Making Medical School Admissions More Equitable

[LizzyM]

Closing the Gap — Making Medical School Admissions More Equitable

• Efrain Talamantes, M.D., M.B.A.,
• Mark C. Henderson, M.D.,
• Tonya L. Fancher, M.D., M.P.H.,
• and Fitzhugh Mullan, M.D.

in the February 28, 2019 issue of The New England Journal of Medicine
N Engl J Med 2019; 380:803-805.

Check it out then share your thoughts.

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[Lucca]

Tl;dr: 1. Proportion of URM students entering medical school has fallen over last 20 yrs (15 to 13% of total enrollment) and rate of medical school attendance among urm groups has fallen by 20%. URM students are more likely to practice in underserved areas and come from communities facing challenges related to health disparities.

2. Black and Hispanic medical students are 3x as likely as white students to come from families making less than 50k annually.

3. Academic health centers can increase the number of URM and rural students entering the medicine pipeline by targeting and investing in specific communities and building programs to both tackle health disparities and train up healthcare professionals to serve the community. Gives example of ba/md at UNM, and others.

4. Admissions committees implementing a greater number of “holistic” admissions policies tend to have more diverse classes. Further, there are policies outside the review process which med schools can pursue to increase diversity: “training committee members in implicit bias, blinding interviewers to applicants’ academic metrics, conducting multiple mini-interviews, and involving diverse groups of patients or community members in the admissions process.” Medical schools can also adopt more sophisticated tools for measuring advantages and disadvantages related to SES. Authors give example of a continuous grading scale for this used at UC Davis.

 

[Lucca]

Things I found interesting: the decrease in URM proportion of med students given by authors in the paper comes from the fact that while med school enrollment has increased by 54% over the last two decades, the number of URM students has only increased by 34%. At the same time, the absolute number of Black and Native American students has decreased in the last two decades. That means that the increase in the absolute number of URM students is almost entirely due to the increase in the number of Hispanic medical students. The authors did not comment on this specifically but I am curious what would happen to all of these numbers if you factored in demographic changes over the last two decades in the US. I suspect the results would be even more damning of diversity in med Ed than even this paper suggests.

The acknowledgement that efforts to increase diversity in med Ed must happen at every step in the pipeline and especially early on and that those efforts must reflect a direct commitment or investment on the part of institutions. I agree strongly with this. As competition and cost increase at every level of education, the ability to compete for the best opportunities, scholarships, universities, internships, etc. which will most impact your career development coming from a background unlikely to have a strong professional network in their family/immediate community will become more valuable. That ability depends greatly on institutional knowledge and there exists a significant knowledge gap in this area across racial and class lines in the US

 

[LizzyM]

Thanks @Lucca for the summary. I found it interesting that the authors chided medical schools that don't accept community college credits given that shuts out some low income/URM candidates.

 

[Peter Pan.]

Thanks @Lucca for the summary. I found it interesting that the authors chided medical schools that don't accept community college credits given that shuts out some low income/URM candidates.

Interesting. This is a tough call. I actually don’t blame medical schools for not accepting prerequisites from a community college. I think someone should be able to get as much credit from one as possible if need be like the general education requirements and maybe a couple prerequisite classes to cover the science requirement for an AA. But to take all your sciences (besides some upper divisions) at one just shouldn’t be done.

I went to a community college and took 3 science classes there. They were so easy and looking back I’m kinda embarrassed I took them there. Sorry if this is harsh but it’s just how I feel. Later I tutored at one. Students would routinely get take home tests, insane amount of extra credit, and tests were curved when the class average wasn’t bad at all. Then some of these students would later go to university (where I’m at) and then do worse in prerequisites or upper division level classes. It actually does them a disservice because they’re given false confidence from the community college and then later have to switch to something else. So they spent all that time and money with false hope. What’s worse is some of these people only take them at community college because they know it’s easier. SES should definitely be taken into account during admissions but someone taking prerequisites at a community college shouldn’t be treated the same as someone who took them at a university or Ivy League school.

 

[LeaveNoTrace]

1. Medical school interviewing is expensive and poverty is disproportionate among URMs.
2. The whole process, FAP included, is expensive.
3. The entire pipeline to medical school is busted.

