Sociodemographic Factors Major Driver of Students Leaving Medical School

The findings of new research point to ways to promote diversity among medical students.

Medical students are more likely to leave medical school if they are underrepresented in medicine by race and ethnicity, have low income, or come from underresourced neighborhoods, a new research article found.

Earlier research has shown that several racial and ethnic groups such as Blacks and Hispanics are underrepresented in the physician workforce compared to the demographics of the U.S. population. The lack of diversity in the healthcare workforce has a negative effect on patients of color, according to a report published earlier this year.

The new research article, which was published by JAMA Internal Medicine, features data collected from more than 33,000 allopathic doctor of medicine medical school students. The primary outcome examined by the researchers was medical student attrition, which was defined as withdrawal or dismissal from medical school for any reason.

The study has several key data points.

• Among the 33,389 MD students in the study, 2.8% experienced attrition from medical school
   
• Compared to non-Hispanic White students, students without low income, and students who did not grow up in underresourced neighborhoods, students who were underrepresented in medicine such as Blacks and Hispanics, students who had low income, and students who grew up in underresourced neighborhoods were more likely to experience attrition from medical school
   
• Students that had all three marginalization characteristics (underrepresented in medicine, low income, and growing up in an underresourced neighborhood) had an attrition rate 3.7 times higher than students who were not underrepresented in medicine, did not have low income, and were not from an underresourced neighborhood
   
• Students who were underrepresented in medicine experienced about twice the rate of attrition as non-Hispanic White students (5.6% versus 2.3%)
   
• Students who had low income experienced about twice the rate of attrition as students without low income (4.2% versus 2.3%)
   
• Students who grew up in underresourced neighborhoods experienced about twice the rate of attrition as students who did not grow up in underresourced neighborhoods (4.6% versus 2.4%)

"This retrospective cohort study demonstrated a significant association of medical student attrition with individual (race and ethnicity and family income) and structural (growing up in an underresourced neighborhood) measures of marginalization. The findings highlight a need to retain students from marginalized groups in medical school," the study's co-authors wrote.

Interpreting the data and conducting interventions

Earlier research has shown that medical students who are underrepresented in medicine are exposed disproportionately to interpersonal and structural barriers that affect their medical school experience. These students have other experiences that contribute to medical school attrition, the study's co-authors wrote.

"These students also often lack identity-concordant mentors and role models, are frequently burdened with instances of minority tax (similar to the disparity in responsibility for underrepresented faculty), and commonly experience microaggressions and discrimination, including exposure to bigoted remarks by patients and faculty, bias in evaluations, and inequities in the receipt of academic awards. These experiences of social isolation, racism, and discrimination have been associated with burnout, depression, and attrition and highlight the need for medical schools to adopt a more proactive antiracism strategy," they wrote.

The data from students with low income and students who grew up in underresourced neighborhoods indicate an important finding, the study's co-authors wrote. "Poverty and growing up in an underresourced neighborhood may have long-term consequences that are accentuated in medical training, such as lack of social and cultural capital to navigate medicine's hidden curricula, social isolation from affluent majority peers, and financial stress, which may be associated with attrition among students with low income."

Medical schools should consider conducting three interventions to reduce attrition among marginalized students, the study's co-authors wrote:

• "Given the higher attrition rate among marginalized student groups, medical schools should consider reforms that dismantle structural inequities in medical culture and training that equate privilege with merit and physicians as an elite class of citizens. These reforms may begin with tuition and debt reform and purposeful partnership and support of local and national underresourced communities."
   
• "Reforms could include robust financial and administrative support for diversity, equity, and inclusion offices and affinity groups representing marginalized groups. These offices should be populated with staff who are trained in critical race theory, health equity, and inclusive pedagogy and should be resourced to facilitate students' preclinical and clinical curriculum, offering programming for students, faculty, and staff on implicit bias, structural competency, and civil discourse."
   
• "As medical schools strive to create an inclusive and equitable learning environment, [another] consideration could be an aggressive effort to hire faculty from diverse backgrounds, who may offer critical mentorship opportunities for all medical students. In addition, interactions between medical students and a diverse faculty have been shown to be associated with reductions in implicit bias in the learning environment."

Related: CommonSpirit and Morehouse Addressing Underrepresented Physicians and Health Equity