Dr. Piraino is professor of medicine and associate dean of admissions and financial aid, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Dr. Stull is an American Medical Student Association Education and Research Fellow, Reston, Virginia.
Dr. Pettigrew is assistant dean for student affairs and director, Diversity Program, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Dr. Mahoney is associate professor of emergency medicine and associate dean for medical education, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Correspondence should be addressed to Dr. Piraino, 518 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261; telephone: (412) 648-9891; e-mail: Piraino@pitt.edu.
In 2006, the Association of American Medical Colleges (AAMC) Criminal Background Check Advisory Committee published recommendations for performing criminal background checks on medical school applicants, citing four reasons for this practice: increasing the public's trust in physicians, the safety of patients, the ability of medical students to eventually be licensed as physicians, and liability issues affecting both medical schools and their affiliated clinical facilities.1 We agree with this report. Checking for a history of criminal behavior of accepted medical students is the right policy at the right time.
Many hospitals and outpatient facilities require criminal background checks on all newly hired employees, and this standard is increasingly being applied to trainees. Children's hospitals in particular must be ethically and legally mindful of who has access to their vulnerable population. Like many children's hospitals, the Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center will not permit those with domestic violence or child abuse convictions to be in contact with the children in the hospital. If the University of Pittsburgh School of Medicine inadvertently or knowingly admitted a student with a history of such a conviction, the student would not be able to complete requirements for graduation, since the student would not be able to do the inpatient pediatric rotation, which is part of the core curriculum and a requirement for graduation. Criminal background checks that include such information prior to matriculation prevent such outcomes.
In Pennsylvania, as in many other states, a felony conviction precludes medical licensure. Under these regulations, if a student who has been convicted of a felony completes medical school, he or she would not be able to obtain a license to practice medicine. Is it fair or a reasonable use of resources to train a medical student through four intensive years if the graduate is not then able to get a medical license? With a physician shortage projected for the future, it may not be reasonable for medical schools to train physicians who will not be able to contribute directly to patient care. It is also not fair to the student who has invested years and considerable finances in obtaining the medical degree, if the student cannot subsequently receive a license to practice medicine.
Patients have a right to know who is caring for them. In the current “information age,” patients can access evaluations of and information about their physicians online and likely want to know if anyone involved in their care has a criminal background, especially students. If medical errors occur during patient care, background information about all involved in the event—including students—is likely to come to light during ensuing litigation. Although students are exempt from malpractice claims, hospitals are not. Juries are unlikely to look favorably on any institution that does not disclose information of a student's criminal history to the patient.
The process of performing criminal background checks is already in place at most medical schools. The AAMC piloted criminal background check testing on a select group of volunteer medical schools and expanded the program to all interested schools for the class entering in 2010.2 For the 2011 entering class, 91 medical schools in the United States will be participating in the AAMC-facilitated background check service.3
Many issues remain to be resolved. Schools need to determine where the database for the criminal background check process should be located, which institutional officials should have access to the information, the relationship of the medical school's admission policy to the state's licensure rules, and inclusion or exclusion of expunged legal records.1 Further, the criminal background check is likely to disadvantage those with a lower socioeconomic background, as these individuals are disproportionately implicated in legal proceedings due to a lack of resources. Arrests of minorities and those with low income more often lead to convictions than do arrests of those from more advantaged backgrounds.4 Medical schools will need to make every effort to be fair in this process.
We feel that criminal background checks for medical students are here to stay. We must do this to be responsible to the applicant, the patients, and the institutions involved in training. To be successful, criminal background checks must be respectful of applicants' confidentiality and must be ingrained in schools' professionalism policies. This policy, when implemented correctly, can be beneficial to all involved.
Other disclosures: None.
Ethical approval: Not applicable.