 

[Master Thinker]

Thanks @Lucca for the summary. I found it interesting that the authors chided medical schools that don't accept community college credits given that shuts out some low income/URM candidates.

But then I feel like if they consider community college credits equally, all students would attend those schools for high GPAs. Then community colleges would essentially be the norm. Personally, I think SES should be considered more highly than race/ethnicity. How they overcame economic challenges speaks much more than which race you are.

 

[LizzyM]

But then I feel like if they consider community college credits equally, all students would attend those schools for high GPAs. Then community colleges would essentially be the norm.

Really? Someone holding an admission offer from Princeton will choose to go to Gateway Community College to get a better gpa?

 

[Master Thinker]

Really? Someone holding an admission offer from Princeton will choose to go to Gateway Community College to get a better gpa?

I see your point but most people won't be comparing between Princeton vs a CC. Most would be between state school vs CC. Personally, if credits are weighed equally, I would take the CC over the state school. Medical school admissions is competitive and for many premeds, college is just a stepping stone to med school.

Also, I go to a top 10, and many students take "difficult" science classes at a nearby state school to pad their GPA. So I don't think people choosing a CC would be all that surprising.

 

[OchemOficionado]

But then I feel like if they consider community college credits equally, all students would attend those schools for high GPAs. Then community colleges would essentially be the norm. Personally, I think SES should be considered more highly than race/ethnicity. How they overcame economic challenges speaks much more than which race you are.

I don't know if it would be a bad thing if more students choose to go to cc. They still have to transfer to a university to earn their degree. They could take upper div science courses as electives or for their major. The anti-cc logic makes me wonder if people are against informal post bacs to raise sGPAs. Anyhow, the MCAT is what standardizes it all.

Ehh. As someone who grew up both poor and Black I disagree with that last sentence.
I think both race and SES are important as do schools. Anyone can fill out the disadvantaged portion of the app so that’s great. Race can give a person a unique set of challenges, and in my opinion, those challenges have been equal to or greater than the challenges of not having money.

 

[lalalallala]

I took community college classes in high school. The community college that I went to is ranked amongst the top 10 or 20 community colleges in the country, but the classes were consistently easier than my high school classes. The reason that I took them is because there were more subject options. Of course taking community college classes doesn't make me an expert on all community colleges, but it is my opinion that the classes are not at all comparable to the difficulty level of 4-year college courses. I understand that they are less expensive, but I do not think that the rigor is there. Since medical school is so academically difficult, I do not think that the answer can be reducing the amount of information that students need to know or reducing the academic rigor of becoming a physician.

I think many people would agree that the ideal make-up of physicians and therefore medical students should mirror that of the US population. I agree with the article that this needs to start from an earlier stage. I think that URM applicants should be given more slack in MCAT scores for example because the URM numbers should not be decreasing over time, but I think the better (and harder to implement) solution is to create programs in middle or high school to help URM or SES disadvantaged students gain access to better educational and mentoring opportunities. While we want more URM physicians, I do not believe that simply letting in more URM applicants with lower stats is the answer.

I think an under discussed idea is how the medical schools/residency system presents itself. The extremely high COA of medical school, the low salaries and insane hours of residents, and the overall culture of bullying that some physicians exhibit needs to change. Making the career of a physician more manageable and accepting of different life paths and needs would be a decent step towards recruiting more URM medical students. Consider URM or SES disadvantaged students who have siblings or parents that they need to care for. They may not see becoming a physician as an option because the time before you start making money is so long and what would their family do in the meantime? Yes- residents need to work many hours to get the training necessary to be excellent physicians, but there is also much work that could be reallocated so residents are more able to live their lives, practice safer medicine, and fulfill their responsibilities to their children and families. There are certainly URM students who choose other careers because of the barriers they perceive in medicine.

 

[lalalallala]

Ehh. As someone who grew up both poor and Black I disagree with that last sentence.I think both race and SES are important as do schools. Anyone can fill out the disadvantaged portion of the app so that’s great. Race can give a person a unique set of challenges, and in my opinion, those challenges have been equal to or greater than the challenges of not having money.

