AAMC Calls on Medical Schools to Improve Diversity

As debate about the affirmative action policies at U.S. universities continues, the AAMC is boldly pushing medical schools to improve diversity among their students to reflect the patient populations they will treat.

The American Association of Medical Colleges is one of dozens of organizations that filed an amicus curiae (friend-of-the-court) brief supporting the University of Texas' affirmative action policy that is being challenged in Fisher v. University of Texas at Austin. The U.S. Supreme Court heard oral arguments on the case December 9. The American Medical Association, American Academy of Family Physicians, and other healthcare-related organizations also filed an amicus curiae upholding the AAMC's support of affirmative action.

As SCOTUS cases usually are, the actual issue is narrow (one student is challenging the policy), but the outcome has broad implications for, in this case, race-based college admissions. In medical school, the issue of diversity is more than academic. AAMC President and CEO Darrell Kirch, MD, made it clear in his speech at the AAMC annual meeting in November that in order to improve healthcare quality, diversity on medical school campuses must also improve, saying, "…we must admit medical school classes that reflect the diversity of our communities."

More than half of students enrolled in U.S. medical schools are white, according to the AAMC. At American University of the Caribbean School of Medicine, an international medical school in St. Maarten where 85% of the students are from the U.S., the racial make-up is reversed: 51% of the students are non-white, with large groups of Asian, African-American, and Hispanic students, says Dean Heidi Chumley, MD.

"We have a lot more students from diverse backgrounds, not only in race and ethnicity, but also geographically," Chumley says. "We have students from rural areas and also students who are economically disadvantaged. The key to admitting a class that is diverse is looking at the barriers that are keeping diverse populations out of medicine."

MCAT hurdles
One of the biggest barriers, says Chumley, is the MCAT. The entrance test was revised earlier this year to include a psychological, social, and biological behavior component to gauge students' softer skills.

"Being a good doctor is about more than scientific knowledge," Kirch said in a 2012 statement when the changes were first announced. "It also requires an understanding of people."

Hospital and healthcare system leaders know that the softer skills of physicians, such as bedside manner and communication style, can impact patient experience, satisfaction, and quality. They're spending time and money on leadership classes that teach the very things the new MCAT is gauging before medical students step into their first rotation.

But despite the changes, Chumley says medical schools should look beyond the MCAT scores. "The AAMC has made a big push toward holistic admissions," she says. "But what happens is that the higher the [MCAT] score, the better. When you do that, you select for people who have been privileged, advantaged, and can afford to take MCAT prep courses, which are expensive. It creates an inherent selection bias."

This perspective of bias on standardized tests isn't new, but the AAMC's response to reengineer the test and push for more diversity among medical school students show it is taking the issue seriously.

Chumley, who was previously senior associate dean for medical education at the University of Kansas School of Medicine, says challenging the importance that medical schools place on MCAT scores is controversial. But, she says that capable students are getting rejected. She says at the University of Kansas, she blinded the actual numerical MCAT score of prospective students from the admissions committee and instead gave them a grade range the students scored, such as A, B, and C.

"It drove the admissions committee crazy not to see the exact number," Chumley says. "You couldn't tell the difference between the A and B range; the C range was a higher risk, but there is this whole other group not getting admitted who is perfectly capable. The MCAT affects the diversity of classes."

Chumley says students who score below the mean are prepared for medical school. At AUC, the average MCAT score is equivalent to a pre-2015 two-digit score in the 20 to 29 range, with some students achieving higher scores, but it is still below the mean. "They pass the same tests [at AUC], prepare the same way U.S. medical school students do," she says.

AUC students also do most of their clinical training in the U.S. The school's campus is on a Caribbean island, but to practice medicine there, students have to have a Dutch license, which requires taking the test in Dutch, as well. There are some rotations in the community, however, which helps students from diverse backgrounds connect with each other, says Chumley. The match rate among AUC students is also high. Chumley says 84%–85% of students match on their first try, additional students match on their second try.

AUC graduates are also filling a void in the U.S. healthcare system. About half of AUC alumni return to practice in medically underserved and primary care shortage areas.

"There are not simple answers to improving diversity in medical schools, or people would have done it," Chumley says. "Every search committee group—formal or informal—we pay a lot of attention to who is included. You want to give students glimpses of your intentionality."