REPORT OF COUNCIL ON MEDICAL EDUCATION
CME Report 3-A-07
Subject: Criminal Background Checks for Medical Students
Presented by: Dennis B. Dove, MD, Chair
Referred to: Reference Committee on Science and Education
Criminal background checks on medical students by medical schools and healthcare institutions are becoming a common practice in Texas as part of a sweeping national trend. The AMA Council on Medical Education researched the status of their use in 2006 and determined the checks are being pursued to reinforce the public's trust in the medical profession, protect the safety and well-being of patients, facilitate the ability of medical students to eventually become licensed physicians, and as a result of liability issues affecting medical schools and their affiliated clinical facilities. Although some states have enacted statutes which require these checks, Texas does not have such mandates at this time.
Texas medical schools and teaching hospitals/clinics [1] are commonly requiring the use of criminal background checks for students before they matriculate. The rationale defined in The University of Texas Health Science Center at San Antonio's policy on this topic encapsulates the issues, as noted below:
Health care providers who are entrusted with the health, safety, and welfare of patients, have access to controlled substances and confidential information, and operate in settings that require the exercise of good judgment and ethical behavior. Thus, an assessment of a student or applicant's suitability to function in such a setting is imperative to promote the highest level of integrity in health care services.
Further, the San Antonio medical school recognized the need for synchronization with clinical training facilities as well as a future linkage with state medical licensure or employment requirements, as follows:
Clinical rotations are an essential element in medical school curriculum. Students who cannot participate in clinical rotations due to criminal or other adverse activities that are revealed in a background check are unable to fulfill the requirements of medical school. Additionally, many healthcare licensing agencies require individuals to pass a criminal background check as a condition of licensure or employment. Therefore, it is in everyone's interest to resolve these issues prior to a commitment of resources by the University of Texas at San Antonio Medical School, the student or applicant. [2]
The AMA Council on Medical Education's findings on criminal background checks were summarized in Report 9 adopted by the AMA House of Delegates at A-06. The following concerns were identified in the report and were corroborated by the TMA Council on Medical Education in consultation with representatives of Texas medical schools at a meeting in May 2006:
- Lack of standardization in background checks across universities and health care systems;
- Financial burden on students; both fee amount and likelihood of multiple fees for repeated checks by various authorities;
- Validity of information collected; need for credible data collection methods; and need for fair data review standards;
- Unnecessary duplication due to widespread requirement for checks but lack of synchronization across facilities, universities, etc.; and
- Need to protect a student's privacy and ensure confidentiality of records and findings.
Additionally, the AMA urges caution in the use and interpretation of student criminal records, calling for consideration of the possibility of an uneven administration of justice in the U.S. court system for minority and disadvantaged individuals. To address this, the AMA reference committee included the following remarks in the A-06 reference committee report:
"There is a clear and immediate need to work to assure that there is both standardization and fairness in the process that evolves. A caution was raised, however, that some groups are not treated equitably in the criminal justice system. Any system for background checks must be sensitive to this issue."
Texas medical schools recognize the benefit that could be derived from establishing a single, centralized criminal background assessment process in the state, and have identified the Texas Medical & Dental Schools Application Service as a potential candidate to provide this service. All Texas public medical schools already use the application service to process medical school admission applications. Baylor College of Medicine in Houston, the state's private medical school, utilizes an application processing service offered by the Association of American Medical Colleges.
The Council on Medical Education sought input from medical school representatives in evaluating the current system used by medical schools for background checks and determined that the system should be uniform across the state and transferable among university and health care systems. Further, in researching this topic, the council became aware of the reasonable and cautious manner utilized by Texas medical schools in developing new policies in this area. The council believes it is warranted to include recognition in TMA policy of these accomplishments by the medical schools. Based on these findings, the council recommends the following as new TMA policy:
The Texas Medical Association recognizes that the use of criminal background checks on medical students is becoming standard practice among many medical schools, teaching hospitals, and community-based training sites. The Texas Medical Association applauds the cautious and thoughtful manner used by Texas medical educational institutions in establishing policies on this issue to date. When checks are conducted on medical students, it is recommended that strong consideration be given to: ongoing necessity for checks, prevention of duplication, collaboration, and consistency across educational and healthcare institutions, related financial burden on students, and consistent guidelines for the interpretation and storage of sensitive information, with confidentiality protections for students.
Reccomendation: Approval as TMA policy.
[1] The Joint Commission (formerly Joint Commission on Accreditation of Healthcare Organizations or JCAHO) does not explicitly require criminal background checks unless required by state law, regulation, or organizational policy. It is becoming common policy, however, among healthcare institutions. The Association of American Medical Colleges recommends checks for all individuals accepted into medical school.
[2] Excerpted from Student Background Check Policy, The University of Texas Health Science Center at San Antonio Web site, February 2007 (http://som.uthscsa.edu/admissions/Policy.doc).
TMA House of Delegates: TexMed 2007