Dispelling a few myths about AA, URMs, and medical admissions

Myth: Minorities’ past records of having lower scores on the MCAT and having lower GPAs reflects their collective lack of cognitive abilities.
False:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11302036&query_hl=10
Do underrepresented minority medical students differ from non-minority students in problem-solving ability?

BACKGROUND: In medical education, examinations must assess a logical progression toward problem-solving skills. Differences in cognitive development between underrepresented minority students (URMs) and non-URMs may affect examination performance and subsequent attrition rates. PURPOSE: The authors investigated URM and non-URM performances by retrospectively analyzing success rates on exam items of differing cognitive demand. METHOD: Mean correct responses to exam items classified as Recall, Interpretation, or Problem-Solving questions were calculated. Both URM and non-URM groups were stratified by grade point average (GPA) and scores on the Medical College Admission Test (MCAT). Differences were investigated with analysis of variance and general linear models. RESULTS: For all students, performance levels decreased as the cognitive demands of the exam items increased. When stratified by GPA and MCAT score, several important differences were found between URM and non-URM performance. CONCLUSIONS: Because cognitive measures fail to account for the majority of performance differences, noncognitive attributes must contribute to the poorer performance of URMs.

Myth: Inherent mental capability is the best predictor for who will do well on the MCAT.


There have also been studies that show a strong positive correlation between parental income and MCAT scores.

Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7495461&dopt=Abstract

PURPOSE. To test the hypothesis that family financial status is associated with the academic performance of a medical student. METHOD. The relationships between parental income and mean scores on the Medical College Admission Test (MCAT) and United States Medical Licensing Examination (USMLE) Step 1 were examined for the students in the 1994 and 1995 graduating classes at the UMDNJ-New Jersey Medical School who had applied for financial aid in 1991 and reported annual parental income. Pearson correlations were used to analyze separately the data for minority and majority students, for men and women, and for the four subgroups by gender and race-ethnicity. RESULTS. The final study cohort consisted of 192 students (55% of all students). Significant positive correlations were found between the (1) MCAT and USMLE Step 1 for the women, men, majority, and minority students, (2) MCAT and parental income for the subgroups of majority men and minority women, and (3) USMLE Step 1 and parental income for the subgroup of minority women. CONCLUSION. Parental income was correlated significantly with performances on the MCAT and USMLE Step 1. These relationships may be particularly strong and persistent for minority women.
Facts: On average, minority applicants come from families of much lower socio-economic status;

Source: http://www.unmc.edu/Community/ruralmeded/admissions_ratios_and_us_med.htm



Myth: There have been no studies proving that URMs actually go on to work in underprivileged areas. The “bar” is simply lowered for URMs without any proven results.

Source: http://www.aamc.org/diversity/amicusbrief.pdf

“Minority physicians are more likely to serve minority patients even when controlling for premedical school performance and socio-economic backgrounds”

“Minority patients were over four times more likely to receive care from non-white physicians than were Caucasian patients”

“African American physicians practiced in areas where the percentage of African Americans was nearly five times as high, on average, as in areas where other physicians practiced”

“Although black physicians account for less than 5% of the total US physician workforce, they serve as regular health care providers for 23% of black individuals.”

The article goes on to quote studies that show minorities are more likely than other ethnic groups to go into primary care, serve uninsured populations, give care to individuals using medicade, and (yes) practice in under served areas.

Myth: there are FEWER URMs in medicine because under represented minorities are, on average, lazier than non-URMs or because these individuals are afraid they can’t hack it in medical school.

Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14507613&query_hl=16

Against this background, applications by members of racial and ethnic minorities, who represent an increasing fraction of the college age population, become particularly important. The author reports the trends in education, over several decades, by members of the principal racial-ethnic groups-whites, blacks, Hispanics, and Asians-traces their participation from kindergarten through college, and projects the likelihood of their applying to medical school over the next two decades. (A companion article in this issue reports a parallel study from the standpoint of gender.) One prominent observation is the firm link between academic achievement in the earliest grades and success thereafter. A second is the profound influence of parents' education, income, and expectations at each step along the way. Inadequacies in either sphere erode the potential for children to reach college and to do so in ways that predict interest in and capacity for medical school. Yet, even when that potential emerges, inadequate finances deflect qualified high school and college students from the paths that lead to medical education. These factors weigh most heavily on black and Hispanic children, particularly boys, but are prevalent among whites, as well. Without aggressive education in the earliest years and without adequate financial support in the later years, it is not clear that there will be a sufficiently large pool of qualified applicants for the number of medical school seats that must exist in the future.

Myth: Considering race and ethnicity compromises physician competence.

Source: http://www.aamc.org/diversity/amicusbrief.pdf

Medical school retention rate for URM students is, on average, 88%. This is the percentage of URMs that pass their required tests and go on to be practicing physicians. Before you note that this percentage is lower than for other groups, consider the fact that there are far fewer minorities in US medical schools than other students. If one minority drops out of medical school, he represents a much larger percentage of the entire class. Conversely, one non-URM student represents a smaller percentage of that ethnic group’s entire population. (i.e. if 1 out of 6 URM drops out of school, the drop out rate for URMs is 17%. If 1 out of 100 non-URM students drops out of medical school, the drop out rate for non-URMs is 1%).
Myth: The primary goal of AA in medicine is to give students from disadvantaged backgrounds a “break” on admissions.

Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=13678423&query_hl=32

The consideration of race in medical admissions is not based on the individual, but on the entire US population. There are staggering health disparities that affect those groups that are traditionally under represented in medicine. Admiting more URMs has been the only proven way to directly remedy these disparities.

Myth: Programs based on socio-economic status would do better at admitting minorities and those who truly need the help.

Source: http://www.pubmedcentral.gov/articlerender.fcgi?tool=pubmed&pubmedid=13678423

Remember the primary goal of considering race and ethnicity in medicine is to diversify the medical community. No race-neutral factor can effectively substitute for direct consideration of race for admissions. For example, substituting “economic hardship” for race in admissions decisions would not address the pressing need to increase the number of minority physicians being trained in America. Studies confirm that the relationship between a physician’s race or gender and his willingness to care for underserved populations was significantly more pronounced than the relationship between a physician’s socioeconomic background and his commitment to these same groups.

 

The best estimate I can find is "Over 95%" though I didn't get this from an official/reputable web site. I can't find the statistic on AAMC.org.

Also, here are average level of parental income of applicants by ethnicity:



This is from the source:
http://www.unmc.edu/Community/ruralmeded/admissions_ratios_and_us_med.htm

 

If you look further down, there is information on why URMs tend to score lower on the MCAT (educational differences, socioeconomic status, etc.) but I guess i'll post another link. While the summary is a bit ambiguous, I'm not going to buy the full study to satisfy your curiosity.

Source: http://www.pubmedcentral.gov/articlerender.fcgi?tool=pubmed&pubmedid=13678423

Disadvantages in early education contribute to minorities' low test scores. Many educators believe a host of interconnected factors are responsible for such a disadvantage including poorly equipped schools (i.e. computers, activities, after school programs, test preparation), fewer competent instructors, stereotypically lowered expectations of teachers of minority students and minority students themselves, and the lack of domestic and social support [11]. Although low income level is an additional factor, minority students from middle-class families have been shown to have lower academic achievement as a measured by GPA and SAT scores than whites and Asians [13,14]. Such evidence of disparity between minority and non-minority groups reveal the immense social, educational, cultural, and economic forces still operating along racial lines in this country.

Why is that? If medical school classes are only 6% African American (for example) your sample size skewes the statistical representation. Comparing a larger sample size to a smaller sample size is unfair in this case for the reasons I've stated above. For example, UT Houston has 4 African Americans in their current MS1 class. If you measured the drop out rate at graduation and compared it to the drop out rate of non-blacks, one person could make a HUGE statistical difference. Say 6 non URMs out of 200 drop out while only one out of four African Americans drops out. The drop out rate for non-blacks is 3% while the drop out rate for African Americans is 25%. I'm just saying that, considering the much smaller population of URMs in medicine, 88% is not a bad retention rate.

