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Analysis

Medical Schools Failing to Increase Representation of Minority Groups

By Christopher Cheney  
   September 27, 2019

New research indicates that increases in minority students who are applying to and enrolled in medical school are not keeping pace with increases in minority populations nationwide.

Despite a decade-long effort to racially and ethnically diversify medical school graduates to reflect the diversity of the general population, underrepresentation of minority groups in medical schools remains problematic, new research shows.

Earlier research has demonstrated that demographic representation in the physician workforce has multiple benefits, including better healthcare access for underserved populations, better cultural effectiveness among physicians, and better medical research and innovation for all populations.

In 2009, the Liaison Committee on Medical Education created accreditation guidelines mandating medical schools to develop programs or partnerships that would open up medical education to more students with diverse backgrounds.

A co-author of the new research, which was published in the Journal of the American Medical Association, told HealthLeaders that boosting physician diversity is beneficial at the patient bedside and at healthcare organizations more broadly.

"Oftentimes, we talk about diversity at the frontlines of healthcare because we want to make sure that we have diverse providers engaged with diverse patients because it will mitigate interpersonal bias or individual biases. The truth of the matter is that we need a diverse medical workforce not just at the frontlines but also among those generating the science of tomorrow and generating the systems in which we deliver care," said Jaya Aysola, MD, MPH, an assistant professor of medicine at the University of Pennsylvania's Perelman School of Medicine and executive director of the Penn Medicine Center for Health Equity Advancement.

Medical school diversity by the numbers
 

Aysola and her JAMA co-authors examined data from 2002 to 2017. The primary metric was representation quotient (RQ), which is a ratio that shows the proportion of a particular subgroup among the total population of medical school applicants or enrollees relative to the proportion of that subgroup in the U.S. population. An RQ greater than 1 indicates overrepresentation. An RQ less than 1 indicates underrepresentation.

The researchers generated several key data points:

  • The main finding is that the overall numbers and proportions of black, Hispanic, and American Indian or Alaska Native (AIAN) medical school enrollees increased from 2002 to 2017, but the increases did not keep pace with increases of these minorities in the general population.
     
  • For minority medical school applicants from 2013 to 2017, Hispanic female applicants were the only minority group that showed a statistically significant increase in representation, with RQ rising from 0.29 to 0.34. For the same time period, the RQ for Hispanic male applicants was relatively constant at 0.28.
     
  • For medical school enrollees from 2012 to 2017, there were no significant RQ increases or decreases for any racial or ethnic group. For example, the RQ for male and female Hispanic graduates was relatively constant at about 0.30.

"Black, Hispanic, and AIAN students remain underrepresented among medical school matriculants compared with the U.S. population. This underrepresentation has not changed significantly since the institution of the Liaison Committee of Medical Education diversity accreditation guidelines in 2009. This study's findings suggest a need for both the development and the evaluation of more robust policies and programs to create a physician workforce that is demographically representative of the U.S. population," Aysola and her co-authors wrote.

Addressing underrepresentation
 

Aysola told HealthLeaders that the underrepresentation problem cannot be solved by just focusing on societal factors such as educational disparities early in life.

"When we consider the pipeline in isolation as the only contributing factor, we are ignoring the system inequities that also play a big role in underrepresentation. I'm interested in what is intrinsic to the system that makes a difference in who is selected to attend our medical schools. What are the systematic biases that exist that prevent professional diversity?" she said.

One policy change that could make a difference at medical schools is already in place at many commercial businesses, Aysola said. "We want to test the priming technique, where you can prime interviewers and selection committees to consider their biases before an interview and after an interview, then determine whether biases are playing a role."

"For example, after you are done conducting an applicant interview, the interviewer considers whether there is anything about the applicant that they see in themselves. Is there anything in the applicant's CV that resonates with the interviewer? You are encouraging interviewers to screen themselves for their own personal biases, so they become more self-aware."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

Diversity in the physician workforce not only improves care at the bedside but also improves medical science and the design of systems of care.

For minority medical school applicants from 2013 to 2017, Hispanic female applicants were the only minority group that showed a statistically significant increase in representation.


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