3 essentials for medical schools as they refine admissions policies

If you look back at California in 1997, just one year after voters in the state passed Proposition 209 banning affirmative action in the areas of public employment, contracting and education, you’ll notice a dramatic change took place on the campuses of many of its most esteemed universities.

Enrollment of students from historically excluded racial and ethnic groups fell between 30% and 40% at the University of California at Berkeley and the University of California, Los Angeles, according to David A. Acosta, MD.

Dr. Acosta, chief diversity and inclusion officer at the Association of American Medical Colleges, spoke during an AMA webinar held on the heels of the high court’s recent rulings restricting the use of race-conscious admissions at institutions of higher learning, including medical schools.

The AMA joined in an amicus brief led by the Association of American Medical Colleges in the cases, asking that the court refrain from overturning what had been an important precedent for medical schools seeking to diversify the nations’ physician workforce.

Dr. Acosta and others on the panel were concerned they might see a replay of the California enrollment phenomenon nationwide—or at least in the 41 states where affirmative action had been legal prior to the high court’s decision—followed soon after by a corresponding plunge in the number of medical school applicants from historically excluded  racial and ethnic groups.

But there are concrete steps that medical schools and medical associations can take, they noted, to continue to promote diversity in medical education without considering race in admissions.

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“We have to keep in mind the end point for what we do in medicine,” said William A. McDade, MD, PhD, chief diversity, equity and inclusion officer at the Accreditation Council for Graduate Medical Education.

“If you are an African American physician, the likelihood of you seeing an African American patient is about 23 to 24 times that of a white physician,” Dr. McDade said during the discussion, recorded as part of the AMA ChangeMedEd webinar series and moderated by David Henderson, MD, the AMA’s vice president of equity, diversity and belonging in medical education.

Dr. McDade noted that some 60–63% of Black first-year medical students say they want to serve groups that have been economically or socially marginalized, compared with 20% of first-year white students.

“So, if you want to maintain the mission of elimination of health disparities, creating a workforce that’s more prone to do that is something that I think we still have to value.”

“We need to codify the holistic review that’s been referred to as a process that’s been embraced by the majority of medical schools, including our historically Black medical schools, so that it’s clearly described and people understand what that means,” said Jeanette E. South-Paul, MD, executive vice president and provost of Meharry Medical College.

“We recognize that no medical schools admit a student on only one criterion—nobody—but evaluate a broad set of criteria that incorporate academic achievement, leadership experience, personal goals, life experiences and letters of recommendation,” as well as overcoming adversity, Dr. South-Paul said.

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“Chief Justice Roberts gave us a little bit of a nugget that we may have to concentrate on, and that is metrics,” Dr. Acosta said. “He had stated pretty strongly that he felt that the Harvard and UNC [University of North Carolina] cases did not present very clear goals of why they wanted deference on race-conscious admissions. But, also, they didn’t have any metrics that they were convinced that they could actually use to measure what those goals were about.”

What medical schools need, he said, is data showing “because of what we’ve done in admissions policies, this is where our graduates go, these are the communities that we take care of—proving the fact that that’s why this is so important.”

Find out more about the AMA’s work on equity, diversity and belonging in medical education.

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