about National Health Insurance, she simply stated that socialized medicine would be a hindrance to the American people--and did not really elaborate on this. When I asked her about her stand on abortion, she simply said that she would never perform one, and would try very hard to talk a prospective patient out of having an abortion, even if this was a rape victim. Although these are sensitive areas, and people's opinions vary a lot, I felt that Ms. l's answers were preformed...