Paper published on holistic evaluation and discussion point for writing informative letters of recommendation/evaluation.

1. 'The Ad1-isor
I Competency-Based Holistic Evaluation of
Prehealth Applicants
Ei'i'ziI T.Chuck, PbD
Introduction
C ommunicating the qualifications of
an applicant through a reference let-
ter is always a challenge. hlany references
In other n~ords, is designed as a de-ei-
it
opmental model and standard against
r-hich all are measured. hl!- goal in
take a position of strongly recommending developing a competency-based eralua-
candidates based on the academic record tion rubric was to emphasize the lifelong
and accomplishments in the contest of development of these professional
specific classes, but often the humanistic traits to applicants, references, and eralu-
elements of an applicant are not easily ators by providing a framenrork for dis-
discussed or deciphered. cussion and assessment of the individual
applicant without resorting to arbitrary
With the emphasis on an applicant's abil- "class rank" or subjectil-e, non-specific
ity to del-elop the professional s l d s and characterizations.
insights necessary to becoming an escel-
lent health care provider, it is unfortunate The Process and Research Rationale
how little these s M s and insights are
evaluated within the contest of academic At Virgnia Commonwealth Unirrersity,
letters of recommendation. T:llile it is the competencies articulated by the Ac-
important for professors to describe the credtation Council for Graduate hfedical
context of a student's grade in a lecture Education (ACGhlE) have been applied
or small-group discussion-based course, to prehealth students'. But the literature
there is often very little insight offel-ed to reveals few efforts where a system of ad-
admissions committees (and institutional vising focused on competency-based
evaluation committees) on the non-aca- evaluations is utilized. At the time I be-
demic qualities. Yet, nriting about an gan advising at George hlason Uniwrsit!;
applicant's character and/or service ori- no evaluation rubric for committee let-
entation is often a complete1~- subjective ters or professional letters s~~pporting
assessment. If an applicant did not have prehealth students could be found
a modicum of compassion for others, online. ,It the same time, my own inter-
XI-ouldwe be willing to write a letter on est in professional career del-elopment
behalf of the applicant? In the current for graduate students and postdoctoral
Let-IIIassisfnntpi.@rsor application system, all applicants hare scholars in science and engineering fields
of' biolqgi ut George that compassion which unfortunatel!. brought me to participate as a committee
i,fc~.io~~U11i~'et:iifjl.
He fails to materialize in patient assessments. member and Professionalism section au-
a~elromes co~x~?/ents ci/~d thor for the National Postdoctoral
jedbcirk o hir r~tb/-lc hle&cal education most recentlj- has
m Association's Core Competencies.
fi-o/ll nlili~oi.s,an~~/issio~ls adopted competent!--based el-aluations to
denlrs lid dil-ecto/:r,01. guide professional development to irr- Eventuallj; my search for guidance
health ~ ~ ~ o f e s s ~ o i ~pro-e the qualin- of patient-doctor inter-
.r brought me to the Technical Standards
.schools .ctt~dellt
.ffC~its actions and of patient care. Competen- for admitted students outhned b! man!-
clenns. f dd1.e.r.r
i cies are best described as the masteri- of medical, dental, pharmac!; optometry,
sMls that express specific characteristics podiatry, 1-etennary, and other health
or criteria that are d u e d by a profession. professional programs. Regardless of

2. The Advisor
the degree offered, all the Technical Standards at kno- whether the applicant's career goals can be fa-
these schools n-ere fairly uniform in the expectations cllitated througll the mission, resources, and experi-
for students and graduates of their programs. Fur- ences offered b!- a particular institution. Y'hile t h s
thermore, these standards paralleled the basic tenets piece ma!- not bc easily addressed in generic letters of
of Harold Gardner's multiple intelhgence theory recommendation, I hare evaluated earl!--admission
From these data, I identified ten areas of competency sophomore applicants n-ho v a n t to gain admission
that characterize the holistic quabties desired in in- through articulation agreements x-ith this element in
coming students and future professionals. mind.
