A holistic review process therefore emphasizes attributes, including learning ability, that are associated with excellence in physicians. Applicants are evaluated according to criteria that are institution-specific, mission-driven, broad-based, and applied consistently across the entire applicant pool at a given school. Holistic review does not abandon the assessment of aptitude in science. Rather, it places such measures in the broader context of the applicant’s life experiences, with a particular focus on adversities overcome, challenges faced, advantages and opportunities encountered, and the applicant’s demonstrated resilience in the face of difficult circumstances. Each factor, be it the undergraduate grade-point average (GPA), the MCAT score, or the leadership roles assumed in volunteer service organizations, is evaluated in the context of the complete portfolio of information available about the applicant. That is, a given level of accomplishment for one applicant may look very different in the context of another applicant with a different life story. Medical schools have many more qualified applicants than they can realistically interview, so holistic principles must be applied from the initial screening through the entire admissions process for their desired effect to be realized. The imperative for a diverse physician workforce in an increasingly diverse society is one important driver of the move to take a more expansive view of excellence in medical student selection. This more comprehensive approach to considering a multitude of factors in evaluating all applicants provides a context for the inclusion of race, ethnic background, language, culture, and heritage, among other factors, in a way that is educationally sound and legally viable. The AAMC’s Experience–Attributes–Metrics Model includes consideration of many dimensions of applicants, broadening the context in which their development, accomplishments, and potential can be evaluated. The metrics include grade trends in addition to the usual GPA and MCAT scores; attributes range from fields of interest, intellectual curiosity, and maturity to languages spoken, gender identity, and family status; and experiences may include everything from education and research to general life experiences. In 2003, the Boston University School of Medicine (BUSM) became one of a number of US medical schools to launch a systematic transition from a traditional admissions model based largely on the review of academic metrics to a comprehensive, holistic review process. It was a slow and deliberative transition, but by 2008, changes in the BUSM admissions program were clear and substantial, and the effects were evident in the entering class of 2009. The BUSM Committee on Admissions first developed a mission statement for itself that reflected the concepts in the institutional mission statement and then created a set of decision-support tools using performance metrics, characteristics, and behaviors that are identified in that mission and used in a clearly defined and universally applied manner. The table shows one such tool: a list of desirable traits for physicians matched with the elements of applicant data that reveal or predict those traits. Direct measures of these traits are often unavailable, so proxies are used. Holistic review is an information-hungry process; electronic processing greatly facilitates both the application and the evaluation of the program. Experiences, attributes, and academic metrics are evaluated and scored in a systematic and consistent manner across the entire applicant pool, with due consideration to the demonstrated validity of various criteria in predicting success in both medical school and …