I'm not trying to be confrontational - I truly want to understand. For Black students who grew up in rich or middle class households and attended quality schools and whose parents went to college and they went to good schools and all. What do you think makes it so that there is still a gap in test scores? Some researchers speak to stereotype threat. Others say it's the toll that discrimination over a lifetime takes. In other words - for you are those challenges that you mention in your last sentence - are they school factor or life factors that make you feel like SES help in admissions isnt enough?

 

[Walter Raleigh]

Really? Someone holding an admission offer from Princeton will choose to go to Gateway Community College to get a better gpa?

Someone holding an admission offer from Podunk State might very well choose to go to Podunk Community College for a better GPA, especially if money is an issue.

 

[OchemOficionado]

I'm not trying to be confrontational - I truly want to understand. For Black students who grew up in rich or middle class households and attended quality schools and whose parents went to college and they went to good schools and all. What do you think makes it so that there is still a gap in test scores? Some researchers speak to stereotype threat. Others say it's the toll that discrimination over a lifetime takes. In other words - for you are those challenges that you mention in your last sentence - are they school factor or life factors that make you feel like SES help in admissions isnt enough?

Life factors for sure. Growing up poor has its challenges and experiencing life as a minority in this country has another set of possible challenges, regardless of socioeconomic status.

 

[Master Thinker]

I don't know if it would be a bad thing if more students choose to go to cc. They still have to transfer to a university to earn their degree. They could take upper div science courses as electives or for their major. The anti-cc logic makes me wonder if people are against informal post bacs to raise sGPAs. Anyhow, the MCAT is what standardizes it all.

Ehh. As someone who grew up both poor and Black I disagree with that last sentence.
I think both race and SES are important as do schools. Anyone can fill out the disadvantaged portion of the app so that’s great. Race can give a person a unique set of challenges, and in my opinion, those challenges have been equal to or greater than the challenges of not having money.

I do agree that we need more minorities in medicine, but someone coming from an inner-city area with poorly performing schools is going to have a much harder climb than someone who is URM but came from a middle-class background. It is generally assumed that URMs have lower SES but this is not always the case. I have a lot of respect for those who came from poor backgrounds but worked hard and succeed.

 

[efle]

Maybe I'm way off here since it's been a while since I looked at the numbers: don't we already admit the vast majority of URM applicants that have numbers predicting success per the AAMC? That is, groups like black males are already very likely to get into an MD school if they have an MCAT in the upper 20s / GPA in low to mid 3.0s?

If that's true then it would seem there's not much adcoms can do; change has to come at the high school and college levels to provide more qualified applicants

 

[lalalallala]

The article mentions how race-conscious admissions is prohibited in 8 states including California. Does anyone have any info on the effect that has had in medical school admissions? I thought people had said that on the college level it lead to an increase in asian and white students.

 

[OchemOficionado]

I do agree that we need more minorities in medicine, but someone coming from an inner-city area with poorly performing schools is going to have a much harder climb than someone who is URM but came from a middle-class background. It is generally assumed that URMs have lower SES but this is not always the case. I have a lot of respect for those who came from poor backgrounds but worked hard and succeed.

I agree. I think everyone that makes it this far has worked hard as well.

The medical school admissions process recognizes that even URMs from a higher socioeconomic class face unique challenges and bring a much needed perspective to medicine so that’s why they still get the boost if that’s what you’re getting at.

 

[bearcalbear2019]

Although I am not URM I have worked extensively with URM populations in education, free clinics, and a safety net hospital where gunshots are normal. URMs face SO many barriers to education and health care -- and it honestly starts with societal and institutional discrimination, stereotypes ("lazy Mexican, Black thugs"), and the school to prison pipeline loves to throw URMs in jail at a young age. I'm surprised adcoms aren't doing more to recruit URMs and looking down on CCs is just one way to discourage URMs. At my top public school my URM premed friends were weeded out by 3rd year, as they came from high schools/zip codes with little to no resources while asians and whites are destroying the curve coming from posh families and already having experience with bloody competition in high school.

I'm also curious as a SES disadvantaged student to learn more about schools that have a similar method to the UC Davis continuous scale to advance equity in med school admissions? I would think service oriented schools like Loyola, Rush, Tulane account for this. But I feel like top research schools like Northwestern, Vanderbilt wouldn't honestly care about this too much as they want the best applicants with the best stats and leadership potential, rather than a SES and/or URM student with much lower stats who would definitely be a risk. @LizzyM Thoughts as someone at a top school?