Academic acconrplishments.the scientific grade Competencies in each area are ewluated based on
point average, coursework rigor, overall evidence that demonstrates the derelopment of that
coursework variety and difficult); depart- area. In general, the levels of competencies are best
mental or school-wide honors, scholarships described as follovs.
and recognition.
A'azic There is little mention or support-
I~~tellectualabifi~:
competency with, success in ing evidence of interest or devel-
and interest in lifelong learning. opment.
KOLIZCE: Evidence and references suggests
S o d intelligence: demonstration of interper- that one passi~el!; accepts the im-
sonal sldls, empathy, effective teamwork, and portance of those s l d s and is
cultural awareness (especially outside one's "learning" new tasks.
own identity). Adt~a~icedNol~ice:
While the skill has been taught, the
individual needs more practice on
Practicalintelligence:leadership, project and time his/her on7n.
management, fiscal management. PrOfinent: The individual can perform the
task satisfactorily.
Emotionalintelligence:profession&sm, ethics, Couqeterrr: The individual considers ways to
morality, emotional stability, and competency improre the task or outcome and
to self-assess and improre. makes adjustments.
E.~.er-r: The individual tests improvements
Ae~thetic
intelligence: observational and diagnostic to tasks in a systematic manner.
skills. ilrla~fe~: The individual is rccognized by
others for contributions that reflect
Killesthetic intelligence manual dexterity and fine masten- of the area.
motor shlls.
Examples of holistic evaluation
Written commtttticatiol~
skills, as evidenced by
pre-application essays, personal statement, For this article, I draw upon some fictionalized es-
and general communication. amples of comments in solicited letters of recom-
mendation or feedback from committee interviews
Oral commrrnicotion skills, as eridenced by inter- that could help me to assess an applicant's competen-
views and general communication. cies. All of these examples are composite partial pro-
files, and the intent of this document is to provide a
h%to~vleAge t h e p r d e s ~ iawareness of chal-
~ o~~: platform for discussion with frequent letter-writers,
lenges that WILI face health care and the pro- interviev evaluators, co~nlnittee letter writers, and
fession, with sensitirit!. to adjust to those adn~issions officers to determine whether these ex-
challenges on a personal, professional, and amples mould provide better insight for an adrnis-
societal level. sions decision. Vhile the possible examples can be
infinite, I have deliberately tried to provide diverse
The one other area that is also critical for admissions experiences as models, noting that many of the ex-
decisions is the question of "fit with the institution." amples can also touch more than one competency
This criteria is not a competency, but it is critical to area. Feedback is always elcom come, and a competency

3. The rdvisor
Competency-Based Holistic Evaluation of Prehealth Applicants ~ ~ o / I / ~ ; I I I ~
rating should alva!-s be rien-ed with possible error of Intellectual ability, including willingness to
one rating category hgher or lover than assigned. succeed in lifelong acquisition of knowledge
Alost of these examples corer undergraduate and re-
cent graduate applicants instead of postbaccalaureate ,e:
ATc/ji The applicant apparentlj- did really
or career-changing applicants. XI-ellin my class, though I hardly
remember llun/her connecting I-ith
Academic accomplishments others during class dscussions.
So~,ice: The applicant's lab reports were
A7c7it'e: The applicant has just begun to grammatically correct but reflect
take science-rigorous courset-ork. ven- little adclitional insight or in-
As mentioned in the personal state- terest in the main topics COI-ered
ment, the applicant has occasionally with the exercise.
vithdra~:n from courses n-hen A d ~ ~ n n c e d N o ~ i c e :In a club meeting -here -e
his/her n-orliload outside the class- brought in a cardiologist to talk
room seems to get heal-; but st111 about his/her career journey, the
believes that s/he can handle the applicant askeci questions which
challenges of a health professional reflect a desire to clarify topics
education. that were apparently confusing.