I'm sure this is what you think, and that's fine, but you didn't do any studies to test your hypothesis. I'm not using my words here, this information was gathered from studies performed by the AAMC. Apparently diversity of experience does not serve the US population to the same extent that ethnic diversity does. Furthermore, how do you define "qualified"? Consider this: If we, as a nation, are in dire need of producing more ethnically diverse physicians, why isn't ethnic diversity a qualification? I.E. Considering the current demands of the medical community, being an under represented minority makes one inherently more qualified. I'll give a tangible example: The population of Hispanic Americans is quickly increasing in America. Because of this, there is a growing need for Spanish speaking physicians. While anyone can learn Spanish, those who are most qualified to speak comfortably with native speakers are those who come from Spanish speaking homes (i.e. Hispanic physicians). In this way, a Hispanic applicant is more qualified to serve populations that have limited access to health care. The point is, someone has to get the spot so choosing applicants who will do best for our Nation is the first priority in admissions. No one "robbed" ORMs of "their spots". People aren't penalized for not being URM in admissions.

With regard to the bolded print:
The truth is there are fewer spaces in medical school than there are qualified applicants. Completely unqualified minorities do not get into medical schools—certainly not at prestigious institutions. By your reasoning, every individual who gets into medical school costs another “his spot”. If I didn’t get in this year I could just as easily say, “Some Asian applicant took my spot. Why are so many ORMs accepted anyway? I’m more qualified because more URMs are needed in medicine.” Also, just because you work in an underserved area for economic incentive does not mean you are the best physician to serve this population. If you are a practicing physician in an urban area, you are never required to give health care to those who can’t afford it. In the study on diversity that I quoted above, it shows that URMs are more likely to provide health care to the uninsured. Besides there are other benefits to having URM doctors work with URM patients including minority patient satisfaction and the biomedical research promoted by minorities. You can read about these specific benefits at:

http://www.pubmedcentral.gov/articlerender.fcgi?tool=pubmed&pubmedid=13678423

Under the heading: “Affirmative Action Minimizes Heath Disparities”

 

Hey, I didn't say it. The AAMC did.

Besides, I really did my research on this one. You could at least be courteous enough to respond with something better than this.

 

You can apply as a disadvantaged applicant and talk about your commitment to underserved populations in your essays. I know schools take this information into consideration during the admissions process. Are you from a rural area or an urban area? Many schools hope to increase the number of physicians who pursue rural medicine; your application would probably be most compelling at these schools.

 

No you are mixing your issues. You asked why minorities tend to score lower on standardized tests. I provided an answer and sited a reputable source. Since the specific question had nothing to do with the reason why URMs should be selected over non-URMs, you should not assume this answer serves to explain Affirmative Action.

In medicine, Affirmative Action does not serve to help individuals who are disadvantaged in the application process. It does seek to deliver health care to those who are underserved.

The reason why URMs tend to have lower test scores is directly related to certain educational disparities.

See how these are separate statements that serve different purposes?

The statistic I gave was for the 2003-2004 graduating class. Averaging statistics for graduating classes over the years would produce inaccurate results because many factors have historically effected minority enrollment and retention. The most accurate statistic should be a discrete and current one. Also, if this group regularly represents a small number of medical school students, then each URM regularly counts for more of the class. For instance, African Americans comprise 6% of the medical school population (given 100 students, 6 will be black) if one drops out every year, the retention rate is reduced by 17%. There would have to be a good number of graduating classes with 100% minority retention to produce a 98% retention rate. Surely you see how a higher sample size would yield more forgiving statistics.

I'm not using circular reasoning. Through diligent study of the topic performed by capable institutions, it has been determined that the most effective physician population is one that mirrors the diversity of the general population. Because of this, admissions committees seek to create ethnic diversity in US medical schools. Other methods for creating this racial diversity have been tested, but the best method is racially based Affirmative Action.

