Flourishing and the Future of US Medical School Admissions

US medical school admissions have been under increasing pressure from state and federal governments, while contending with the implications of the 2023 US Supreme Court decision that ended race-conscious admissions. Change is necessary, but few have offered ideas for how best to proceed. In this article, we first review past eras of US medical school admissions. We describe the establishment of standardized admissions processes, which maintained a largely uniform medical student demographic of more than 90% white men through the first half of the 20th century. Subsequent changes in US society and federal government policies began to push for demographic diversity in medical schools in the 1960s. While the language used to describe the diversity focus shifted from affirmative action to race-conscious admissions to holistic review, the goals remained the same and have not been achieved to date. We then consider the future of medical school admissions as guided by the concept of human flourishing, based on Aristotle's depiction of eudaimonia as the highest human good. Flourishing has been gaining momentum and relevance globally in education and healthcare. Flourishing-guided admissions may offer a new paradigm that enables medicine to proactively define its admissions policies rather than deferring to US federal and state policies. Flourishing is an integrative concept that emphasizes relationships between individuals and communities; it can reduce emphasis on individual and institutional competition to better align admissions practices with system and societal needs. We suggest options for implementing flourishing-guided principles at the levels of admissions committees, institutional structures, and broader partnerships. Re-orienting medical school admissions toward human flourishing could link ageless ideas with contemporary needs.