Admissions Policies of the Jacobs School of Medicine and Biomedical Sciences

Policy Review History:

Policy Preface Faculty Council Approved—04/29/2020
Policy Faculty Council approved—08/27/2014, 01/31/2018, 08/31/2018
Policy Faculty Council revision approved—02/28/2019, 08/28/2024, 06/25/2025
Technical Standards Faculty Council approved—01/25/2017

In view of the extraordinary challenges posed by the pandemic to undergraduate institutions and with ongoing commitment to our holistic review process for all applicants to the Jacobs School, we agree to the following time-limited changes to the admissions policies and practices of our School.

• Online Courses: Our current admissions policy explicitly states that prerequisite courses should be completed in a classroom setting and that laboratory coursework must be completed in an actual – not virtual or online – setting. However, due to the Covid-19 pandemic and the challenges of holding in-person classes, the Jacobs School will accept online coursework from spring and summer 2020 semesters as well as give consideration to those for the 20-21 academic year.
• Pass/Fail Grades: The admissions committee prefers that grades for prerequisite coursework be letter graded. According to AAMC, two thirds of undergraduate schools adopted variations of a pass/fail grading system for the spring semester of 2020; therefore, we will accept pass/fail grades without prejudice for this semester.

The mission of the Jacobs School of Medicine and Biomedical Sciences (Jacobs School), University at Buffalo is “to advance health and wellness across the life span for the people of New York and the world through the education of tomorrow’s leaders in health care and biomedical sciences, innovative research and outstanding clinical care”.

The admissions policy of the Jacobs School of Medicine and Biomedical Sciences (Jacobs School) serves as the cornerstone for achieving our mission through admission of a diverse class of highly qualified individuals, of the highest integrity and ethical standards, who will become the next generation of competent physicians, medical educators and clinical investigators.

The Jacobs School embraces diversity as a core value embodying inclusiveness, mutual respect for persons of all backgrounds, heritages, races, and ages. Our goal is to recruit a class that brings a wide variety of life experiences, personal interests and academic achievements. We believe that student diversity enriches the learning environment, advances student performance, and contributes to the health of the citizens of Western New York and beyond.  

To achieve diversity in medical admissions the Jacobs School employs a holistic review process.  Holistic review provides a means to tailor the individualized assessment of an applicant's capabilities through balanced consideration of life experiences, attributes, and academic metrics that when considered in combination, predict how the individual might contribute value as a medical student and physician.

In making admission decisions, the Jacobs School does not discriminate on the basis of race, age, ethnicity, gender or sexual minority, religion, sexual orientation, disability, or military service. Further, the Jacobs School complies with the diversity policies of the University at Buffalo, and all state and federal laws.

Assessment criteria focus on essential and unique attributes that include, but are not limited to, academic and personal achievement, intellectual curiosity, industriousness, obstacles overcome, commitment to service, compassion, personal integrity, communication skills, potential for leadership and unique personal characteristics.  Each entering class is selected from the total applicant pool to include individuals whose credentials indicate their dual capacity to meet the rigorous training requirements of medical school and to contribute to the diverse learning environment of their fellow students and ultimately to the diverse practice environment of the population served.

Since the Jacobs School is funded by the taxpayers of the State of New York, when qualifications are equivalent, preference is given to New York State residents, particularly to those residing in Western New York.

The Jacobs School employs a three-step process for selecting the medical class. Each step is performed independently.

In the first step, all applicants are holistically evaluated to determine their suitability and readiness for medical training. Dossiers are reviewed to select those applicants who will be invited for personal interview. In order to be selected for an interview, an applicant must provide compelling evidence that they possess those attributes that are considered essential for successful careers in medicine as well as unique attributes and experiences that are likely to add diversity to both the learning and practice cultures of medicine.

In the second step, interviews are conducted to explore, in detail, the applicant’s unique potential to bring quality and diversity to the class and the Jacobs School. These interviews are blinded to all metrics, such as GPA or MCAT scores. The interview results in a narrative assessment of the applicant’s likelihood to meet the training and diversity goals of the Jacobs School.

In the third step, a summary review of all interviewed candidates is conducted and a medical class is selected for admission. The rationale for the final step is based on the fact that all candidates selected for interview are academically qualified based on historical academic performance norms for the Jacobs School. Accordingly, it is the unique potential of individuals in the interview pool that provides the basis for selecting a diverse medical class that meets the overall mission, goals and values of the Jacobs School.