 

[lalalallala]

I agree. I think everyone that makes it this far has worked hard as well.

The medical school admissions process recognizes that even URMs from a higher socioeconomic class face unique challenges and bring a much needed perspective to medicine so that’s why they still get the boost if that’s what you’re getting at.

I understand why schools give URMs a boost but I still don't quite get why high-SES URM students need the boost. Picture a middle class student who lived in a diverse area and then went to Howard for example. There are many internships specifically designed for pre-med URm students. Yes this student has likely faced discrimination in their lifetime and that is likely very tiring but why does this student need a boost - why didn't they do as well as asian applicants who (while being asian in america isn't the same as being black) experienced their own unique challenges of having their culture disrespected, their food called smelly, or never quite feeling like they were accepted.

 

[907914]

Maybe I'm way off here since it's been a while since I looked at the numbers: don't we already admit the vast majority of URM applicants that have numbers predicting success per the AAMC? That is, groups like black males are already very likely to get into an MD school if they have an MCAT in the upper 20s / GPA in low to mid 3.0s?

If that's true then it would seem there's not much adcoms can do; change has to come at the high school and college levels to provide more qualified applicants

While “all” is a stretch, if a black student is above a 3.0 and 24 (equivalent to a 500) then they have no less than a 50% chance of admission. Above a 3.2 and 27 (about a 504) is greater than 75%. So, in general I think you are correct - there is not much that individual medical schools can do to remedy the issue as they are already admitting the majority of qualified candidates.

Reform has to occur on the cost of the application itself and the support of undergrad institutions for URM to apply to medical school.

https://www.aamc.org/download/321514/data/factstablea24-2.pdf

 

[tanbrucewayne]

The article mentions how race-conscious admissions is prohibited in 8 states including California. Does anyone have any info on the effect that has had in medical school admissions? I thought people had said that on the college level it lead to an increase in asian and white students.

I got rejected from all the UCs for college and my brother couldn’t get into UCB or UCLA but ended up at a top 10 school. So I think it’s true or maybe I’m still salty, n=1 tho

 

[lalalallala]

I'm also curious as a SES disadvantaged student to learn more about schools that have a similar method to the UC Davis continuous scale to advance equity in med school admissions? I would think service oriented schools like Loyola, Rush, Tulane account for this. But I feel like top research schools like Northwestern, Vanderbilt wouldn't honestly care about this too much as they want the best applicants with the best stats and leadership potential, rather than a SES and/or URM student with much lower stats who would definitely be a risk. @LizzyM Thoughts as someone at a top school?

Yes - I'd like to hear more about top schools. I feel like they talk a big game about diversity and do let some URM students in but I feel like their priorities are really in high stats and research (or at least accepting crazy high stat students to balance out the numbers). Why don't top schools care more about having a mix of research oriented, service oriented, and education oriented students?

 

[lalalallala]

I got rejected from all the UCs for college and my brother couldn’t get into UCB or UCLA but ended up at a top 10 school. So I think it’s true or maybe I’m still salty, n=1 tho

People definitely get into 1 top 10 and not another all the time - but when this happened did you feel like you wished you had gotten a leg up for being URM? Like did you feel like that would have been the fair thing to do for you

 

[bearcalbear2019]

I understand why schools give URMs a boost but I still don't quite get why high-SES URM students need the boost. Picture a middle class student who lived in a diverse area and then went to Howard for example. There are many internships specifically designed for pre-med URm students. Yes this student has likely faced discrimination in their lifetime and that is likely very tiring but why does this student need a boost - why didn't they do as well as asian applicants who (while being asian in america isn't the same as being black) experienced their own unique challenges of having their culture disrespected, their food called smelly, or never quite feeling like they were accepted.

The student is getting a boost because patients need people who look like them and can relate to their experiences. The URM ''boost'' is meant benefit patients not the applicant. If we lived in a society were blacks and hispanics did not have to go through hoops and barriers that most don't have to go through there would be no such thing as URM, and all races would be considered equally. If the URM boost did not exist there would be nearly no URM doctors and the cycle of social injustice would even worsen.

