Now is the time to diversify the country’s medical workforce – here’s how

In retrospect, 2020 seems to be a crucial time in medical education. In the past year, the following events occurred: the SARS-2-COVID-19 pandemic, social upheaval, the decision of the National Board for Medical Examiners (NBME), passed the US Medical Licensing Examination (USMLE) Step 1 / Failing has increased the number of applications to medical schools, especially from underrepresented races and ethnic groups in medicine (URM), and the growing recognition of so many well-meaning people in medicine and healthcare for the importance of joining our medical school classes diversify. All of these developments make now the best time to adapt our admission campaigns to the rhetoric.

There are many documented benefits of diversity in medicine. For one thing, black patients and black babies have better health outcomes when their doctors are black.

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URM students add important benefits to medical school teaching, and these have been widely publicized. URM students are more likely to return to medically underserved communities to practice. They will have a better understanding and empathy for the problems their future patients will face because they come from the communities they will serve. URM students bring their unique perspectives, life stories, and courage to the medical school classes they attend, thereby enhancing the academic experience of their medical school classes. These URM students help their classmates learn about their different cultures and help their classmates become familiar with cultural mores that are different from theirs. In this way, URM students help improve the cultural competence of the entire class.

The importance of diversity extends to patient care outcomes as well. Minority patients have higher levels of acceptance and trust in their physicians who are of the same race and ethnicity, leading to positive health outcomes for them. Indeed, given the ongoing COVID-19 pandemic, these URM doctors are the lifeline for their underserved minority patients.

The increase in Diversity, Equity, and Inclusion (DEI) officers recently appointed in most organizations is evidence that academic medical centers are recognizing the importance of diversifying the medical workforce. Many medical disciplines have followed suit and have set up DEI committees to recruit URM students into their programs. For many years, many schools and organizations seem to have agreed to diversify their medical school teaching and study programs, but results have varied and have not shown a significant increase in the number of URM candidates selected. For example, for the allopathic medical school in 2020, only 1,767 of the 22,197 students enrolled were identified as black or African American. In 2018, only 5.0% of active doctors identified as Black or African American compared to 13.4% of the U.S. population in 2019 who identified as Black or African American.

The role of pipeline programs:

To increase the number of competitive URM applicants for medical school, medical schools must establish effective pipeline programs:

• They should recruit URM youth from the communities around their schools and hospitals and beyond
• Bring them into the STEM areas, provide academic enhancement, mentoring and professional advice
• Provide the necessary resources, inclusive and positive learning environments, and effective role models. Many URM students are first generation college students whose parents are ignorant of the ins and outs of higher education to guide their academic endeavors, and many attend schools with limited resources
• General instruction in critical / analytical thinking skills, tutoring in basic concepts in STEM disciplines, preparation for the MCAT and opportunities to be supervised by doctors

Diversity is an accreditation requirement:

The diversity of medical schools is such an important finding that the Medical Education Liaison Committee that accredits all allopathic medical schools in the United States and Canada has included this as a Standard 3.3 accreditation requirement. Many schools are therefore working to increase the number of URM students in their classes. Some schools have made significant strides. The pace of diversification is slow, however, and many schools are looking for the same small cohort of URM applicants who have competitive medical college (MCAT) admission tests and a science grade point average (GPA). Unfortunately, many medical schools use both the MCAT and the GPA in large part to select their admission classes. These two metrics are therefore considered to be “gatekeepers” that limit the chances of URM applicants to enroll in medical faculties.

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MCAT scores do not predict the quality of medical care an applicant will provide to their patients after training. MCAT scores do not predict one’s ability to work effectively in teams or the level of advocacy a medical student, resident, or practitioner will have for his or her patient or service to vulnerable communities. After all, MCAT scores don’t predict empathy. However, some schools mainly base their selection on applicants with outstanding results. MCAT results predict performance on standardized exams. MCAT levels are a range and appear to have a “threshold effect”. Many medical schools have been able to recruit students with “modest” MCAT (medium scores) scores and have achieved excellent results. Schools need to move away from this heavy reliance on the MCAT score.

Holistic review:

Medical faculties should use the holistic assessment framework when selecting applicants:

• Weighing up each applicant’s personal characteristics, experience, and academics
• Each school has its unique mission and should aim to recruit broadly skilled students who embody their mission and serve the increasingly diverse nation in culturally savvy ways
• MCAT and GPA should be used as part of this holistic review
• Take into account the life story, background, personal characteristics of each applicant, demonstrated service orientation, motivation for a career as a doctor, and desire to study in medical school

Inclusive and affirmative learning environment:

Recruiting diverse students is only part of the goal. Schools need to purposely create inclusive, learner-centered, and empowering environments so that URM students can feel at home and thrive. Recruiting and retaining URM staff, faculty, and administration is equally important in helping URM students develop that sense of belonging that increases their chances of success.

The Morehouse School of Medicine was able to achieve these results. The school embodies diversity at all levels, uses holism in the selection of medical school applicants, creates a caring and welcoming learning environment, and has shown successful results for its students regardless of their socio-demographic descriptors and academic metrics input.

Ngozi Anachebe is Sr. Associate Dean, Admissions & Student Affairs at Morehouse School of Medicine.

This article originally appeared on Brookings’ How We Rise blog and was republished with permission.