Each step of the process contributes to the selection of students who are well positioned to contribute to and benefit from a unique learning experience that will prepare them to meet the diverse needs and expectations of their future patients.

In evaluating each applicant, the Admission Committee looks for those essential attributes that are required of all competent medical students and future physicians, as well as unique potential that brings diversity to the learning and practice cultures of the medical community. Included among these attributes are the following:

Academic readiness for successful completion of medical school is predicted from the aggregate of quantitative measures including GPA, improving grade trends, course load in conjunction with employment, successful completion of required science courses, rigor of undergraduate academic institution, completion of advanced degrees (MA, MS, PhD, MPH, other), and MCAT scores.

Attributes that reveal competency include intellectual curiosity, the capacity for diagnostic reasoning, and the cognitive ability to assimilate academic, scientific and technical knowledge with ease.

Genuine interest in a career in medicine is assessed from information provided in the applicant’s biographical data and through the interview process.  Evidence includes personal experience in medically related activities, knowledge of current medical issues related to ethics, cost-conscious health care and health care delivery, as well as informed views regarding state-of-the-art medical research.

Evidence of a relevant strong work ethic is demonstrated by focused and passionate dedication to research, clinical exposure, and in evidence of the ability to persevere. This is requisite to weathering the vicissitudes of work in medical school and beyond.

Evidence of altruism may include participation in community service (particularly in underserved areas), experience in caring for the sick and disabled, and a thoughtful expression of one’s intentions to give of one’s time, energy and knowledge in service to those in need of care.

Evidence of empathy may be evident in the applicant’s personal essay and in letters of recommendation.  The applicant’s response to vignettes designed to reveal one’s sense of empathy may be used during the personal interview.  Focused questioning may be used to reveal the applicant’s capacity to recognize suffering and his or her willingness to act to alleviate the problem.

The personal behavior and attitude of the applicant must reveal an understanding of the level of honesty, ethics, integrity, professionalism and humanism required in the practice of medicine. Personal commitment to these character attributes may be gleaned from testimonials and letters of recommendation. 

Written and oral communication skills are essential for a physician and are evaluated through the applicant’s personal statement, letters of recommendation, and communication during the interview process. The ability to communicate effectively in a team setting is also considered essential and is evaluated in the interview.

In a preclinical setting, collaboration is valued so that students can both teach and learn from their classmates. In the clinic, collaboration is necessary to be able to participate in and eventually lead interdisciplinary teams of care-givers.

Underserved populations may include patients from rural locales or the inner city or may include patients who are financially disadvantaged, from minority populations, or uninsured. Applicants with previous experience and/or a compelling desire to serve underserved populations are given consideration in the admissions selection process.

Applicants with compelling interest and/or past experience in medical education, in advancing cultural awareness, and in resolving health training disparities, especially those affecting populations experiencing inadequate health services or underrepresentation as physicians are given consideration for their value in contributing to a diverse training environment.

Physicians provide leadership in patient care, medical education and research, and in the development of health related public policy. Leadership experience and/or training are considered a valuable attribute and are given consideration in the admissions process.

Physicians serve patients from all walks of life and must have the cultural and ethnic sensitivity to treat each patient with empathy and respect. Unique life experiences that teach such sensitivity are valuable and given consideration in all admission decisions.

Applicants with interest and/or experience in research are likely to become the next generation of clinical investigators in biomedical science. Their presence and influence is considered an indispensable asset in the diverse intellectual environment of the Jacobs School and is given consideration in the admissions process.

Socioeconomic status is a component of diversity that contributes to the basic training of all physicians.  Assuring training opportunities for individuals from the broad socioeconomic spectrum is a core value of the Jacobs School and a fundamental component of the admissions process.

Application for admission to the Jacobs School requires that each applicant submit the following documents:

1. An American Medical College Application Service (AMCAS) application
2. Three letters of recommendation with at least one from Science Faculty
3. Any additional information requested by the Admissions Office

Applicants must be United States citizens or permanent residents of the United States. Applicants who have been granted Deferred Action for Childhood Arrivals (DACA) status are eligible to apply. It is expected that a candidate will have earned an undergraduate degree prior to entering the Jacobs School of Medicine.

