Medical schools have always subjected applicants’ academic records to close scrutiny. Now, more are starting to look at criminal records.

Several institutions recently started --  or will soon start -- criminal background checks of those accepted to medical school. The checks have two purposes: to help students whose previous crimes mean they must go through certain programs before they can get a medical license and to keep out of medical school applicants whose crimes are deemed too serious to be eligible.

With more state legislatures requiring background checks for medical students, the Association of American Medical Colleges' Executive Council last month recommended that medical schools require background checks of all accepted applicants. According to the AAMC, 18 of the 86 medical schools that responded when asked recently said they are already conducting checks. Others said that they would soon start checks that will likely bar most students with felony convictions from enrolling in medical school.

After a state legislator introduced a bill that would require checks on all medical students in North Carolina, Wake Forest University decided it will begin a program that it hopes will be up and running within a few years. Wake Forest already required checks for its physician’s assistant program, but now will extend that to medical students.

Twenty-two state medical boards have the legislative authority to conduct background checks for a doctor to get a license, and North Carolina’s board is one of them. “It would be kind of a shame if a student went all the way through medical school and then had something in their background that precluded them getting a license,” said Robert Conn, spokesman for the Wake Forest University Baptist Medical Center.

The Dallas-based Federation of State Medical Boards expects more boards to gain the right to do background checks because “it’s a public protection issue,” said Dale L. Austin, senior vice president and chief operating officer of the federation.

Ohio State University’s College of Medicine and Public Health just completed its first year with background checks. Incoming students are given the chance for self-disclosure, and then university security checks their criminal backgrounds, and that of every enrolled student each year. If a previous crime is unearthed, the case is handed to a special counselor. The counselor helps students get whatever documentation that they will need to be eligible for residency. “It’s really not a witch hunt,” said Daniel Clinchot, associate dean for clinical education.

“The students face a background check to become a resident anyway. This gives them a chance to get the necessary material together in case they had a DUI or something like that. They have to show they went through an alcohol program.”

Incoming students have to pay between $15 and $39 for the check, which uses data from various law enforcement agencies, including the Federal Bureau of Investigation. After the initial check, Ohio State picks up the tab. If a check reveals felony convictions, sex crimes, or child endangerment, a student may be blocked from enrolling, or asked to leave. With the first year of checks done, Clinchot said several minor things came up, but nothing that forced anybody out of the college. He also said that, though faculty members initially worried that students would feel the checks were an invasion of privacy, they were “uniformally well received,” he said. “That was a little bit of a surprise to us.”

According to 2003 self-reporting survey by the American Medical Application Service, 201 of the 34,000 applicants who used the service reported felony convictions. Of those 201, 199 were not allowed to enroll in medical school.

Leana Wen, national president of the American Medical Student Association, does not think that minor infractions should keep people out of medical school, but supports the notion of using background checks as part of a character evaluation. "The larger question is about ethics overall," said Wen, a medical student at Washington University in St. Louis. “Any of us who have gone to med school know people who have lied and cheated. We think med schools should screen for qualities of professionalism in each individual in general. Criminal background may be part of that process.”

In Minnesota, the state requires any person in the health-care industry to undergo a background check. For the last decade, the state has paid for every student at the University of Minnesota Medical School to undergo a background check. Only in the first year were any flags raised, and only for a handful of students. “They were for things that were a long time ago that they thought they had taken care of, and they appealed successfully,” said Helene Horwitz, associate dean for student affairs.

High profile incidents, like a 2004 murder-suicide by a University of Arkansas medical student, may have prompted some schools to get programs going. Horwitz said several attention grabbing events prompted the requirement in Minnesota. “From a pragmatic standpoint, our experience hasn’t indicated any great need, but from a public confidence perspective, there’s a strong argument for going ahead," she said.