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UC Davis Health System Application for UC Sautter Award

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1 UC Davis Health System Application for UC Sautter Award
April 27, 2009 Admissions Software for School of Medicine ‘Longitudinal Application/Student/Alumni Record for UCD SOM’ Health Science Support System HS3

2 Application for 2008 University of California Larry L
Application for 2008 University of California Larry L. Sautter Award for Innovation in Information Technology Date: April 27, 2009 Project Title: Admissions Software for UC Davis School of Medicine Submitted: Michael Minear, Chief Information Officer Phone: (916) Table of Contents Project Overview Process Assessment and design………………………18 Software development…………………………………..36 Project outcomes……………………………………………42 Appendix – Software application-examples…..52

3 To take on the challenge, first create a Partnership
Project Overview To take on the challenge, first create a Partnership

4 Summary This project focused on the admissions and associated processes used to manage the UC Davis School of Medicine Over many years, the processes in UCD SOM evolved similar to most organizations They were created by many people over many years Tasks were defined to meet a goal, and were often not changed as requirements or best practices for that task evolved over time Software was applied to the SOM process in a scattered non-integrated fashion without a core strategy or architecture Work tasks and processes were supported by some technology and lots of paper A new way of approaching these challenges was started – the foundation being a partnership between all people & roles in the medical school and support functions such as information technology Processes were formally analyzed and an optimal process was designed, with much input from across the SOM

5 Summary (continued) New software was created to deliver the improved processes designed The new process and software has been implemented in a ‘just in time’ approach to be able to deliver improvements to the current admissions cycle and to provide students, faculty, and staff with improved technology as soon as possible The project has been very different that any other approach attempted at the UC Davis Health System The outcome of the project has been successful beyond the wildest dreams of all involved This approach to obsolete work processes and non-integrated technology is being used with other challenges at the UCDHS

6 Challenge for UC Davis School of Medicine
In late 2007, the leadership of the UCD School of Medicine identified the admissions process and associated support processes and tasks to be nearing a crisis point Admissions to UCD SOM was frustrating applicants so much that it was severely impacting admissions to the school High quality candidates, many who said UCD SOM was their first choice - were taking offers from other SOM as they had many other offers in hand, but had not yet heard from UCD UCD SOM’s admission process was slow, non automated, and frustrating Looking inward, SOM leadership saw massive duplication of effort many inefficiencies in daily tasks for staff, faculty, and students lack of basic data about the status of annual student admissions and other key issues poor deployment and use of information technology time delays massive amounts of paper …something had to be done

7 Paper, Paper, Paper…everywhere
Paper files for one years worth of SOM admissions! 5000+ applicants annually Office of SOM Registrar – Academic Files

8 No off site storage of current or archived paper documents!
More Paper… No off site storage of current or archived paper documents! Student Financial Aid files (double sided cabinets) Many SOM Registrar paper forms for students 4th year flight plans (student study plans) tracked in only in these binders

9 Dependency on Excel to store critical data
Excel is heavily used in all aspects of current processes Groups depend on Excel for their “class lists” Due to lack of an integrated system, Financial Aid relies heavily on Excel Over 17,000 Excel files located on server supporting the School of Medicine Impact of using Excel Many are a duplication of effort Data quality impossible to manage Human error can destroy data Process becomes inherently labor intensive Reuse of data is essentially impossible Most financial data was tracked in Excel spreadsheets.

10 Many Paper Forms were Embedded throughout the Process
Paper based 4th year flight plan (study plans) Students must hand carry to each department for approval Takes students many hours or even days to complete

11 Few Policies or Guidelines are Formalized
The process and software used to support the SOM process will only be as good as the level of common policies & guidelines, and the support/adherence by all At the current time deadlines and due dates not regularly adhered to The impact of policy in-formality Time and work flow transitions turn in road block and delays Data integrity at risk Massive duplication of effort Data difficult to access Data quality difficult to measure Et cetera…

12 Most Painful Processes Elements
Admissions Current gaps are a serious and growing barrier to student recruitment Using software elements that are 10+ years old (not web based) Paper dominates admission tasks and is a nightmare for all Photocopies made for each interview and committee member Over 147,000 pages of paper (~300 reams of paper) copied and delivered during each admissions cycle - Not Green! 4th year scheduling challenges Tracking students through 4th year electives 25 different Department Coordinators Communication of the availability of 4th year electives Students have to hand-carry forms to departments Start of 4th year scheduling overlaps with departments availability due to residency programs Financial Aid Most data records exist in Excel only Not integrated with any databases 17 Reams of Copy Paper Equals 1 Tree Image and statement from:

13 Day to Day Reality… Final grades available two months AFTER a student graduates Ethnicity report data is NOT consistent between Registrar, Admissions, Financial Aid, Banner & Student Information System Suboptimal process design and software support negatively effects all audiences – student, staff, and & faculty Reactive versus proactive Data consistency not present due to each group managing their own documents and files No centralized data warehouse Data integrity issues due to operational independence School of Medicine Departments Office of Medical Education Lack overall viewpoint of process, data, operational issues Student performance over time Curriculum planning and assessment Communication Ability to assess and manage Built-in challenges to collect data for accreditation

14 Unique Aspects of Admissions for a School of Medicine
One of the unique aspects of supporting the admissions process for a SOM is the AMCAS service and data set “The American Medical College Application Service (AMCAS) is a non-profit, centralized application processing service for applicants to the first-year entering classes at participating U.S. medical schools For the 2010 entering class, most medical schools are participating in AMCAS AMCAS does not render any admission decisions and does not advise applicants where to apply. Each participating school is completely autonomous in reaching its admissions decisions. AMCAS provides only the application processing service. The AAMC and AMCAS neither endorse, nor have any relationship to, commercial counseling services concerned with admission to either U.S. or foreign medical schools. Regardless of the number of AMCAS schools to which you apply, you submit just one application to AMCAS via the Web. You must also request an official transcript from each college of registration in the United States and Canada. AMCAS then assembles your application file, verifies it and forwards the application to your designated medical schools. AMCAS also sends your MCAT scores for tests taken since April 1991, provided you have released them to AMCAS.” (1) (1) AMCAS web site,

15 AMCAS Application Web Site
AMCAS 2010 Instructions, © 2009 AAMC,

16 UCD SOM AMCAS Reality The AMCAS data set is invaluable for any American SOM, as all applicant information is available in a high quality, consistent, and documented digital format However, due to the lack of effective information technology, in the IS process, the SOM was accepting digital copies of these student records, Printing them onto paper, and then moving them around within the paper application files to support faculty review The AMCAS data had to be manually entered into many existing databases or spreadsheets As part of applicant review, 147,000 pieces of paper was being created each and every year! It was painfully obvious that the UCD SOM needed to take advantage of this digital data… and enter the digital age

17 Growing risk of losing exceptional Medical School applicants
Strategic Impact Growing risk of losing exceptional Medical School applicants Non-automated admissions process Focus on priority issues & tasks suffers due to rework and wasted time Students Flight Plan (study plan) scheduling Faculty Admission process and evaluations Staff Course Scheduling, reporting, access to management data Poor stewardship of critical data Potential to lose valuable data when stored on local desktop/laptop computers Integrity of privately held data Inaccurate data/reports due to separate systems and data locations Risk of losing of paper documents due to fire or theft Lost potential – Student data resource Poor data quality Data can not be queried Becomes a barrier for almost every task Strategic Goals difficult to support Ongoing assessment and data access for planning, management, and accreditation

18 Project Vision

19 Project Vision and Plan
The SOM would stop deploying niche software applications, Excel files, and Microsoft Access databases Would create an integrated technology approach All efforts were stopped to deploy more niche software or local databases These efforts were only making the problem worse Rather than first deploy software and hope it helped, the typical approach for many years, Information Technology and SOM leadership would partner to investigate and understand the needs of the organization Detailed work processes and requirements would be assessed and documented, and a new optimal process created Only after the requirements were fully understood and documented would software design or development occur

20 All data and process steps must be designed in an integrated fashion
Vision of new Approach All data and process steps must be designed in an integrated fashion Paper must be eliminated SOM must become part of the digital age An integrated data architecture should be adopted The needs of all SOM roles and constituencies must be served: applicant, student, staff, faculty, and alumni Unique opportunity exists to simplify and enhance all support processes and technology support for SOM And by doing so, prepare for the new School of Nursing and future School of Public Health