Since the practice of medicine involves intellectual communication among professionals and important personal interaction with patients, the Admissions Committee prefers that courses, particularly prerequisites, be completed in a classroom/laboratory setting. However, some on–line coursework may be accepted at the discretion of the Admissions Committee. Such coursework must be completed at a college or university accredited by one of the six United States regional accrediting agencies or one of the provinces of Canada. “Virtual” laboratory courses are not acceptable. The applicant must identify on-line courses if the educational institution does not indicate this information on the official transcript.

All applicants must have an unencumbered criminal background check and meet the technical standards for admission established by the Jacobs School (see Section 8).

Every applicant’s admissions folder is reviewed using holistic analysis to:

1. Evaluate their ability to meet the academic challenges of the Jacobs School curriculum,
2. Assess their suitability for a career in medicine, and
3. Assess their ability to fulfill the mission and values of the Jacobs School and the profession of medicine.

The Admissions Screening Subcommittee reviews all application documents provided by the applicant to assess the essential and unique attributes of the applicant.

The review process assesses an applicant’s academic metrics, attributes, and experiences in the context of the three criteria listed above.

Once an applicant is deemed capable of successfully mastering the challenges of the Jacobs School curriculum, specific academic metrics such as GPA and MCAT scores are not given additional weight during the review process; rather they are assessed within the context of the applicant’s other attributes and experiences. 

At the completion of this review a select group of applicants will be invited for interview.

Members of the Admissions Interview Subcommittee, who are well versed on the mission and values of the Jacobs School and the rationale for our diversity goals, conduct standard interviews of each selected applicant. Each applicant is interviewed separately by two members of the Subcommittee. Interviews are focused on specific attributes and experiences that must be evaluated, and a narrative report is prepared detailing the outcome of each interview. Third interviews are granted at the discretion of the Admissions Committee.

An evaluation form is completed after each interview. This evaluation delineates the specific qualities and attributes of each applicant with respect to the mission and values of the Jacobs School.

To allow for a complete, holistic assessment of each applicant’s attributes and experiences independent of academic performance, interviewers are blind to the applicant’s academic metrics both during the interview and when preparing the evaluation.

The Admissions Selection Subcommittee conducts a complete and holistic review of each interviewed applicant. Each applicant’s interviewers (still blinded to academic metrics) present their impressions, and are available to answer questions and engage in discussion. A quorum of 10 committee members must be present to begin this portion of the process.

After this discussion, an overall summary recommendation is generated for each interviewee based on all available information with respect to the applicant’s experiences, attributes and academic metrics. This information is utilized to determine the likelihood that an applicant will be able to meet the academic challenges of the Jacobs School curriculum, fulfill the mission and values of the Jacobs School, and succeed in a medical career.

The Admissions Selection Subcommittee selects the class to include a critical mass of students that best matches the mission and diversity goals of the Jacobs School. The Jacobs School has no quotas for any particular quality or attribute.

The final decision for all applicants regarding admission to the Jacobs School rests solely with the Admissions Selection Subcommittee. Only applicants who have progressed through the entire admissions process will be considered.

The Admissions Screening Subcommittee evaluates all applicants for the purpose of selecting those who will be invited for personal interviews. The interview screening process is based on a holistic assessment of each applicant’s experience, attributes, and academic metrics. All essential and unique attributes are considered in this screening process.

The Admissions Screening Subcommittee is comprised of the Associate Dean for Admissions and Jacobs School personnel needed to accomplish the screening process. Members are drawn from full-time faculty and volunteer faculty, of the Jacobs School and are appointed by the Dean of the Jacobs School, or the Dean’s designee. The Dean (or designee) may also appoint local physicians and other community members who hold a professional degree.

The Admissions Interview Subcommittee conducts a detailed holistic assessment of the non-academic attributes, both essential and unique, for each applicant interviewed.  The interview provides a means for acquiring detailed knowledge of those attributes that may have significant impact on the diversity of the entering class.  An interview report, that includes a holistic evaluation of the applicant, is submitted to the Admissions Selection Subcommittee for final processing.

Members of the Admissions Interview Subcommittee are drawn from full-time faculty, volunteer faculty, local physicians, professional community members, and Jacobs School medical students. Subcommittee membership is through appointment of the Dean of the Jacobs School, or the Dean’s designee.