Ad~lamced o ~ ~ i c e : The applicant's science GPA stands
X Proficie~zt The applicant -as engaged in the
at 3.07 because of transitional is- course I teach on the homeless
sues that occurred in the semester community. The questions s/he
after changing from sociology to asked were probative and
biophysics as a major. So far the thoughtful.
applicant has only taken prereclui- Co71pete11f: The applicant mas inspired from
site courses with a couple of up- taking my class on cancer biology
per-level biomedical courses in epidemiology. hlany of the ques-
progress. In the last year, the tions s/he asked revealed intellec-
applicant's semester-b!.-semester tual engagement in the topic, so I
GPA has risen to 3.6 in science +as pleased when the applicant
coursevork. asked me to mentor him/her in
The applicant's difficulties freshman an independent study project.
year contribute to the 3.17 science E3,pe/per-t: The applicant has been verj- help-
GPA. Sophomore-year and be- ful in designing surveys for our
yond grades ha-e been above 3.50 psychology esperiment on interra-
each semester. cial dating and sexual behavior,
(Io//lpele/,fi The applicant has escelled in chal- and s/he has further decided to
lenging science coursevork (science take language courses in Farsi to
GPLI3.42) despite a C in first-se- develop the project further.
mester physics (calculus-based). In L 1~1.rter
l The applicant was instrumental in
fact, -hle the applicant is an art giving 1-ital feedback 11-hile writing
hlstorp major, s/he has shon-n sur- a peer-rerien-ed journal article on
psisingly little difficulty with science. more effective health comrnunica-
The applicant's outstandingperfor- tion strategies for Nspanic youth,
mance in science-rigorouscourse-m-ork ~-Ilich submitted one month ago.
was
( G P L ~ nas recent$ acknov-1-
3.62)
edged with the "outstanding or- Social intelligence
ganic chemistry student" award.
Representing our school, the appli- A-023e: The applicant keeps remarlcing
cant was finished the top score on hor- because I n-as not raised in
the team in the recent Putnam his/her famil!- that I would not
mathematics competition. understand the pressure to be-
come a doctor.

4. The Advisor
Aiolice: Yhen describing his/her role as
- PrOfiir~~t: The applicant attended the re-
president, the applicant's authority quired meetings for club treasurers
and indi~idual contributions is ap- but did -en- little to help the club
parent. Yrllat is not obvious is the request new funds for programs it
applicant's abhty to consider the intended to run.
opinions of hs/her collaborators, Co/llpete~tt: The applicant created a notebook
and he/she gets very defensive when (:hich we never had before) that
it comes to constructi~~e criticism. documented the steps taken to or-
Ad~uncedAro~'ice: f hile the applicant claims to enjoy ganize the annual awards banquet.
diverse company when it comes to The notes included comments on
group projects, the applicant pre- how to improve the process for
sents very few definitive examples the next person assigned to orga
that she knows what constitutes a nize the event.
good team versus a bad one. E.ybe?-t The applicant's answers indicate a
The applicant has been volunteer- vcrg veil-planned process of se-
ing at a local nursing home. YMe lecting a career in the health pro-
the supervisor's letter re~eals that fessions n~hile maintaining personal
the applicant seems to "work well interests outside the health profes-
with the staff" without providing sions. illternate timelines in case
much detail, the applicant does ar- the applicant were to reapply were
ticulate his/her duties at the nursing considered and evaluated.
home. A.laste7: The applicant was cited by refer-
Competent Through this exchange program, ences repeatedly for hls/her abkty
the applicant exchanged emails to multitask and address contin
with a pen pal in an Iranian sci- gencies and emergencies calmly
ence-oriented school for girls. Her and reliably. The applicant re-
description of what she learned ceived a leadership award from
about Iranian culture articulates the Office of Student Activities.
great respect for the hstory and
scientific contribution of Persia. Emotional intelligence
Expert: The applicant's dedication to build
large student support for the club's 1Yaz1x The applicant is solely focused on
Relay for Life team helped him/ doing well in class and on stan-
her attract over 30 students and dardized exams that s/he sees little
friends and collect over 92000 in reason to consider others' opinions
pledges. on alternatives.
