Diversity in Medical Education, Part I

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

(1)    Whitla DK, et al.  Educational benefits of diversity in medicalschool: a survey of students. Acad Med. 2003 May;78(5):460-6.