The Admissions Selection Subcommittee conducts a comprehensive review of all interviewed applicants and selects the medical class that best matches the mission and diversity goals of the Jacobs School.

Members of the Admissions Selection Subcommittee are Jacobs School faculty who have served on the Admissions Screening Subcommittee and/or Admissions Interview Subcommittee, who are appointed by the Dean of the Jacobs School (or designee). The Admissions Selection Subcommittee chair is selected by the members and serves a two-year term, which may be renewed. The Senior Associate Dean for Student and Academic Affairs, the Senior Associate Dean for Inclusion and Cultural Enhancement and the Director of the MD/PhD Program shall serve as ex officio, voting members of the Admissions Selection Subcommittee.

The Admissions Policy will be reviewed annually by the Standing Committee on Medical Admission Policy of the Faculty Council and modified when appropriate.   Outcomes assessment of the admissions process will be conducted annually by the Senior Associate Dean for Student and Academic Affairs and reported to the Faculty Council and the Dean.

The Jacobs School recognizes the importance of inclusion and diversity in achieving excellence in the training of competent physicians. To meet our goals of excellence the Early Opportunity Program in Medicine program serves to identify and recruit qualified applicants at an early stage in their undergraduate development. Similar to our AMSNY Post-Baccalaureate program, the EOPIM is designed to expand the pool of underrepresented, economically and educationally disadvantaged students in medical school. Students accepted into the EOPIM are provided the opportunity for professional interaction and career training at the Jacobs School before their graduation from college. Students at partner institutions who are nominated by Pre-health Advisory Committees and who fulfill the following requirements are eligible to apply to the EOPIM.

Eligible students must be in the second semester of their undergraduate sophomore year at a designated partner institution. The Pre-health Advisory Committee at each partner institution nominates students who have demonstrated strong interest and aptitude for careers in medicine. 

The Jacobs School Admissions Interview Subcommittee interviews each EOPIM qualified applicant. Admission into the EOPIM is based on holistic review of each applicant with appropriate consideration of academic metrics, personal attributes and life experience. The Jacobs School Admissions Selection Subcommittee makes the decision to accept an applicant into the EOPIM.

Post-acceptance requirements for continued participation in the EOPIM and entry into the Jacobs School of Medicine include:

1. Completion of all Jacobs School premedical requirements at their college or at a not–for–profit college or university accredited by one of the six United States regional accrediting agencies or one of the provinces of Canada.
2. Satisfactory academic performance of a 3.5 or above grade point average in science and non-science courses in each semester, including the last semester of the senior year.
3. Demonstration of consistent academic progress leading to college graduation.
4. Participation in clinical and/or basic research, educational and professional development activities at the Jacobs School during summer sessions either as rising juniors or rising seniors.
5. Adherence to the code of conduct of the participant’s undergraduate institution.
6. Submission of an official transcript to the Jacobs School Admissions Office within two weeks of college graduation.
7. Submission of an AMCAS application, including an MCAT score, to the Jacobs School Admissions Office in their senior year.
8. An applicant must have an unencumbered criminal background check and meet the standards for admission established by the Jacobs School for all applicants (Section 8).

The Jacobs School Admissions Selection Subcommittee is responsible for determining compliance with all requirements of the EOPIM before the student is permitted to enter the Jacobs School of Medicine.

In the case of non-compliance with EOPIM requirements, the Jacobs School Admissions Committee may dismiss the student from the EOPIM and rescind the option to enter the Jacobs School of Medicine.

Application to the M.D./Ph.D. Program is made to a subcommittee of the Medical School Admissions Committee that is empowered to interview candidates to the M.D./Ph.D. Program.

This subcommittee includes members from both the Medical School Admissions Committee and members of the Steering Committee of the M.D./Ph.D. Program.

This subcommittee will submit a rank order list of candidates to the Office of Admissions.

Representatives of the subcommittee, who are regular members of the Admissions Committee, will present an oral and written summary of the candidate’s record and interview to the Admissions Selection Subcommittee who will vote on acceptability.

Medical students enrolled in another LCME accredited school may be considered for acceptance into the third year of the Jacobs School curriculum only after successful completion of all basic science courses and only if there is availability of clinical rotation positions in the upcoming 3rd- and 4th-year clerkships, as determined by the Dean or Dean’s designee. The Admissions Selection Subcommittee will assure that admitted candidates show evidence of acceptable mastery of the Phase 1 curriculum in preparation for clinical clerkships.

