Noting the “disappointing progress in enrollment of medical students from racial and ethnic groups underrepresented in medicine,” three new studies published by the Journal of the American Medical Association (JAMA) Network examine the barriers deterring students from medical education and ways higher education can improve diversity, equity, and inclusion (DEI) in medical school and medical residency programs.
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One of the new studies, published this month in JAMA Health Forum, explored racial and ethnic differences in certain barriers reported by 81,755 students taking the Medical College Admissions Test (MCAT)—and those barriers’ connection to racial and ethnic gaps in medical school application and matriculation. The study found that Black, Latine, and Indigenous MCAT examinees had lower parental educational levels, shouldered increased educational and financial barriers such as outstanding loans, and were more likely to have been discouraged from pursuing a career in medicine. Students facing these deterrents were ultimately less likely to apply to and matriculate at medical schools.
“If we see that these barriers exist in those who are already taking the MCAT, we can only imagine how many students are really falling off before that,” Dr. Jessica Faiz, an emergency medicine physician, National Clinician Scholars Program Fellow at UCLA, and lead author of the study, told Forbes. “By studying these upstream factors and potential mechanisms for why we are behind in diversifying the physician workforce, we can come closer to solutions that will ultimately improve care for our patients.”
The study highlights several opportunities for improvement, including addressing costly elements of the application process, such as MCAT preparation courses, application fees, and interview travel. Noting that underrepresented groups often lack opportunities to shadow physicians or participate in college labs, the researchers also call for broadening premedical educational opportunities. In addition, the study shows how interpersonal discrimination can weaken the medical school pipeline, as American Indian, Alaska Native, Asian, Black, and Latine examinees “were significantly more likely to report that their prehealth adviser negatively influenced their decision to pursue a career in medicine.”
Overcoming admissions barriers
All three JAMA Network studies touch on the admissions process and its role in diversifying medical school enrollment and medical residencies. The survey of MCAT-takers emphasized the ongoing need for admissions processes that are not only holistic—considering applicants’ hardships and the value of having diverse experiences—but also race-conscious and cognizant of structural barriers to medical careers for groups underrepresented in medicine (URiM).
A second study, published in JAMA Network Open, examined how 39 US medical school deans and directors of admissions address racial inequities in the medical field and where they encounter hurdles. Participants in the qualitative study said structures of institutional racism and a lack of resources to support DEI policies are barriers to increasing diversity.
They also suggested ways medical school admissions practices can help overcome these obstacles, such as selecting applicants based on their potential as future physicians rather than their performance on standardized tests, providing implicit bias training for admissions committee members, and including student input in the admissions process.
“Comprehensive institutional- and process-level reforms are needed to dismantle admissions systems that perpetuate institutional racism,” the authors. “Increasing the racial and ethnic diversity of the physician workforce is foundational for achieving health equity.”
Foundational strategies for residency program DEI
A third study published in JAMA Network Open identified efforts that had been successful in diversifying medical residency programs in the years since the Accreditation Council for Graduate Medical Education added a diversity standard to its accreditation process. Programs that successfully recruited and retained diverse students deployed a combination of what the study calls “foundational” (smaller-effort) and “aspirational” (or more resource-intensive) strategies. The former include adopting a DEI-focused mission, assessing applicants with that mission in mind, and partnering with local community colleges. More resource-intensive options included creating DEI and health equity curricula for residents and compensating residents who engage in DEI work beyond core residency requirements.
Ultimately, many of the strategies implemented by the most DEI-focused residency programs are “very simple and wouldn’t require a lot of resources, but probably would have a significant benefit,” Dr. Dowin Boatright, an emergency-medicine doctor at the NYU Grossman School of Medicine who led the study, told The Chronicle of Higher Education.