21 Project Guiding Principles
1 Project Guiding Principles SOM and IT leadership formed a new partnership and defined shared guiding principles Inclusiveness Address the entire education process Design process & technology that will also support the SON and SPH Change Seek dramatic change in all required improvements – not incremental change Data integration Create a single data repository and integrated all relevant data Don’t duplicate data Transparency Ensure data that should be shared and available is accessible Process of design and software support is fully communicated and all relevant people and roles have full input Confidentiality Adequately support student and organizational confidentiality Regulation & accreditation Ensure all issues are incorporated and addressed for UCDHS to be compliant with regulations and accreditation guidelines Fully support AMCAS and other all relevant data standards

22 Project Guiding Principles
2 Project Guiding Principles Become Fully Digital Fully eliminate paper in the Educational process Service Every participant in the process and using the technology is adequately supported Excellence Support excellence in every task and over all SOM performance Adequate communication Link people, departments, and processes Sustainable Process and software affordable and delivers a long term solution Data fully accessible Within desirable security parameters; all students, faculty, and staff have appropriate access to all relevant data System usage System usage and performance will be measured and monitored for problem assessment and improvement

23 Any Technology Deployed Must Service Multiple Dimensions and Constituencies
All technologies deployed to support education must be designed and supported to ensure the needs of multiple requirements and constituencies are understood and supported Faculty Students Administration Regulatory Accreditation Compliance Security and privacy The list of constituencies is not in priority order; all of these groups / requirements must be met for the any system to successfully support education

24 Process Assessment and Design
Assess your situation fully, and then design where you want to be…

25 Scope of Initial Assessment Project
Integrated, multi competency team was created to investigate and document the IS process 4 IT staff supported process mapping and documentation efforts Alisa Hsiu - database administrator, Jason Dohrn-systems administrator, Mark Carroll - Assistant Director, Recruitment and Retention, Health Informatics Graduate Program, Dan Cotton - Manager Educational Technology 7-10 SOM staff, leaders, and faculty, including; Mark Henderson M.D., Associate Dean for Admissions, Gurmeet Rai, Manager for Office of Medical Education, Ed Dagang, Admissions Coordinator, Lanina Sanders, Admissions Coordinator, Terri Hall, Admissions Coordinator 12+ Office of Medical Education groups interviewed Joint group began interviewing SOM staff on 1/28/08 4+ meetings per day, included department managers, supervisors and key personnel Documented and gained understanding of “IS” process (current state) Created process models and meta process maps 69 process models created Collected various sample documents from department groups Utilized online collaborative tool to store information and documents collected

26 Understanding and Creating the IS Process
Using process assessment methodologies, the joint IT and SOM team fully researched the way ‘things are done at the current time' or the IS process Documents how things really work How each task is done What content (paper or automated) is used Defines the total information flow Investigates all forms of software used (databases, spreadsheets, applications, , everything) Inventories all paper forms Listen to all staff to understand the barriers and problems they have to perform their jobs When the IS process is finally fully understood, it can be very humbling, and often the people doing the work stand back from the process map and wonder ‘how do we ever get anything done?’

27 The IS Process Map – the ‘current state’ Process
Reduced version of the SOM IS Process map. The process map has vertical ‘swim lanes that show each ‘actor’ or role in the SOM (typically a department). The process map starts at the left (with a candidate applying to the SOM, and flows to the right as work is performed. The map ends on the far right with tasks to support alumni. The meta process map represents the beginning, the end, and everything in between that the SOM does. It is divided into major sections documenting the admissions element and the four years of medical school. The pie charts show all of the different types of content (Excel, paper, , software applications…) When printed on large paper, this IS process map is 10 feet long…

28 Content used by SOM staff in the IS Process
In addition to task and process steps, a complete inventory of current different types of content (Excel, paper, , software applications…) The assessment found an amazing array of different content types, and very little integration The more colorful the pie chart is, the less integrated the content is, and more difficult for staff and faculty to use

29 Summary of Discovery – initial assessment and creation of the IS process map
Applicants had to submit paper based information and mail checks for application fees Identified 68+ processes dealing with student information Over 17,000 Excel spreadsheets with data (on server) Not stored in a single location (folders) Data stored on desktops and laptops – SECURITY ISSUE! No standardized backup protocols for desktops, laptops – SECURITY ISSUE! 9 separate databases – None are integrated Admissions alone generates 147,000 pages of paper each admissions cycle Wide spread duplication of data entry Student roster sheets, schedules, financial aid documents (mostly in Excel) In 2008 SOM processes are still manual and labor intensive In 3rd and 4th year managing paper becomes more challenging as 25 clinical departments are involved Each of the 25 clinical departments has their own process