 

[907914]

Yes - I'd like to hear more about top schools. I feel like they talk a big game about diversity and do let some URM students in but I feel like their priorities are really in high stats and research (or at least accepting crazy high stat students to balance out the numbers). Why don't top schools care more about having a mix of research oriented, service oriented, and education oriented students?

Because research brings publications. Publications bring sweet sweet NIH grants. NIH grants bring publicity. Publicity brings more donors. And the cycle repeats.

 

[OchemOficionado]

I understand why schools give URMs a boost but I still don't quite get why high-SES URM students need the boost. Picture a middle class student who lived in a diverse area and then went to Howard for example. There are many internships specifically designed for pre-med URm students. Yes this student has likely faced discrimination in their lifetime and that is likely very tiring but why does this student need a boost - why didn't they do as well as asian applicants who (while being asian in america isn't the same as being black) experienced their own unique challenges of having their culture disrespected, their food called smelly, or never quite feeling like they were accepted.

I’m not sure I can give you the clarity you seek. You may find some interesting articles on the topic if you’re willing to search them out. Also, remember that it’s more about the patients and less about the students.

 

[Master Thinker]

Although I am not URM I have worked extensively with URM populations in education, free clinics, and a safety net hospital where gunshots are normal. URMs face SO many barriers to education and health care -- and it honestly starts with societal and institutional discrimination, stereotypes ("lazy Mexican, Black thugs"), and the school to prison pipeline loves to throw URMs in jail at a young age. I'm surprised adcoms aren't doing more to recruit URMs and looking down on CCs is just one way to discourage URMs. At my top public school my URM premed friends were weeded out by 3rd year, as they came from high schools/zip codes with little to no resources while asians and whites are destroying the curve coming from posh families and already having experience with bloody competition in high school.

I'm also curious as a SES disadvantaged student to learn more about schools that have a similar method to the UC Davis continuous scale to advance equity in med school admissions? I would think service oriented schools like Loyola, Rush, Tulane account for this. But I feel like top research schools like Northwestern, Vanderbilt wouldn't honestly care about this too much as they want the best applicants with the best stats and leadership potential, rather than a SES and/or URM student with much lower stats who would definitely be a risk. @LizzyM Thoughts as someone at a top school?

Generally, schools that value service and Jesuit schools care more about SES than research-intensive schools. So schools like Loyola, Rush, SLU, Creighton, GW, Temple, and Drexel would give additional consideration to people from low SES backgrounds. Northwestern seemed to have lots of student from wealthy backgrounds though....

 

[tanbrucewayne]

People definitely get into 1 top 10 and not another all the time - but when this happened did you feel like you wished you had gotten a leg up for being URM? Like did you feel like that would have been the fair thing to do for you

I didn’t even know being a URM gave a leg up otherwise I would’ve applied to all the ivies and not just were my stats were competitive lol 16 year old me was so dumb and applying to college with no guidance other than google

 

[OchemOficionado]

People definitely get into 1 top 10 and not another all the time - but when this happened did you feel like you wished you had gotten a leg up for being URM? Like did you feel like that would have been the fair thing to do for you

Please, let’s not get into a debate about whether boosts are fair or not. This thread seems to be going ok, let’s not go left.

 

[lalalallala]

I am clear on why patients benefit from URM doctors. I just think that truly understanding what leads to URM applicants having less competitive applications or less applicants overall is the first step to fixing it. If we don't understand why it is not just SES status, then we can't fix it

 

[Gilakend]

I'm not URM so I can't comment in that regard but am very low SES in background (the lowest AAMC income bracket provided) and I can say that the medical school admissions process is absolutely grueling if you don't have an immediate source of financial assistance. I had an unpaid internship (required by my school) during the day and worked overnight for the entire summer just to barely scrape by the application process, this was in addition to trying to fit in sleep and writing secondary essays. I spent more money applying to schools than I made working all summer. However, honestly I don't know what can be done besides maybe the expansion of FAP, but even then that doesn't take into account the amount of other obstacles low-SES applicants face. Very interesting read.

