Criminal Background Checks for Applicants Accepted to Health Professions Schools Robert F. Sabalis, PhD Associate Vice President Student Affairs and Programs March 16, 2006

AAMC Executive Council Action In June 2005, the AAMC Governance approved the Group on Student Affairs (GSA) proposal that criminal background checks be completed on all applicants accepted annually to medical school Four major purposes for checks: Maintain the public trust in medicine Ensure the safety and well-being of patients Assist applicants/students to enter clinical clerkships and be licensed as physicians Limit schools and hospitals liability

Medical School Involvement A need for active medical school involvement in defining criminal background check (CBC) requirements: Affiliated clinical institutions policies are mandating CBCs States statutes are mandating CBCs Applicants need accurate information Admission decisions are a faculty responsibility

Other Health Professions? CBCs discussed at a 2/1/06 FASHP meeting General interest and concern expressed Different approaches to the CBC challenge: Some associations have promoted a decentralized approach to CBCs Other associations only now beginning this discussion Cost of CBC identified as a factor Some professions leaving the CBC decision to licensing boards rather than schools

AAMC Background Expectations of the public? Two-fifths of state medical boards require (or can require) CBCs of licensure applicants But school employees, volunteers, and others must have them In the face of societal stressors and recent medical school events, the public is seeking reassurance where it can Federation of State Medical Boards recommended that member boards seek legislation to permit CBCs for licensure applicants

GSA Recommendations One year in development, /4 of schools currently performing CBCs Others schools are considering them, but waiting for guidance Schools want national process through AAMC: Cost-effective for applicants, with Consistent and comprehensive results Schools want to retain authority for decision-making, but desire guidelines for interpretation of CBC data

GSA Recommendations CBC be completed upon first school acceptance Same CBC report be available to all schools that later accept the same applicant CBCs be part of post-acceptance matriculation process, not of application/interview process Matriculation decision follow schools review of CBC report Applicant authorize CBC and receive report Each schools faculty develop relevant CBC policies in collaboration with clinical affiliates

GSA Recommendations Factors to be considered when CBC reveals information of concern include: Nature, circumstances, frequency of offense(s) Length of time since offense Documentation of successful rehabilitation Accuracy of information provided by applicant One comprehensive CBC be done, with each school getting all data that it desires and permitted by law Each school should develop guidelines for CBC data handling

GSA Recommendations CBCs should: Be based on past areas of residence Include in-person search at local county level And search at state and national levels Not be completed solely via computer databases Include sex offender search Include search for dishonorable discharge from Armed Forces

GSA Recommendations CBC should involve: All levels of offense All types of adjudications All unresolved legal processes All types of offenses Arrest data only when case has not been fully adjudicated; otherwise only conviction data

GSA Recommendations CBCs should not be limited to specific time period, given age range of applicants GSA should develop guidelines for consideration by schools about use of CBC data Schools should consider the uneven administration of justice in the US for minority and disadvantaged persons in decision-making School policies on CBCs should be developed separately from policies about medical and psychiatric conditions and disabilities

Unanswered Questions Where should CBC data be housed? Which school officials should have access? Should data be shared between school offices? Should terrorist search be included? What about juvenile/expunged records? Should CBCs include fingerprinting, search for professional license revocation, and/or drug screening?

Current Status 18-member AAMC CBC Advisory Committee met 2/13-14/06 in DC Composed of AAMC constituent and external, medically related groups Adopted nine goals for CBCs: SimplicityTransparency EquityAffordability AccuracyRisk mitigation Community involvement Ownership by medicine Effectiveness/success

Current Status CBC Advisory Committee recommended: An AAMC-sponsored centralized, national CBC service Implementation of the GSA recommendations + –Revision of AMCAS application to collect additional self-report criminal history information to be checked against CBC report –CBC reports should exclude: oJuvenile offense data oArrest (without conviction) data

Current Status CBC Advisory Committees recommendations will be presented to AAMC Governance in June 2006 Earliest implementation date: fall 2007 for fall 2008 entering class Information being sought about schools, states, and clinical affiliates requirements GSA starting to develop best practice guidelines for use by schools

Lessons Learned An emotionally charged topic requiring more time for discussion and working through than expected Potential exists for a wide variety of requirements from schools, states, and affiliated facilities Schools must get out ahead of this discussion before others mandate widely divergent requirements and systems The complex decision for or against checks is only part of the equation; implementation is also very complex