Why can't you believe that racial and ethnic issues matter in this country? People weren't enslaved and subsequently denied rights because they were too tall or short, too fat or thin, fast runners, exceptionally strong, or had unique life experiences. They were denied rights because of skin color. While I agree that this practice was unfair, it has left scars on our nation. Since the Civil Rights Movement, individuals of all races have gained rights, but not equal footing. The health disparities in certain ethnic populations reflect the scars left by years of racial injustice. Since the heath disparities are related to racial issues, it follows that a direct method for correcting these disparities has to involve race. In the end, it's not an argument over whether or not Affirmative Action is morally correct, it's a question of whether or not it works best to achieve a defined goal. It has been proved time and time again that this answer is yes.

First, can we please get over this notion of people having "spots"? There are a limited number of seats in medical school and a large applicant pool. These seats will be filled with individuals who can best serve the US population. I know you can't control your ethnic background, and it's unfortunate that this uncontrolable factor makes a difference in our imperfect society. That being said, there are many other controlable factors that influence whether or not you get in. I know you got in to many Texas schools as an out of state applicant, and you are not URM. If AA made so much of a difference, there would be no such thing as over represented minorities.

There are economic incentives for physicians to enter urban areas and to pursue primary care:
Source:http://jama.ama-assn.org/cgi/content/full/279/17/1403

"There is evidence to indicate that financial incentives influence specialty choice,10 and managed care is providing new economic incentives for young physicians. Between 1985 and 1993, states with the highest penetration by managed care also had the highest rate of growth in primary care physicians' income."

Ethnicity just seems to work better than economic incentive. When it comes down to it, it is cheaper and more effective to admit minority students who want to work with minority populations than to pay groups of different ethnic backgrounds to work in an environment that would be otherwise unfavorable to them.

I agree that AA is a quick fix to a larger problem, but until there is massive reform of the education and health care systems it will be the most efficient way to produce an adequately diverse physician population.

 

I think the difference is that this thread is aimed at spreading valid information while the last thread was a haven for individuals who "resent URMs" to vent their frustrations. Any thread entitled, "Do you resent (X ethnic group)" is probably inappropriate and offensive.

 

This again goes back to your definition of "best qualified physicians"

Also, the AMA has ALWAYS been intricately involved in politics. Medical schools get most of their funding from the NIH and that is a government agency. The government has decided that this is a truly laudable social goal and it has pressured the medical community (including medical schools) to act accordingly. Besides, who cares who decides to fix a problem as long as it gets fixed?

 

Ok, wait. Let’s simplify. Is your problem that you don't understand why racial diversity is a lucrative goal that should be pursued through Affirmative Action?

 

Ok, first let’s admit the fact that race matters in this country. When U of H boasts about its amazingly diverse student body, everyone understands the racial/ethnic implications. If we had an SDN meet and I walked into the room, the first thing you would notice is that I’m black. People in the United States of America are not color blind; it makes a difference in how people interact.

That being said, these are reasons why racial diversity alone is favorable necessary especially with regard to physician populations. The information is provided by: http://www.pubmedcentral.gov/articlerender.fcgi?tool=pubmed&pubmedid=13678423