30 The SHOULD process defines how the SOM should perform its work
Once the current state or IS process is investigated and documented, work began to design the SHOULD or the preferred state of the SOM process The SHOULD process defines how the SOM should perform its work What if…could start from scratch and define how things are done? What if…we could design our work around best practices? What if…we had the perfect software? What if…all content was available when needed in the form required to optimally perform a task? What if…we did a task ‘the way it should be done’ rather than ‘we have always done it this way…’ What if…we did not have any paper to shuffle? What if…we created data one time, and appropriately re-used that data from that point on…rather than every person, every task, and every department re-creating the same data over and over again? What if…our work was fully documented and fully understood by all?

31 Was designed by SOM staff and faculty that do the work every day
The SHOULD Process Was designed by SOM staff and faculty that do the work every day Input was sought from students, leadership, and others who interact with the SOM Best practice was used for all aspects of the design A fully digital work process was assumed and designed The process map was not complete until all open issues were covered and resolved One representation of the SHOULD process is shown on the next four pages When printed on large paper, this SHOULD process map is 27 feet long…

32 1 The SHOULD Process Map

33 2 SHOULD Process Map

34 3 SHOULD Process Map

35 4 SHOULD Process Map

36 Software Development

37 A Unique Approach to Software Development
Once the SHOULD process was completed, it was time to design and write the software application to support the optimal process IS process completed in April 2008 SHOULD process completed in July 2008 But the reality of SOM student admissions annual cycle, is that work for the 2010 class would start in June 2008 Without new software to support the SHOULD process, another entire admissions cycle would have to be done with the IS process and poorly performing information technology So…while fully understanding the risk of this approach; Information Technology leadership offered to build the system during the 2010 admissions cycle, and create just in-time application modules, so SOM faculty and staff could use the new SHOULD process supported with new technology Work on the new software application started in May 2008 with only a partial SHOULD process map completed Image from -

38 Technology Assumptions
Health Science Support System HS3 Build and Buy approach Technology Foundation Oracle SQL database / Linux server Onbase Document Management System/Windows server Fully integrated into overall SOM support application Assume same as would be used in Dean’s office Development software suite Integrated JAVA development environment Oracle development tools Key Design Attributes Pure Internet User Interface Theme: all data entered once and reused many times Hardest elements to write: Exam and evaluation sub-applications Use Extreme Programming – agile style design & build approach Rapid development cycle and paired programmer approach Assume reuse of curriculum database and course management modules Assume 4-6 FTE Developers Internal team started work on the new technology on 5/15/08 Assume 9 – 15 month total time to build/test/train/deploy First online admission component ready by August 2008 Very tight week total time

39 Software Development Status – April 2009
Initial software modules completed by August 2008 and placed into production The admissions cycle of 2010 began in the summer of 2008 using the newly designed SHOULD process, and was fully digital using the new software designed to support the SHOULD process The new SOM software application continues to be built in a modular fashion, with software functionality being delivered ‘just in time’ to support students, faculty, and staff – as they work their way through the SHOULD admissions process The 2011 admissions cycle will start with all software application components in place Enhancements will continue to be delivered

40 New Online Dashboard – Real Time Statistics on the Entire Admissions Process
Invaluable real-time data with status on the entire admissions process SOM leadership now know up to the minute statistics such as; # of applications received # students passed screening criteria, # of students did not pass # of application letters received # applications pending decisions And many more…

41 Admissions – New Software Features
Direct data feed from AMCAS No more re-keying of applicant data Applicants initial processing completed in minutes Applicants notified within 5 minutes of need to complete Secondary Application with UCD Initial applicant screening now done 100% paperless Screeners have access to online AMCAS data report, Supplemental application and letter of recommendation Applicants have ability to self register for selected interview dates online Onsite interviewers have access to online applicant information No Paper Generated! No staff time photocopying applicant packet No departmental reprographic costs No risk of “misplaced” applicant packet containing identifiable information Credit card payments now supported

