Do we
need diversity in our medical schools? Let me say right at the beginning. The
answer is emphatically and non-equivocally YES!
One of
the important values inherent in this discussion is that the medical school
class and then subsequently the graduating physicians should look like the
general population of the United States. Right now it does not. Medical
students are richer (or at least their families are), more suburban, and they
are much more white than the overall population.
Why is
this important? Well for one reason,
students may not have had exposures to people that are different than they are
when they were growing up. A survey in Academic Medicine from two medical schools (Harvard and UCSF) found
that only 27% of medical students reported having frequent contact with people
of different races or ethnicities when they were “growing up”(1). The number
increased to 41% by the time they got to college, but the message is clear.
Students rarely had contact during their formative years with people that
looked or sounded or saw the world differently than they did.
A
diverse medical school class will be a better class of students. I would like
to define diverse very broadly. It is not just about having more than just
white students. Yes, it is important to have black students, and hispanic
students, and asian students, and native american students. But other aspects
of diversity are important. We need students from rural counties, who grew up
on a farm. We need students from low income brackets. We need students from
other countries, who see the world differently than I do. We need gay and
lesbian students, and older students, and women..... And so on. You get the
idea?
But, it
does not happen by chance. Every school has to work constantly to make
their class diverse.
I have
heard many discussions about this during the admissions process. It is not
overt racism or classism or urbanism. No, it is more subtle. There are
suggestions that it is unfair to put students into a situation where they might
fail. There is a suggestion that the students are less prepared or less able to
handle the academic rigor of medical school. There is a reminder of other
students that have struggled. All of this is said by well-meaning faculty, but
the reality is that the variables that they are talking about do not have much
to do with how good a doctor a student is going to be. Does the MCAT predict
that? Absolutely not! Does USMLE Step I predict that? Again, no. How about
performance in their college courses? Still, no.
I heard
Darrell Kirsch, MD, the president of the AAMC talking about the new MCAT a while back. The most important statement that he made (from my
perspective) was that schools that continue to emphasize the MCAT and GPA will
by that very act be anti-diverse. That is a pretty bold statement, but
completely defensible. If the admissions committee only looks at numbers (GPA,
MCAT) the admissions process is going to be biased against non-white,
non-urban, non-wealthy students. I would put forth that for most schools much
of the admissions process is biased against minority, rural, and lower income
students.
I will
talk about each of these in my next blog and put forth some ideas to make the
admissions process better.
References