Nouicp. The applicant responds to stressful
Practical intelligence situations by avoidmg discussion
or changng the subject. Vhile the
hTai'ue: The applicant fails to understand applicant appears remorseful, s/he
the importance of deadlines when tends to obsess over all the faults
submitting assignments. of his/her application and has not
hrozice: The applicant consistently arrives sought additional support to
late to advising appointments and handle the stress.
forgets to bring the appropriate Ah~ancedNouire: The applicant is au7are of some of
materials that would make the the resources at the college that
meeting productive. ?ill help him/her with stress man-
AdvancedhTouice: The applicant occasionally needs agement. Holverer, the applicant
and expects attention, alvays ask- appears conrinced that successful
ing others to show him/her how to practitioners would never use these
use the spectrophotometer. resources because one should
never look weak to one's peers.

5. I l ~ Advisor
e
Competency-Based Holistic Evaluation of Prehealth Applicants ro~iti~ilred
Projcitnk The applicant confides often with the Eqert The applicant's description of the
University chaplain rrhenever s/he patients s/he saw and the emo-
finds hlrn/herself doubting his/her tions he experienced by watching
abilities. B?llie reference may express how the phj-sicians consoled them
confidence in the applicant, none of mere vivid and sensitive.
the references reflects a strong role as . laster: The applicant produced a series of
a confidant or a mentor. tea kettles for a local art sho~v
which
References express confidence in n-on a "people's choice" award.
the applicant's integrity and charac-
ter in general terms. When asked Kinesthetic intelligence or dexterity
about ways that s/he ,ill manage
the stress of a professional career, Xak~e: There is no mention of the
the applicant identifies a few issues applicant's dexterity.
nrith some specific resources that A70tire: The applicant cites texting as
s/he could access. evidence of dexterity.
References enthusiastically pro- Adrwced Kol~ire: It is peculiar how the microbiol-
mote the applicant. They articulate ogy lab instructor does not ex-
with specific examples their sup- press as much confidence in the
port for thc apphcant as a mentee. applicant'sdexterity. There is little
For example, one of the profes- mention of the lab exercises that
sors' letters recalls how the appli- the applicant had to complete
cant disclosed his/her absences w h c h requircd delicate handling.
from class due to family problems. Pi-ojhe~zt: The applicant has been washing
The applicant received the dishmare and handling small tissue
Goldman award, honoring a stu- samples.
dent who best emulates the core Cotltpetent: As a co-recreational softball
values of integrity and service to- pitcher, the applicant describes
wards others. hov he/she has practiced impart-
ing spin on the ball while throwing
Aesthetic or observational intelligence to get more batters to strike out.
Eqerr: The professor discusses the
Nazue: The applicant lacks any listening applicant's output in a circuit de-
s U s when it came to the intervieni. sign class as not only being func-
Arovice: The applicant repeatedly needed tional but also economically artistic.
guidance in operating the labora- it lastet: Describing his discipline and focus
tory equipment. approaching the campus "garage
Adva~~cediVovice: The applicant's description of the band" competition, the applicant
mission trip to Nicaragua mas de- plays lead guitar for a rock band
void of details about the village which recently finished in the Final
served, the people cared for, or Four.
the diseases being treated.
The applicant describes the way Written a n d oral communications skills
the physician s/he shadowed me-
ticulousl?- look at a mammogram Xuzi .t: Responses are extremely brief, de-
to point out the location of the spite the opportumq- for the appli-
benign growths. cant to esplore his/her thoughts.
I was amazed hon. I was drawn ire:
L2'o~ Responses reflect estrcme diffi-
into the applicant's enthusiasm for culty in language skills. It is diffi-
model trains. The applicant taught cult to comprehend the applicant's
me some of the subtle differences thoughts or their organization.
and the histories each of his favor-
ite trains had. .

6. The Advisor
fi~nice:
Ad~sa~lrrd The applicant can respond to ques- The applicant realisticall!- describes
tions briefly though some difficulty the challenges facing the health care
in language slillls is discernible. system and has developed an-are-
Responses tend to provide little in- ness and sensitix-ity to how practi-
teresting information of relevance. tioners manage careers.