42 Project Outcomes Results to date

43 Data Points Demonstrating Impact of New Process and Software
Old Process & Technology Used for many years New Process and Software Class of 2009 Admissions Cycle AMCAS data printed and manually inserted to paper files Student paper applications are sorted and manually inserted to paper files 147,000 pieces of paper created and moved for each annual admissions process 2,200 paper checks processed each admissions cycle Interviewer evaluation process was impossible to evaluate for consistency, fairness, and completeness The old admissions cycle took 13 months to complete, long after most other SOMs had offered candidates positions Candidate data was often not available when needed; often decisions were made without complete and consistent data Paper and online files rarely backed up Candidates had to phone or to seek the status of their application AMCAS data automatically loaded to new SOM database Any other student application data self loaded from web site Initial applicant screening now done 100% paperless 1 paper check processes, all other payments fully electronic Online metrics available real-time for all applicant reviewers and outcomes The process now takes 7-9 months and could be even quicker on the next and future cycles All candidate data is available real-time for all SOM faculty/staff System automatically backed up – all content is protected Students now have online access to real-time data on the status of their application

44 Faster Process Cycle Time Creates Strategic Value
UCD SOM loses best applicants Old process UCD SOM competes for best applicants New process For the next admissions cycle (2010) It is anticipated that interviews COULD actually start in July, speeding up The process again by six months! Students offers completed 4-5 months earlier… while receiving applications 2 months longer Initial screening and interviews completed 6-7 months earlier

45 Student Applications have Real-time for Data Input and Viewing Status
The first student-facing web site was turned on July 15, 2008 Just after the first automatic generated went to applicants telling them they had passed the first screening filter, and they needed to submit the additional information about themselves… Within 5-10 minutes there were students already on the new web site entering in the additional data requested Students can check their status 24 x 7 – and they use this capability!

46 Comments from Faculty “The development and implementation of HS3 has revolutionized nearly all aspects of the admissions process. The process mapping uncovered multiple areas of duplication, inefficiency, waste, and potential breeches of security in our process. The prior process was characterized by lack of data and hence, poorly informed decisions, unacceptable delays associated with the paper process, and marked heterogeneity in the way applications were handled by individual screeners, interviewers, admissions office staff, and selection committees. The rapid deployment and technical support of the IT team has allowed us to take immeasurable steps forward in terms of security, efficiency, fairness, ease-of-use for faculty (e.g. web-based access from anywhere), and a more data-driven process including real-time surveys of all applicants that allow continuous quality improvement. With future enhancements, we will be able to give concrete feedback to all individuals and committees in the process (e.g. rating behavior of all screeners and interviewers), and correlate admissions parameters with other longitudinal aspects of subsequent academic and clinical performance, which will ultimately enhance the quality of these high-stakes decisions and provide research into an poorly studied aspect of medical education. In my opinion, this has been an extremely worthwhile if not visionary investment on the part of UCD.” Mark C. Henderson, MD, FACP, Associate Dean for Admissions, Residency Program Director, Department of Internal Medicine, UC Davis School of Medicine

47 Comments from Staff “As the Director of Admissions for the School of Medicine for over 17 years, the opportunity to go "GREEN" is a blessing. Going "paperless" was long overdue. Recognizing the aches and pains that come with a new and imperfect system was worth the scratches and bruises in the program's earlier stages, shapes and forms. In all honesty, I cannot wait for the next admission cycle to begin in order to utilize the "new and improved" version. Customer satisfaction (i.e. the applicants, faculty, medical students, and administration) will surpass the impressions of the program's first version. Overall, I have seen a increase in productivity by all those involved in this complicated process and see the benefits of the new system for future applicants and the success of the SOM to select, interview and admit the best applicants from a pool of thousands. I appreciated the team approach in the program's development and the responsiveness of the technology crew in making improvements as the system was underway. It would not come as any surprise to me if the e-admissions program at UC Davis School of Medicine becomes the standard or model of e-process programs at our sister UC medical schools in the future.” Edward D.Dagang, Director of Admissions & Outreach, UCD School of Medicine