 

[stayathomemom]

Closing the Gap — Making Medical School Admissions More Equitable

• Efrain Talamantes, M.D., M.B.A.,
• Mark C. Henderson, M.D.,
• Tonya L. Fancher, M.D., M.P.H.,
• and Fitzhugh Mullan, M.D.

in the February 28, 2019 issue of The New England Journal of Medicine
N Engl J Med 2019; 380:803-805.

Check it out then share your thoughts.

I would check it out if I had access to scholarly journals. But alas, I am not a student, nor am I employed in an academic setting, and so some privileges are not afforded to me.

I find this fact just a little ironic.

One thing I've noticed over my years, both long ago as a traditional (and naive and uncounseled) premed student and now as a non-trad is that this system is really hard if you:
a. don't know what you don't know, and there is no one to tell you how much you don't know
b. are poor in both economic and social capital

For point a, at least nowadays at least a google search will net you SDN. So hopefully most premeds will get at least SOME guidance. (But sometimes not, see "less informed premeds" thread.)

As far as point B, just taking the MCAT is costing me around $800 between study resources and the exam itself. Do you know how much $800 is to a family living paycheck to paycheck? It's insane if not impossible. (Thankfully I no longer live hand-to-mouth, but those years still impact me.) Even if the exam fee is waived, it's still so much money.

Another thing for point B is how difficult it is to get shadowing hours if you don't already have preexisting relationships with doctors, either yourself or your family. I keep hitting dead end after dead end. Either nobody wants to take on a shadower (and who would? It's a pain) or bureaucratic red tape keeps them from doing it. I'm afraid after all my hard work this is what's going to keep me from getting accepted. Scribing jobs are good, but they pay is horrible and depending on life situations the hours might not work.

Another aspect is the difficulty of rural students to access things like medical volunteering or shadowing opportunities, but I have less experience with that. I thought I'd mention it though.

 

[907914]

I am clear on why patients benefit from URM doctors. I just think that truly understanding what leads to URM applicants having less competitive applications or less applicants overall is the first step to fixing it. If we don't understand why it is not just SES status, then we can't fix it

It is a combination of SES, differing cultural values, the systemic oppression of URM groups by everyone ranging from police to teachers to the medical system itself. Even if you are the most successful black female musical artist the US has ever seen, biases of medical staff can still lead to them providing inadequate care for you despite your high SES (google Beyoncé pregnancy issues if you don’t know what I am talking about). These same biases are something URM live with their entire lives.

 

[Master Thinker]

Part of it is our fault as applicants as well. We have gotten so competitive to the point where we are doing everything in terms of ECs and test prep. Schools can afford to be very picky despite the fact that many who were rejected would have made fine doctors. Will be so much better if everyone relaxed, but this is the prisoner's dilemma at work lol

 

[907914]

Part of it is our fault as applicants as well. We have gotten so competitive to the point where we are doing everything in terms of ECs and test prep. Schools can afford to be very picky despite the fact that many who were rejected would have made fine doctors. Will be so much better if everyone relaxed, but this is the prisoner's dilemma at work lol

What if we just did Transcripts, MCAT, and LORs for a primary application? Let students talk about themselves in secondaries and interviews, but let your education and others speak to who you are as an applicant?

 

[Master Thinker]

What if we just did Transcripts, MCAT, and LORs for a primary application? Let students talk about themselves in secondaries and interviews, but let your education and others speak to who you are as an applicant?

I think that might further amplify the importance of grades and MCAT, and give the opposite effect.

 

[lalalallala]

Part of it is our fault as applicants as well. We have gotten so competitive to the point where we are doing everything in terms of ECs and test prep. Schools can afford to be very picky despite the fact that many who were rejected would have made fine doctors. Will be so much better if everyone relaxed, but this is the prisoner's dilemma at work lol

I agree with you - but this is tough on both ends. If schools stop rewarding people for having a 525 instead of 521 and thousands of hours of research vs hundreds then maybe applicants will feel like they can do non-premed things some - but then how do schools pick people. This is also happening in undergrad admissions and I think it's sad. HS kids shouldn't have to be crafting their lives into perfect admissions stories.