1. Minority Practice in Underserved Areas.
Collectively, diversity in medical education provides enhanced access to health care for underserved populations. Many studies provide evidence that minority physicians are more likely than their non-minority colleagues to practice in underserved and often minority populations [4,10,23,24]. Despite the same insurance, income, and medical conditions, a congressionally commissioned report of the National Institutes of Medicine (NIH) [25] suggests that minorities are often left with fewer diagnostic tests, less sophisticated treatments, and ultimately inferior care. These intolerable racial disparities in medicine can be diminished by diversity of medical practitioners who treat underrepresented minorities, in addition to financial incentives for those who practice in such environments. Minority physicians are more likely to enter primary care specialties, work in underserved and disadvantaged areas, and provide health care to the medically indigent, irrespective of a patient's race or ethnicity, thereby reducing the racial and ethnic health disparities [10].
2. Biomedical Research Promoted by Minorities.
Congress has identified various medical disparities generally on the basis of race that plague our health care system and also acknowledge the contributions of minority medical professionals in combating them. Congress is eliminating the inequalities by allocating scholarship funds and creating programs aimed at disadvantaged and minority individuals in medical and scientific professions (i.e. the Minority Biomedical Research Support Program, one of the largest of its kind instituted by the NIH to increase minority researchers in the field of biomedical sciences). The NIH has even recognized that the momentum of the scientific progression depends upon diverse biomedical investigators [26].
The American research agenda is primarily promoted and investigated by individuals who feel and see the problems they wish to solve. Diversifying the medical (MD) and doctoral (PhD) student pool will only broaden the research foundation of our country, especially areas of public health, biosocial, and medical concerns. Such a workforce will be equipped with the tools necessary to combat the various ailments our country faces, including racial discrimination.
3. Minority Patient Satisfaction.
Studies indicate that minority patients have greater unwillingness to accept physician recommendations or seek medical care than their white counterparts [25]. This predilection may be due to language and cultural barriers [27]; however, in the case of African Americans, a NIH study [25] states that racial preference in their providers may be attributed to the general disbelief in medical professionals that results from racial discrimination and segregated, and ultimately substandard, care for minorities. Though racial preference exists in minority populations for their medical providers, the notion that patients should always have physicians of their own race or that minority medical doctors can only deliver great care to minority patients is foolish. On the contrary, cultural competency should be promoted among all physicians. Consumer choice, especially when it leads to greater patient satisfaction and improved health care, is another reason for diversity and race-conscious programs in medical school admissions.
4. Classroom Diversity Is Favored.
Medical students at Harvard University and the University of California, San Francisco have shown support for affirmative action in admissions as measured by survey [28]. The students expressed that racial diversity enhances their medical education experience, ultimately improving their ability in practicing in an increasing multicultural society and patient body. In addition, the study shows that exposure to diversity contributes to greater tolerance and less discrimination and the ability to comprehend multiple perspectives. A textbook alone cannot adequately teach these vital principles to our physician workforce. Adequate representation among students and faculty is the only real option to successfully integrate such education into the medical school experience and produce "culturally competent" physicians. Also, as previously mentioned, racial preference of minority patients is likely due to language and cultural barriers, and classroom diversity will assistant in bridging the minority patient and physician relationship, irrespective of race or ethnicity, thereby shrinking medical disparities.

 

Sorry if my wording offended you, I was just trying to get to the basis of our disagreement.

Ultimately, you are correct. In a perfect world, admissions should be color-blind. The long-term solution should be to correct the educational disparities that lead to fewer minority applicants and lower minority test scores. The problem is that we need to start creating diversity now. An ideal system would be one that preserves AA for current use with the understanding that this is an inadequate quick-fix. While AA takes care of the immediate need, efforts should be implemented to correct disparities in our education system. As the number of URM applicants increases and URM test scores also increase, the AA system can be scaled back. Eventually the proper method would phase out the improper one.

 

What do you mean what is the incentive? If you start fixing the education system at a very early level, kids will learn better and achieve more. They will take this knowledge with them to higher education. Why would perfectly capable URMs suddenly choose to screw up the MCAT since AA will get them in anyway? Also, I didn't hear about the URM advantage until I started posting on SDN. I'd expect most URMs don't feel comfortable leaning on a system that they are uninformed about. Also, I do not regularly say, "ORMs should stop whining about AA and improve their apps." I made this comment in the thread about mods closing offensive threads to illustrate why discriminatory language is hurtful and inappropriate on SDN. If you read my post history, I do not hinge my arguments on this ignorant notion. As for implementing a new program, I believe many organizations are working towards this goal. As you know, it is very difficult for individual citizens to affect legal change on a national level. I agree that this would be the best plan, however.