Profici~n~ The applicant's responses shon- The applicant's reference letter es-
satisfactor!- communications shlls. presses great tlust in the applicant
Grammar, spelling, and organiza- as a future health care practitioner
tion are generally clear despite an!- and provides extraordinary sup-
adbtional difficulties. port of the applicant's contribu-
Competeni: The applicant's responses show a tion to the profession.
relatively sophisticated level of
depth, detail, and focus when an- Discussion
swering questions.
The applicant's responses appro- Using this rubric to create my evaluation letters allows
priately acknon-ledge the evaluator me to seek specific evidence in the applicant's submit-
and convey confidence as a future ted materials - pre-application, letters of recommen-
professional. dation, interview feedback. This assists in a holistic
The applicant has received a com- evaluation of the applicant against standards that are
mendation for submitting and de- set forth by health professional programs themselves.
fending a senior project/thesis. The articulated criteria are based on the schools' poli-
cies on admission and grounded in ps)-chological re-
Knowledge of the profession search and theory Additional considerations, such as
fit with the institution or an individual's background
Nazitp: The applicant reveals little knowl- and journey to the profession, provide additional
edge of the realities of the profes- context to vien~ application. Secondly, the stan-
the
sion and shows no interest in other dards set forth in the rubric prevent me from subjec-
health care careers. tively changng r ! standards based o n the q p e of
n
Nouice: The applicant is able to articulate program to vhich'the applicant is seehng entry or the
the appeal of a health professional date when I write the letter. While I do have a tem-
career in very generic terms. plate to present an applicant in my institutional eralua-
AduanredAToz~zce: The applicant has begun to volun- tion letter, I am sure to address all of the ten compe-
teer in clinical or community set- tency areas in my final eraluation.
tings to observe hov health pro-
fessionals work with patients wvith Another advantage this rubric has is the opportunity to
various dnesses or disabilities. engage students on the concepts of competency self-
The applicant has a broad set of assessment wvhich the!- must become accustomed to in
experiences that describe how their professional practice. I present thls rubric to in-
health professionals work with pa- coming students as a n7ayfor each potential applicant to
tients. Applicant generally articu- understand how their overall character and accomplish-
lates the challenges patients and ments can be viewed. Presenting their skills in &us n7aj*
caregivers hare in the clinic or avoids the "checl&st" mentality to a certain degree and
community center. focuses attenrion more on the personal and professional
Conpetelrt: The applicant recognizes the chal- development of the applicant. In a retrospective study
lenges of a health professional of graduates from the University of Michigan, students
lifestyle in the career of choice and who have had opportunities to become comfortable
in other associated careers in the with self-assessment tools demonstrate a predictive ten-
field. There is substantial knon-1- dency to exhbit professionally acceptable behavior'. By
edge of current challenges facing having h s clear set of standards and goals, self-analysis
health care practitioners. becomes possible for an indnidual seeking to pursue a
successful career in health care ser~lce establish ap-
and
propriate goals to address an!- areas of deficiency

7. The Advisor jt~ne2009
Competency-Based Holistic Evaluation of Prehealth Applicants co/iti//ued
Acknowledgements (XACOhl), AIelinda hIaris (formerly Johns Hopkins
University), and Michael Druitt (Hampton Univer-
hluch of the work that I did for this rubric mould not sity). I thank the admissions administrators and com-
have been possible without the help of Dr. Laurie mittees who may have reviewed the rubric online
Fathe (former director of the GAIU Center for when evaluating GhfU-associated candidates.
Teaching Excellence) and Ms. Mary Zamon (Office
of Institutional Assessment). Much of the discus- References
sion was sparked by the National Postdoctoral Asso-
ciation Subcommittee for Core Competencies, with ' Harduarsingh, Liebonltz, and Rodurtha. Prehealth students' re-
ceptivit!- to el-aluation b!- ACGAIE competencies. Tl~e
Adl,isor27
many valuable discussions chaired by Dr. Joan
(2): 21-26, June 2007.
Chesney (St. Jude's Medcal Center) and other mem-
bers of the committee. Discussions and informal ' Stern, Frohna, and Gruppen. The prediction of professional
reviews of this rubric were made by Gina Moses 2005; 39: 75-82.
behavior. ,iediraJEdticatio~r