 

[PTPuser]

I think a lot of you guys who mentioned SES, which isn't a bad point, missed the part where patients do much better when their doctors look like them....that's the whole point of this, I believe. It's a ripple effect. Lives, time and money are being saved base on the data they've gathered. So we can argue about the best metric there is but if there's some magic number that the applicant have met which correlates to medical school success, those applicants from URM should be given a more holistic review of their app. Like the article states, our patient population is changing, so our doctors need to reflect that for the best outcome.

 

[907914]

I think a lot of you guys who mentioned SES, which isn't a bad point, missed the part where patients do much better when their doctors look like them....that's the whole point of this, I believe. It's a ripple effect. Lives, time and money are being saved base on the data they've gathered. So we can argue about the best metric there is but if there's some magic number that the applicant have met which correlates to medical school success, those applicants from URM should be given a more holistic review of their app. Like the article states, our patient population is changing, so our doctors need to reflect that for the best outcome.

Well, according to South Park, we will all be a nice homogeneous beige hue by the 22nd century. Lets just hope Matt Stone and Tray Parker are accurate.

 

[Gilakend]

I think a lot of you guys who mentioned SES, which isn't a bad point, missed the part where patients do much better when their doctors look like them....that's the whole point of this, I believe. It's a ripple effect. Lives, time and money are being saved base on the data they've gathered. So we can argue about the best metric there is but if there's some magic number that the applicant have met which correlates to medical school success, those applicants from URM should be given a more holistic review of their app. Like the article states, our patient population is changing, so our doctors need to reflect that for the best outcome.

The data you're referencing is 100% correct and I don't think anyone would disagree with it, but when I was growing up it didn't matter if my doctor looked like me or my parents, they had no idea how to relate to us as patients. The physician interaction I had that pushed me to consider and pursue medicine was with a doctor who is URM (I'm not) and grew up in another country. However, he could relate and connect more to me than any doctor I ever met. While data shows appearances are important, I feel doctors who can actually relate to a patient's situation in regard to SES and communicate effectively with them are also grossly under recruited by medical schools. Only 5% of the students at the school I'm matriculating at are first generation college (this was the closet marker to SES I could find). I often don't think people realize the EXTREME communication barrier between patients from low-SES or less educated background and physicians. Both URM and SES status are incredibly important in my eyes.

 

[deleted480308]

We shouldn't be tracking race percentages as a goal. Lack of racial discrimination should be the goal.

Community college credits would be a great way to allow poorer or more rural students to apply.

Allowing skype interview would absolutely be a way to try and calm down the financial arms race of applying. I'd be all for that and actually asked my school to consider it when I was a student there, I was told no

 

[deleted480308]

I think a lot of you guys who mentioned SES, which isn't a bad point, missed the part where patients do much better when their doctors look like them....that's the whole point of this, I believe. It's a ripple effect. Lives, time and money are being saved base on the data they've gathered. So we can argue about the best metric there is but if there's some magic number that the applicant have met which correlates to medical school success, those applicants from URM should be given a more holistic review of their app. Like the article states, our patient population is changing, so our doctors need to reflect that for the best outcome.

those studies are weak at best and promote racial discrimination by patients at worst.

If we believed the premise you are pushing we would be trying to recruit only white doctors in primarily white areas, which is patently absurd and no one would ever ask for that.

 

[OchemOficionado]

those studies are weak at best and promote racial discrimination by patients at worst.

If we believed the premise you are pushing we would be trying to recruit only white doctors in primarily white areas, which is patently absurd and no one would ever ask for that.

Historical context is important when discussing why minority patient outcomes improve when they are treated by physicians that look like them. Diversity can have an impact in communities that mistrust heathcare professionals and seems to increase both honesty and compliance on the patient’s end.

I’m not sure if the premise has anything to do with white patients only because the historical context is completely different. Surely, being adequately represented in every aspect has to eliminate the need for such measures to improve the health outcomes of white patients.

 

[deleted480308]

Historical context is important when discussing why minority patient outcomes improve when they are treated by physicians that look like them. Diversity can have an impact in communities that mistrust heathcare professionals and seems to increase both honesty and compliance on the patient’s end.

I’m not sure if the premise has anything to do with white patients only because the historical context is completely different. Surely, being adequately represented in every aspect has to eliminate the need for such measures to improve the health outcomes of white patients.