Candidates must submit a completed application and their USMLE (United States Medical Licensing Examination) scores along with other required credentials for full evaluation pursuant to the Admissions Process. The Admissions Selection Subcommittee determines acceptance into the Jacobs School.

The mission of the MD program at the Jacobs School of Medicine and Biomedical Sciences (Jacobs School) at the University at Buffalo is to produce highly skilled and compassionate professionals who are able to adapt to a changing environment. Students are expected to develop a robust health care knowledge base and requisite clinical skills, with the ability to appropriately apply knowledge and skills, effectively interpret information, and contribute to patient-centered decisions across a broad spectrum of clinical situations in all settings. The following technical standards, in conjunction with the academic standards, are requirements for admission, progression, and graduation. The term “candidate” refers to candidates for admission, as well as current students who are candidates for progression or graduation.

The faculty of the Jacobs School acknowledges its responsibility to present candidates for the MD degree who have demonstrated the requisite knowledge, attitudes and skills to function in a broad variety of clinical situations and to provide a wide spectrum of medical care.

The Jacobs School is reflective of the community we serve, with a strong commitment to disability inclusion. Students with disabilities are reflective of and contribute to our community, and we encourage them to apply to our programs.

The University at Buffalo, including the Jacobs School, is committed to providing individuals with disabilities with equitable access to programs and reasonable accommodation for members of the University community as outlined in the University’s Reasonable Accommodation Policy Statement.

The University at Buffalo and Jacobs School is committed to full compliance with state and federal laws and regulations requiring equitable access and prohibiting discrimination based on disability (including the Rehabilitation Act of 1973, the Americans with Disabilities Act of 1990 (as amended) and New York State Human Rights Law).

The technical standards outlined below may be achieved with or without reasonable accommodation. Admitted candidates who have self-identified and disclosed a request for accommodations to meet the technical standards will be confidentially reviewed on a case-by-case basis by the office of Accessibility Resources in an interactive process involving the candidate to determine whether there are any reasonable accommodations or alternative mechanisms that will permit the candidate to satisfy the standards. While it is incumbent on the candidate to self-disclose their disability, formulating and implementing an appropriate action plan must be a collaborative effort with all necessary stakeholders. This process is informed by the knowledge that students with various types of disabilities have the ability to become successful medical professionals. Technical standards should be such that, with appropriate and reasonable accommodations, otherwise qualified students would not be excluded. However, technical standards must be such that the Jacobs School training maintains high quality care, patient safety, accessibility, and equity.

Based on guidelines provided by The Association of American Medical Colleges (AAMC) and Association of Academic Physiatrists (AAP), the following abilities and characteristics are defined as technical standards, which, in conjunction with academic standards, are requirements for admission, progression, and graduation. Delineation of technical standards is required for the accreditation of U.S. medical schools by the Liaison Committee on Medical Education (LCME). Although these standards serve to delineate the necessary abilities of all candidates, they are not intended to discourage any candidate for whom reasonable accommodation will allow the fulfillment of the complete curriculum.

The candidate must be able to obtain information from demonstrations and experiments in the foundational sciences. Candidates must be able to assess a patient and evaluate findings accurately. These skills require the use of vision, hearing, smell, and touch or the functional equivalent. The candidate must be able to acquire information from and evaluate images of microorganisms and tissues in normal and pathologic states. The candidate must be able to utilize auditory perception, visual perception and somatic sensation abilities (or their functional equivalents), to observe and accurately acquire information directly from the patient, both at a distance and close at hand, to develop an appropriate diagnosis and treatment plan. The candidate must be able to consider written documents, pictorial images, simulators, and computer programs and videos to assimilate large volumes of technically detailed and complex information presented in large group sessions, small group discussions, individual and group learning activities, and individual clinical settings. The candidate must be able to process information through observation and respond accordingly in a manner that is consistent, rapid, accurate, and free of bias.  Functional equivalent means the independent performance of the task to meet the Jacobs School’s clinical safety requirements.

The candidate must be able to communicate with patients in order to elicit information, detect changes in mood, activity, and posture as well as perceive nonverbal communication in their interactions with patients to establish a therapeutic relationship. Candidates must be able to communicate effectively and sensitively with patients and their families, and all members of the health care team, both verbally and in writing.

