Review, deliberation, and voting: a study of selection decisions in a medical school admission committee.

BACKGROUND: Medical school admission committees differ in their decision-making procedures. Some assign ratings to groups of application materials to devise rank order acceptance lists, whereas others deliberate and vote on each separate application. PURPOSE: This study examined what the screening review and deliberative processes contribute to decision making in a medical school admission committee. METHODS: We reviewed records of admission committee members' preliminary votes on applicants after initial screening, final votes after committee deliberation, and written comments regarding issues of concern influencing their votes cast. Descriptive univariate and bivariate analyses are presented. RESULTS: Approximately one in five votes cast after initial screening was changed following committee deliberation, resulting in majority vote shifts in roughly 10% of cases containing votes by the same committee members at both time periods. Factors cited as influencing vote changes (in declining order of frequency) included Medical College Admission Test scores, medical experience, comparison with other applicants, grades, letters of evaluation, interviews, individual attributes, residency status, service experience, expressed desire of committee members to discuss the applicant at the meeting, American Medical College Application Service personal statement, and diversity. CONCLUSIONS: Admission committee members' voting behaviors appear to be influenced by the deliberative process. Future studies should explore the extent to which committee group dynamics influences decision making and the relative contribution of particular academic and nonacademic factors to vote-changing behavior.