Whitney Palmer

Medical Schools Seek Security of Student Background Checks

Published in the October 2004 AAMC Reporter

Law enforcement and federal government jobs are not the only professions requiring criminal background checks anymore. Mindful of terrorist threats and increased patient safety concerns in America’s hospitals, many medical schools now conduct background checks on incoming students.

For years many institutions performed checks on all faculty and staff, but because medical students have frequent contact with patients some schools are extending the policy. Several schools conduct checks, and one institution views them as a proactive measure that could benefit students in the future. According to 2003 AMCAS data, of the 201 applicants who reported felony convictions, 199 were not admitted while two were accepted. There were 34,786 total applicants in 2003-2004.

A recent murder-suicide case involving a University of Arkansas medical student who had a criminal history brought the use of background checks back to the forefront. The University of Arkansas does not conduct background checks currently but is considering changing the policy in the wake of this incident.

Ohio State University initiated its own comprehensive background check policy and inaugurated it this year with first-year students. Current students will be retroactively checked, beginning with fourth-year students because they are closer to working in clinical settings.

“We’re doing it to protect the institution and to assess the students so if something does come up, we can work with them to see if they can still become a licensable professional,” said Judith Westman, M.D., Ohio State University’s associate dean of student affairs and medical education administration.

Only applicants who have been interviewed and recommended for acceptance are subject to background checks. Students receive a letter of their admittance pending a background check. Initially, students will pay for the checks, and if they choose to matriculate, the school will reimburse them. Background checks, depending upon whether the student is from Ohio or out of state, cost between $17 and $40.

Checks and Balances

When designing the background check policy, Ohio State officials were careful to separate it from any admission decisions, Dr. Westman said, citing the need to protect students’ civil rights. The school did not want to be accused of conducting a “witch hunt” for students with a criminal background or for denying entry based on past events.

Ohio State divides reported criminal incidents into two categories: minor offenses and those that disqualify a student from accessing clinical sites. For example, if a student had a conviction related to mental health problems, the school would help the student accumulate the documentation detailing successful treatment needed to appeal to the state medical board. But if the check unearthed a sexual assault or child abuse, the student could not be placed in a clinical rotation, Dr. Westman said.

“If someone has been arrested and convicted of voyeurism, how can I put them in a gynecology exam room?” she said. “This is a patient safety issue, and they can’t be placed in a clinical setting. Therefore, they can’t be allowed to continue in the program.”

Almost one half of U.S. states already require criminal background checks or are considering legislation that would require them for doctors applying for licensure, and the AAMC is working with member institutions to develop guidelines on the use of background checks. Several schools indicated they are weighing the benefits and burdens of background checks.

Full Disclosure

Duke University School of Medicine’s policy is similar to Ohio State’s. School officials evaluate both misdemeanors and felonies. Although the school has never found anything unsavory in a student’s past that was not disclosed, there is a policy in place should that happen, said Richard Wallace, Duke’s assistant director of admissions.

If a student lies about a conviction, Wallace said the vice dean of the medical school, dean of students, an advisory panel of four other deans and the school’s legal counsel evaluate the nature of the crime and determine whether the student can matriculate.

“We make it very clear to these students that we’re not trying to keep them from enrolling in school,” Wallace said. “We’re just trying to make sure there are no skeletons in their closet that will come back to haunt them or to haunt Duke.”

The checks also benefit the students when they reach clinical rotations because hospitals affiliated with Duke require everyone who interacts with patients to undergo a background check.

Oregon Health Sciences University also began criminal background checks on first-year students this year because the students will need a background check before entering a clinical setting. However, the school decided that current students will not be checked.

“Our institution felt it made sense to ask questions of students to ensure we have people here who have the background that should allow them to be here,” said Robert Vieira, Ed.D., Oregon’s vice provost for academic and student affairs.

The campus public safety office pays for the background checks from its departmental budget. The cost of adding students to the 12,000 employee background checks being conducted annually is minimal, Dr. Vieira said. If the check unearths an incident, the public safety office along with an administration official and the medical school dean determine whether the student can remain enrolled.

Check Required

Other schools require background checks simply because state law mandates them. Students at the University of Minnesota Medical School submit to background checks at the beginning of each school year. During orientation, students fill out the forms that allow the state to determine whether they are fit to work in clinical sites.

Rather than benefiting the institution, Minnesota officials look at running criminal background checks as a method of protecting the public health in general.

“This is an issue of the public needing to feel the people taking care of them are secure,” said Helene Horowitz, Ph.D., Minnesota’s associate dean for student affairs. “Having the checks in place at the governmental level ensures the public adequate precautions have been taken for those one-in-a-million situations where patients are hurt.”

According to James Thompson, M.D., president and CEO of the Federation of State Medical Boards (FSMB), conducting background checks when students enter medical school would protect the public. One of the Federation’s primary goals is to prevent those with criminal pasts from entering the medical profession.

“The cost to society is great when medical schools educate individuals who will never be allowed to practice medicine because of prior criminal history,” he said. “Having background checks prevents these people from becoming part of the profession.”

Identifying students with criminal records before they enter medical school could prevent situations where potentially violent individuals could be given access to hospitals and lethal doses of medication, Dr. Thompson said. Relying on self-disclosure forms is inadequate because too many applicants lie when questioned. For example, a recent Florida state background check of all healthcare workers discovered that 44 percent of individuals guilty of felonies did not reveal the infraction.

But waiting for background checks can be time-consuming, according to officials at the North Carolina Medical Board. North Carolina runs checks through the FBI and results often take as long as eight weeks, and fingerprints are sometimes lost.

March 25, 2010 - Posted by wjpalmer | Healthcare | criminal background checks for medical students, medical student background checks, patient safety measures, preventing medical school applicants with felony records from accessing patients, who pays for background checks for medical students