A Medical School Tradition Comes Under Fire for Racism

Senior medical student Giselle Lynch has plenty of accomplishments to list when she applies for a coveted spot in an ophthalmology residency program this fall.

But one box she won’t be able to check when she submits her application is one of the highest academic awards medical students can receive, election to the honor society Alpha Omega Alpha.

It’s not because she didn’t excel. It’s because her medical school, the Icahn School of Medicine at Mount Sinai in New York City, put a moratorium on student nominations because it determined the selection process discriminates against students of color.

The award is open to the top 25 percent of a medical school’s graduating class and can be a valuable career boost, making students more competitive for desirable residencies and jobs.

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Over the past five years, around 3 percent of students chosen for the distinction at Icahn were from a racial background that is underrepresented in medicine, which includes blacks and Latinos. In that same period, about 18 percent to 20 percent of each graduating class at Icahn came from those groups.

The school made the change after Lynch led a group of fellow students in an effort to fight inequality at Icahn. The students collected data on how many students from underrepresented minorities were nominated to the honor society at Icahn and presented it in a series of meetings with school leadership last year.

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Announced in May of this year, the decision at Icahn was a controversial one, because many students and faculty fear that not participating in the award puts Icahn students at a disadvantage when competing for slots in residency programs.

The honor society has existed since 1902 and is a sought-after line on the résumés of medical students across the country. Membership can help students secure training in competitive specialties and is a predictor of success in academic medicine.

Membership is generally open to the top 25 percent of medical students in a graduating class, as determined by their grades and scores on standardized tests, but only about 16 percent makes it in. Each medical school has its own criteria for making final selections including qualities like leadership or professionalism.

Icahn is not alone in selecting a disproportionately low number of minority students for the honor society. A 2017 study in JAMA Internal Medicine showed that nationwide, black and Asian students were less likely than their white counterparts to be selected for the honor.

Dr. Dowin Boatright, the study’s lead author and an assistant professor of emergency medicine at Yale, hypothesizes that the disparities may be related to racial inequalities in grading and standardized tests, a phenomenon well-documented in medical education literature. {snip}

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Other medical schools are also considering how their AOA chapters can accurately reflect the racial makeup of their student bodies, according to Dr. Eve Higginbotham, the president of AOA board. {snip}

“Systems we use [for student evaluation] fail to take into account the extra work minorities are doing,” says Dr. Catherine Lucey, vice dean for education at UCSF. “[Minority] students have more stressors they have to deal with, low levels of racism that exist in our patients and our clinical environments.”

Lucey says that UCSF changed its selection criteria for AOA in 2016 to focus less on grades. The number of minority students selected for the honor society that year increased to match the percentage of minorities in each graduating class.

Dr. Jonathan Giftos, an internist in New York who was president of the Icahn chapter when he graduated in 2012, says disparities in the honor society are important to address because when medical education favors white students that can mean fewer minorities in leadership roles.

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“We know that improving diversity will hopefully result in inclusion of talented individuals from different backgrounds, and that will help benefit our patient care,” says Dr. Richard Byyny, executive director of AOA. {snip}

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