I'm aware of the context. To me the context only shows how bad an idea it is to engage in racial discrimination

 

[Med Ed]

As far as point B, just taking the MCAT is costing me around $800 between study resources and the exam itself. Do you know how much $800 is to a family living paycheck to paycheck? It's insane if not impossible. (Thankfully I no longer live hand-to-mouth, but those years still impact me.) Even if the exam fee is waived, it's still so much money.

My contribution to this thread will be noting that the AAMC worked with Khan Academy to create a free MCAT prep course with 1,100 videos and 3,000 practice questions. It did this to lower the barrier to entry. The AAMC guide to creating a MCAT study plan can be found here.

Applicant spend a lot of money on MCAT prep courses, but they have no demonstrated value beyond forcing people to stick to a schedule. If you are capable of creating and adhering to a study schedule then a prep course gains you nothing.

 

[UnlimitedTraction]

But then I feel like if they consider community college credits equally, all students would attend those schools for high GPAs. Then community colleges would essentially be the norm. Personally, I think SES should be considered more highly than race/ethnicity. How they overcame economic challenges speaks much more than which race you are.

Still gotta take the MCAT (ultimate equalizer), do all the extracurriculars. GPA isn't the end-all, be-all.

 

[Lucca]

While “all” is a stretch, if a black student is above a 3.0 and 24 (equivalent to a 500) then they have no less than a 50% chance of admission. Above a 3.2 and 27 (about a 504) is greater than 75%. So, in general I think you are correct - there is not much that individual medical schools can do to remedy the issue as they are already admitting the majority of qualified candidates.

Reform has to occur on the cost of the application itself and the support of undergrad institutions for URM to apply to medical school.

https://www.aamc.org/download/321514/data/factstablea24-2.pdf

I disagree that there isn’t more institutions can do. The authors make the point that effort needs to be put in at all stages of the pipeline as only changing things at the admissions level won’t do much. There are still things school can do, but it takes a lot of initiative and investment so the academic centers have to first admit that they seriously care; some have put their money where their mouths are but not all.

 

[kotaku123]

Differential GPAs and MCAT play a large role in inequity, and reflect the same patterns as robustly demonstrated IQ differences among groups (see Intelligence: Knowns and Unknowns written by APA task force in 1996). It is unclear the extent to which GPA and MCAT are mediated by IQ (compared to SES, related educational opportunities, stereotype threat, personality traits that manifest as work ethic) - but it is my sense that IQ is a strong predictor. It has already been determined that IQ tests are not significantly biased by SES and educational opportunities. The causes of these IQ differences have not yet been determined either, but prior efforts to raise IQ have been ineffective by late adolescence. Effective interventions to equalize IQ for all groups could lead to more fair representation in medical school admissions.**

I understand that this is a very politically charged topic, and I will likely be censored/dismissed as a pseudoscientist or racist - but really, the science behind predictive value of IQ tests, and group differences therein, is undisputed among psychometricians and leading intelligence researchers. If we are truly concerned about inequity, then we must be free to honestly and dispassionately consider its causes to manifest appropriate and effective solutions. As demonstrated by this article, the efforts of the past 30+ years haven't made the cut.

edit: Obligatory acknowledgment that group differences have absolutely no bearing on how we should evaluate individuals, as there is significantly more variation within groups than among groups. Thus, an individual's membership in any group tells us absolutely nothing about their individual academic prowess.

** although I'm not sure what this would look like for Eastern Asians or Ashkenazi Jews, who both score higher than the mean.

 

[boundlesscorpuscle]

On the topic of community college credits, I think that would be an excellent way to recruit more URM/low SES students. To the point that CC courses tend to be less rigorous, I would suggest that medical schools might approach it the way they do AP/CLEP credit- they will accept those as a stand-in for prerequisites given the applicant has demonstrable success in higer level courses in that subject area. Since someone who has CC credits would need to attend a 4-year school to get their Bachelor's, they would have the opportunity to take higher level courses and prove their competency. However, given the lack of rigor of most CC courses, students coming from CC to take higher level courses at a 4-year school are already at a disadvantage once more in terms of academic success, so perhaps this does not completely address the problem.

I agree that ultimately we need to start even sooner than that, addressing the disadvantages URM/low SES individuals face at the pre-baccalaureate level. Of course, easier said than done .