Candidates must possess the capacity to perform a physical examination and diagnostic examination and to provide or direct general care and emergency treatment to patients. 

Candidates must be able to assimilate detailed and complex information and engage in problem-solving across the curriculum. Candidates are expected to possess the ability to measure, calculate, reason, analyze, synthesize, document and transmit information. In addition, candidates must be able to comprehend three-dimensional relationships, understand the spatial relationships of structures, and adapt to different learning environments and modalities.

Candidates must be able to assimilate detailed and complex information and engage in problem-solving across the curriculum. Candidates are expected to possess the ability to measure, calculate, reason, analyze, synthesize, document and transmit information. In addition, candidates must be able to comprehend three-dimensional relationships, understand the spatial relationships of structures, and adapt to different learning environments and modalities.

Candidates must possess the emotional health required for full utilization of their intellectual abilities, the exercise of good judgment, the prompt completion of all responsibilities involved in the diagnosis and care of patients, as well as the development of mature, sensitive and effective relationships with patients, fellow students, faculty, and staff. Candidates must be able to tolerate physically taxing workloads and to function effectively under stress. They should be able to handle work environments that are rapidly changing without warning or in unpredictable ways, to display flexibility, and to learn to function in the face of uncertainties inherent in the clinical problems of many patients. Candidates must demonstrate compassion, integrity, concern for others, interest and motivation. These personal qualifications will be assessed during the admissions process and throughout the educational process. Candidates must be able to cooperate with others and work as an integral part of the health care team. They must be able to comprehend and accept constructive feedback from others and take personal responsibility to make appropriate changes.

Candidates must maintain and display ethical behaviors, commensurate with the role of a physician in all interactions with patients, faculty, staff, students, and the public. The candidate is expected to understand the legal and ethical aspects of the practice of medicine and function within the law and ethical standards of the medical profession.

Any change in student status after matriculation of the ability to perform under the Jacobs School Technical Standards, will be reviewed by the Student Progress Committee or such committee designated by the Dean (or Dean’s designee) of the Jacobs School to review student compliance with the Technical Standards, with or without reasonable accommodations. 

Reasonable accommodations may not significantly interfere with the essential functions of the Jacobs School, alter its essential academic functions, or effect a fundamental alteration in the nature of the services offered by the Jacobs School.

Candidates whose performance is impaired by current use or abuse of alcohol, or other controlled substances, or who are using illegal substances are not suitable as candidates either for admission, progression or for graduation.

This process will follow the procedure laid out here in section 8.7. As in initial assessments at the time of admission, a complete and careful reconsideration of all the skills, attitudes and attributes of each candidate will be performed. This includes an assessment of their willingness, desire, and ability to complete the medical curriculum and fulfill all requirements for medical licensure.

Candidates requiring accommodation or who would like to learn more about the accessibility services available, should contact UB’s Accessibility Resources. Candidates will engage in a confidential, collaborative and interactive, process with a School representative to determine reasonable accommodations. Given the clinical nature of medical education, additional time may be needed to implement accommodations. Timely disclosure and requests by students are essential and encouraged as foreseeable accommodations  cannot be applied retroactively. The Jacobs School reserves the right to request new or additional information in support of requests, including medical records and reports, and/or an independent medical evaluation.

Candidates will be required to re-attest to meeting the technical standards upon entry into Phase 2 and Phase 3 of the curriculum. Should a candidate have or develop a condition that may result in a need for accommodations, an evaluation with UB Accessibility Resources may be necessary. 

Candidates are required to attest to meeting Technical Standards, with or without reasonable accommodations, at the following stages:

• As applicants at time of submitting the secondary application (June – December)
• As accepted candidates as part of the Jacobs School Acknowledgment Form
• As current medical students after completion of their Phase I curriculum and prior to progression to Phase 2 and Phase 3 of our curriculum.

Candidates with questions regarding the technical standards are encouraged to contact UB’s Accessibility Resources. This office works with students across all UB programs, including those in the Jacobs School, to coordinate reasonable accommodations and promote an inclusive learning environment. To learn more please visit the Accessibility Resources Webpage. 

Admission to the Jacobs School is conditional on the candidate’s ability to satisfy these technical standards, with or without reasonable accommodation, and results from a process that examines and values all the skills, attitudes, and attributes of each candidate on a case-by-case basis.