In retrospect, 2020 seems to be a crucial time in medical education. In 2020, the SARS-2 Covid-19 pandemic occurred, social upheaval, the decision of the National Board for Medical Examiners (NBME) to pass / fail the USMLE exam (USMLE) Step 1, increased number of applications in medical schools especially of races and ethnic groups underrepresented in medicine (URM) and the growing recognition of so many well-meaning people in medicine and healthcare the importance of diversifying our medical school teaching. All of these developments make now the best time to adapt our admission campaigns to the rhetoric. There are many documented benefits of diversity in medicine. Having black patients and black babies better health outcomes when their doctors are black.
URM students add important benefits to medical school teaching, and these have been widely publicized. URM students are more likely to return to medically underserved communities to practice. They will have a better understanding and empathy for the problems their future patients will face because they come from the communities they will serve. URM students bring their unique perspectives, life stories and courage to the medicine classes they attend and enhance the academic experience of their medical school classes. These URM students help their classmates learn about their different cultures and help their classmates familiarize themselves with cultural mores that are different from theirs. In this way, URM students help improve the cultural literacy of the entire class. The importance of diversity extends to patient care outcomes as well. Minority patients have higher levels of acceptance and trust in their doctors who are of the same race and ethnicity leads to positive health outcomes for them. Indeed, given the ongoing Covid-19 pandemic, these URM doctors are the lifeline for their underserved minority patients.
The increase in Diversity, Equity, and Inclusion (DEI) officers recently appointed in most organizations is evidence that academic medical centers are recognizing the importance of diversifying the medical workforce. Many medical specialties have followed suit and have set up DEI committees to recruit URM students into their programs. For many years, many schools and organizations seem to have agreed to diversify their medical school teaching and study programs, but results have varied and have not shown a significant increase in the number of URM candidates selected. For example, for admission to the allopathic medical school in 2020 only 1,767 of the 22,197 matriculations identified as Black or African American. 2018 only 5.0% of active doctors identified as black or African American compared to 13.4% of the United States’ 2019 population who identify as Black or African American.
The role of pipeline programs:
To increase the number of competitive URM applicants for medical school, medical schools must establish effective pipeline programs:
- They should recruit URM youth from the communities around their schools and hospitals and beyond
- Take them into the STEM areas, provide academic enhancement, mentoring and professional guidance
- Provide the necessary resources, inclusive and positive learning environments, and effective role models. Many URM students are first generation college students whose parents are ignorant of the ins and outs of higher education to guide their academic endeavors, and many attend schools with limited resources
- General instruction in critical / analytical thinking skills, tutoring in basic concepts in STEM disciplines, preparation for the MCAT and opportunities to be supervised by doctors
Diversity is an accreditation requirement:
The diversity of medical schools is such an important finding that the Liaison Committee on Medical Education, which accredits all allopathic medical schools in the United States and Canada, contain this as an accreditation requirement, standard 3.3. Many schools are therefore working to increase the number of URM students in their classes. Some schools have made significant strides. The pace of diversification is slow, however, and many schools are looking for the same small cohort of URM applicants who have competitive medical college (MCAT) admission tests and a science grade point average (GPA). Unfortunately, many medical schools use both the MCAT and the GPA in large part to select their admission classes. These two metrics are therefore considered to be âgatekeepersâ that limit the chances of URM applicants to enroll in medical faculties.
MCAT scores do not predict the quality of medical care an applicant will provide to their patients after training. MCAT results do not predict one’s ability to work effectively in teams, nor the level of advocacy a medical student, resident, or practitioner will have for his or her patient or service to vulnerable communities. After all, MCAT scores don’t predict empathy. However, some schools mainly base their selection on applicants with excellent results. MCAT results predict performance on standardized exams. MCAT results are one area and appear to be a “Threshold effect”. Many medical schools have been able to recruit and have students with âmodestâ MCAT scores (mean scores) has published excellent student results. Schools need to move away from this heavy reliance on the MCAT score.
Medical schools should use the holistic review framework when selecting applicants:
- Weighing up each applicant’s personal characteristics, experience, and academics
- Each school has its unique mission and should aim to recruit highly skilled students who embody their mission and serve the increasingly diverse nation in culturally savvy ways
- MCAT and GPA should be used as part of this holistic review
- Take into account each applicant’s life story, Career, personal characteristics, pronounced service orientation, motivations for a career as a doctor and training requirements at the medical faculty
Inclusive and affirmative learning environment:
Recruiting diverse students is only part of the goal. Schools need to purposely create inclusive, learner-centered, and empowering environments so that URM students can feel at home and thrive. Recruiting and retaining URM staff, faculty, and administration is equally important in helping URM students develop that sense of belonging that increases their chances of success. The Morehouse School of Medicine was able to achieve these results. Morehouse School of Medicine embodies diversity at all levels, uses holism in the selection of medical school applicants, creates a nurturing and welcoming learning environment, and has shown successful results for its students regardless of their socio-demographic descriptors and academic metrics input.