 

Can we please stop with the notion that members of certain ethnic groups get “bumped” for under qualified URMs. No one has a “spot”. It’s not like admissions committees decide all the spaces are automatically for the people with the highest numbers. Then they look through the other applicants and take spaces from those “more qualified” individuals as they encounter URM applications. Other factors determine who has the potential to be a qualified physician and who does not. Ethnic diversity just happens to be one of those factors—not because one ethnicity is inherently more equipped to be a physician but because of the current demands in medicine.

When I suggested staring to reform education early but keep implementing AA until the scales are balanced, I assume people would develop proper study skills and work ethics early on. No matter who you are, higher numbers= more options—this is the incentive. Minority students try to the best of their ability to make the highest score possible with the resources afforded to them. It follows that providing more educational resources will cause more minorities to make higher scores.

About it not being fair to ORM students, I promise it does not make that much of a difference. After all, they are still over represented. Besides, if an ORM with adequate qualifications is rejected from his top choice school, the probability that he will get into one of his other choices is great. There is a chance that he still will not get in, but this has more to do with application pressure than AA. Is it fair that all qualified applicants don’t get in to medical school? No, but there are a limited number of seats. The job of the adcom is to choose who occupies those seats wisely; not necessarily by who has the highest numbers. Again, it's not about what's fair and consistent, it's about what works best. Right now, this is what works best.

If you take issue with the methods of political representation in the US, I don't have a good solution for you. There are too many people in America for there to be direct representation on every issue. Consequently, we choose a few people to make decisions regarding the masses.

 

All the sources I've read say there is a positive correlation between MCAT/GPA and Step 1 scores and grades during pre-clinical years. However, these factors do not measure success in the clinical years nor do they determine who will be the better clinician. Furthermore, having higher MCAT scores correlates positively for less interest in primary care.

http://www.unmc.edu/Community/ruralmeded/medicine_education_social_status.htm



As you've seen in previous articles sited on this thread, there has been a growing concern for the diminishing number of primary care clinicians. If only 2.5% of people with the highest MCAT scores choose to pursue primary care and these are the specialties most needed in the US, how would admitting only top MCATers best serve the population? I've worked very hard to use valid sources to support my claims. Show me, with actually studied information, that this is all BS--that the best qualified physicians to practice in the US are those with the highest MCAT scores. Show me a reputable study that proves ethnic diversity is not needed in medicine. Also, show me some facts about how minority populations are adequately served by non-URMs and that fewer URM physicians will probably result in relief of health disparities.

 

What I meant was GPA and MCAT scores are good predictors of achievement during the first two years of study in medical school (i.e. on written tests). Since the last two years are devoted to clinical rotations, those with lower MCAT scores perform just as well as those with high scores. People can choose to study whatever they want; I found a study entitled, "Do under represented minorities differ from other students in reasoning ability." This study was published on pub med, so yes I do think this study could have been done. Also, just because a hypothesis assumes one result doesn't mean the findings will support that hypothesis. In this way, a study that attempts to prove diversity is beneficial could unexpectedly prove that it's not. By adequately serve, I mean do non URMs tend to seek under served areas in equal or larger numbers than URMs. Also, are the minority patients of non-URMs satisfied to equal or greater extend than they would be satisfied by a URM doctor. Apparently you can qualify patient satisfaction, because I've seen data on it. You could even show me data that people with higher MCAT scores of ORM groups tend to pursue those primary care specialties that are most needed. I'm asking you to prove to me that your opinion is valid using actually researched information. You can't possibly think all these agencies are just making stuff up because they happen to really like URMs. If you can't prove it, then don't dismiss the opposing argument as "BS" simply because you don't think it's fair.

 

The specific reasons why race, in and of itself, is important in medical admissions were mentioned below under the sited document.

I think the purpose of AA in medical admissions is to make all racial/ethnic groups proportionately represented in order to provide patients with a more balanced set of clinicians.

 

But minorities hardly vote too, remember? If this wasn't something that the AMA and the AAMC felt was necessary, do you really think it would happen? Are politicians suddenly clamoring to gather those last few minority votes? I would expect that it is much more important to political success to be in the pocket of the AMA--not to appease the traditionally poorer minorities.