Leah Samuel, STAT, June 17, 2019
As medical students graduate this spring, American medical schools are celebrating the achievements of the nation’s newest doctors. They are also celebrating something else: an increase in the number of students from underrepresented populations.
From 2017 to 2018, the number of black students enrolled in U.S. medical schools rose by 4.6%, while the number of medical students identifying as American Indian or Alaska Native increased by 6.3%, according to data released by the Association of American Medical Colleges. It’s the latest evidence of a steady increase in the enrollment of nonwhite students over the past several years.
In the seven years leading up to 2009, the number of black medical students in the U.S. had been decreasing annually. In 2009, however, the Liaison Committee on Medical Education (LCME) toughened diversity requirements for accreditation. Specifically, the group went beyond its previous suggestion that medical schools “should have policies and practices ensuring the gender, racial, cultural, and economic diversity of its students.”
Citing Supreme Court decisions among its reasons, the LCME now insists that schools “must” have policies and practices in place that achieve what it calls “appropriate diversity among its students….”
In some cases, schools that have failed to take heed of the new criteria have been forced to pay attention. In 2016, amid complaints of racism and student protests that led to high-level resignations, the LCME deemed the University of Missouri-Columbia medical school “noncompliant” in meeting diversity requirements.
With its accreditation at stake, the school began aggressively recruiting students of color and addressing long-standing problems affecting them. By 2018, the number of black students enrolled there more than doubled, from 12 to 25, while the number of Latino students increased from two to 10, according to AAMC data.
From within, and from the top down
Dr. Keisha Gibson, who has been promoting diversity and inclusion as both a student and faculty member at the University of North Carolina at Chapel Hill, cautioned that administrators and faculty members tend to respond in three different ways.
“Sure, you can make a pretty picture by adding different-colored faces. But the goal of improving representation has to be added to a school’s DNA — has to be embedded in the organizational infrastructure.”
It’s important, she added, for an institution’s leadership to fall firmly into the first category. “When mandates come from the top, that’s when the culture changes,” Gibson said.
Cultural change is what will help schools retain students from underrepresented backgrounds, said McDougle [Dr. Leon McDougle, chief diversity officer at Ohio State University]. “You can recruit all you want,” he said. “But if they don’t feel welcome, they won’t stay.”
It’s not just about the students
Medical schools have historically failed to diversify their faculty. With this in mind, the LCME has called for schools to diversify staffing as well.
“Incentivize deans to value faculty diversity,” he said. “Designate resources, offer funding, dedicate recruitment packages.
But when it comes to recruiting and supporting students of color, a diverse faculty must provide more than visible role models, said Reede, who founded a minority faculty development program for Harvard in 1990.
“I’m not just interested in who gets a seat at the table, but whose voice is heard once they’re sitting there, and how much their voices influence policy,” Reede said.
Making diversity part of accreditation criteria has effectively changed the definition of what makes an institution viable. Similarly, school leaders are rethinking what makes a medical student successful.
Some schools are reevaluating their entry and matriculation requirements, including test scores. They are also taking into account non-academic factors such as socioeconomic status.
Henderson said this is where he often finds the most resistance to diversity initiatives.
“The pushback comes when our average [test score] is lower,” he explained. “Someone in leadership came to me and said, ‘We’re bringing the wrong people into this medical school.’ There’s a lot of entrenched bias, and it can get very antagonistic. But a score on a test does not make a physician,” he added.
McDougle agreed. “They’ll start talking about scores, which have nothing to do with clinical care,” he said. “A high MCAT score does not correlate with high performance in medical school.”
All medical students, but especially those from underrepresented communities, can now expect more help. Today, schools may assign them coaches to help with writing essays and developing portfolios; training in test taking, time management, and other academic survival skills; counseling to help detect and manage learning disabilities and cope with social isolation and academic pressure.
“Of course we’re looking at our pipeline to make sure we get people who can handle the rigors of medical school,” added Gibson. “But we also have to make sure we are setting them up for success.”
Play the long game
Not all news is encouraging when it comes to diversity.
In February, the New England Journal of Medicine examined medical school enrollment data over a 20-year period, 1997 through 2017. While the authors noted a 30% increase in residents from “racial and ethnic groups underrepresented in medicine,” they also found that the proportion of such students had dropped from 15% to 13%.