“Lots of scrambling on the ground.”
That’s how Consuelo Wilkins, the senior associate dean for health equity and inclusive excellence at Vanderbilt University Medical Center, describes medical schools’ current efforts to maintain diversity in the wake of the U.S. Supreme Court’s decision to strike down affirmative action based on race.
“I think there’s a lot of fear, which is probably what concerns me the most, that people are not confident in the holistic reviews that they’ve been doing previously,” said Wilkins, speaking at a panel at the virtual STAT Future Summit on Tuesday.
While many medical schools have adopted what are known as “holistic reviews” that consider the background and skills of students in order to diversify their cohorts, Wilkins explained, some had relied more on affirmative action to guarantee racial diversity. Now they find themselves unable to use their most trusted tool.
Affirmative action was an important tool for diversifying medical school enrollment, panelists said, it was by no means the only one — nor did it lead to sufficient change. The overwhelming majority of medical students are white and come from wealthy backgrounds, while only one in four comes from a family at or below the U.S. median income, said panelist Mark Henderson, a professor of internal medicine and associate dean for admissions at UC Davis School of Medicine.
As the last cohort of students to benefit from affirmative action starts the 2023 school year, those in charge of enrollment are wondering how to continue promoting diversity among their recruits. Here are a few of the tactics the panelists discussed.
Start with the faculty and admissions committee
If a medical school wants to have a diverse student body, it needs a diverse faculty and admissions committee, said Wilkinson.
“I see a medical school where we have individuals from communities that are impacted by health inequities making up at least half of the admissions committee,” she said. “They’re serving as instructors and professors, teaching students as they move along that they have a role in helping to design the curriculum.”
Curriculums built by more diverse faculty and students would also help students who come from privileged backgrounds to better understand issues such as the social determinants of health and to improve their cultural humility, she said.
Stop hazing the healers
Medical school is unnecessarily hard on students, which is also a deterrent to diversity, said Donald Warne, a professor of public health and co-director of the Center for Indigenous Health at Johns Hopkins.
Programs that focus too much on memorizing unnecessary information and preparing for tests bear limited resemblance to the actual work of health care, he said, and put medical school doctors under an undue amount of pressure. Students’ well-being is often ignored, further hurting diversity efforts, especially as the unnecessary stresses of medical education compound for people who are already dealing with financial or social challenges.
“Here’s a radical idea: What if medical school was a healing experience rather than a traumatic experience? We don’t really focus on the wellness of our future providers, and I think that’s a huge mistake,” said Warne.
Move away from the four-year curriculum
“There’s nothing magical about four years of medical education,” said Warne. Many students may need longer, he said, especially those who come from under-resourced backgrounds and may not have had access to the kind of previous education necessary to complete medical school in four years.
“We can’t assume that everyone’s at the same level playing field,” he said. Forcing a four-year timeframe on all students ends up taking opportunities away from those who didn’t have access to high-level education, even if they have the potential, intelligence, and willingness to excel at the medical profession.
Medical schools, which often have large endowments, should also invest in their pipelines, supporting education opportunities in underserved communities, according Carolina Reyes, an associate clinical professor of Maternal Fetal Medicine at UC Davis Health and board chair of the California Health Care Foundation.
“This is not just a concern from individual medical schools, but it is about how do we train a pipeline of individuals to best meet the needs of providing health care? And this begins from the minute a woman is pregnant and the baby’s born,” Reyes said.
Provide substantial financial aid
Students from low-income backgrounds often deal with challenges and responsibilities that can end up compromising their education, said Henderson, who at UC Davis oversees the second-most diverse medical school in the country after Howard University’s despite the fact that affirmative action has been outlawed in California for three decades.
“If you don’t give people opportunities financially, you’re never gonna make progress,” said Henderson. UC Davis offers programs that give students sufficient financial support so that they don’t struggle through medical school. This way, they can focus on their studies.
“I think it’s really important that we do focus on […] making sure that people don’t leave medical school so burdened by debt that they can’t actually survive and thrive,” said Wilkins.
End legacy admissions
Legacy admissions are counterproductive, said Henderson, because they lead to a health care workforce that doesn’t reflect the population it needs to serve.
“The idea that we give such a leg up to people who are already in the guild, to me is antithetical to really building a representative workforce,” he said. “The more representative it is of our patients, the better those patients are going to do.”