48 Comments from Faculty “This single new use of technology in our education mission was the first step in a culture change that not only helped us be more responsive to prospective students but also emphasized to our heath system our commitment to the environment” Ann Bonham, Ph.D. was UCD SOM Executive Associate Dean for Academic Affairs when this project started, and was a key supporter of the project. Ann will start in July of 2009 as the Chief Scientific Officer of the Association of American Medical Colleges (AAMC) "The UC Davis School of Medicine's new electronic admission process is amazing. It is really nice to have access to information about an applicant without needing to sort through stacks of papers. It is also great to be able look up information quickly during the meetings themselves. This allows for more efficient viewing and tracking of an applicant's information. Furthermore, even in this first year, the system keeps improving to meet the users' and school's needs. For example, in screening for interviews, it is now much easier to compare applicants on a variety of different criteria. That type of information was not even systematically available in the old paper based format. It has made my job much easier." Karnjit Johl M.D., Assistant Professor, Hospitalist Section, Department of Internal Medicine

49 Comments from Staff “The new Health Science Student System or HS3 is going to help make us more efficient (operation, communication, management), improve service to current and prospective students, and provide necessary tools to track our students from admissions to graduation for evaluation purposes. The new admission system has transformed the entire admission process and dramatically improved our service to prospective students. Everything from assigning faculty roles to reviewing applicant file is done online with real-time tracking that help admissions staff enhance our management of approx 5,000 files we process every year. Applicants are able to submit admission application, complete secondary application, schedule interview, and follow their application status online throughout the process including accept final offer online. While we started late this year due to the system being built, as of March we are ahead of prior years schedule. Our projection for next year’s cycle is that screening will begin in July, interviews in September (we won’t have to compete with residency interviews for faculty time), and offers will be made starting in October. This will help further improve our service to prospective students and help us better compete with other schools as our timing will be ahead of most medical schools.” Gurmeet "Roy" Rai, M.B.A., Manager, Office of Medical Education, UCD School of Medicine

50 Comments from Staff “The on-line system has given my faculty and students easy access to applicant files, interview times, a summary of who they have interviewed and allows them to track the applicants process through the system. The system saves me time by sending reminder s to interviewers and applicants. It also allows applicants to easily choose the best interview date for them. It has cut down on phone calls, confusion and needless paper photocopies. It has allowed me to focus on other important areas of my job without feeling bombarded with questions and calls about the admissions system. It was easy to train my faculty on the system and I love being able to find information quickly about applicant status, contact information or daily schedules.” Rebecca Miller, Rural-PRIME Coordinator “All in all I really liked the way the program stream-lined the process applications are available to the members so I didn't have to worry about the mail, WHAT A RELIEF!!!!!!!” Terri Hall, Office of Admissions Asst. “There were no paper files to create and maintain.” Lanina Sanders, Office of Admsisions Asst.

51 Staff Comments – IT Manager that Provides Direct Support to UCD SOM
"Because the previous processes were by and large paper based the impact on IT was minimal. However the Admissions office did utilize a 10 year software package that was developed in house, given the language the tool was written in we were not in a position to alter the program to keep pace with changing business needs. In addition, each year we had to copy the previous years database over for the incoming year. We were left with many databases that were not linked, they were not web based and required IT staff to install the software on each person’s workstation. With the new software tool, it is all web based, there is not client to install, the data is all integrated and substantially more secure. This makes the effort of reporting on data more efficient. The old application had minimal data points collected along the way and detailed and granular reporting on the admissions process itself was nearly impossible. With the level of data we are now capturing we are able to provide very detailed metrics to the admissions staff to better aid them in the overall admissions process.” Dan Cotton, Manager Educational Technology, UCDHS

52 Appendix Software Application – Examples
Results to date

53 UC Davis School of Medicine Admissions Internet Page

54 Applicant Log-in to New Software Application

55 Faculty Tool – Full online Screening of all Applications
The new process and software is not just for students – all of the staff and faculty work to assess and interview students is also fully automated – and all content fully integrated

56 Online Dashboard for Faculty - Applicant Screening Detail

57 Applicant Interview Detail – Quick Access to All Applicant Data

58 Dashboard – Status Acceptance offered to Applicants

59 Admissions Dean Dashboard

60 Program Director Dashboard

61 Admissions Director Dashboard

62 Selection Committee Dashboard – Interviews

63 Selection Committee Dashboard – Applicant Selections

64 Faculty Screener Dashboard

65 Dashboard – Applicant MCAT/GPA Summary

66 Applicant Comments View – All Data Collected on Applicants is Online

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