US Medical School Admissions Leaders’ Experiences With Barriers to and Advancements in Diversity, Equity, and Inclusion

Abstract

ImportanceDespite decades-long calls for increasing racial and ethnic diversity, the medical profession continues to exclude members of Black or African American, Hispanic or Latinx, and Indigenous groups.ObjectiveTo describe US medical school admissions leaders’ experiences with barriers to and advances in diversity, equity, and inclusion.Design, Setting, and ParticipantsThis qualitative study involved key-informant interviews of 39 deans and directors of admission from 37 US allopathic medical schools across the range of student body racial and ethnic composition. Interviews were conducted in person and online from October 16, 2019, to March 27, 2020, and analyzed from October 2019 to March 2021.Main Outcomes and MeasuresParticipant experiences with barriers to and advances in diversity, equity, and inclusion.ResultsAmong 39 participants from 37 medical schools, admissions experience ranged from 1 to 40 years. Overall, 56.4% of participants identified as women, 10.3% as Asian American, 25.6% as Black or African American, 5.1% as Hispanic or Latinx, and 61.5% as White (participants could report >1 race and/or ethnicity). Participants characterized diversity broadly, with limited attention to racial injustice. Barriers to advancing racial and ethnic diversity included lack of leadership commitment; pressure from faculty and administrators to overemphasize academic scores and school rankings; and political and social influences, such as donors and alumni. Accreditation requirements, holistic review initiatives, and local policy motivated reforms but may also have inadvertently lowered expectations and accountability. Strategies to overcome challenges included narrative change and revision of school leadership structure, admissions goals, practices, and committee membership.Conclusions and RelevanceIn this qualitative study, admissions leaders characterized the ways in which entrenched beliefs, practices, and power structures in medical schools may perpetuate institutional racism, with far-reaching implications for health equity. Participants offered insights on how to remove inequitable structures and implement process changes. Without such action, calls for racial justice will likely remain performative, and racism across health care institutions will continue.

Understanding and Addressing How Racism Can Affect Medical School Admissions—Making the Invisible Visible

“…The siloed nature of many diversity initiatives can lead to a decentralization that stymies meaningful progress and can render diversity practitioners frustrated, isolated, and burnt out . We agree with Ko and colleagues call for greater coordination in order to make meaningful positive changes in diversity, but additional resources are a prerequisite. The study found that overemphasis on the MCAT and other numerical metrics was partially due to convenience given the large volume of applications received.…”

“…We believe that the study by Ko et al is a call to action for medical school leaders, gatekeepers, and educators who have a unique opportunity to address many of the persistent challenges in advancing diversity within medical schools. Although this qualitative study of a diverse sample of deans and directors of admissions across 37 allopathic schools in the United States was not nationally representative, it nonetheless makes a major contribution to the literature by unmasking processes where racism can operate in medical school admissions.…”

“…Ko and colleagues found that definitions of diversity were often decoupled from the need to address racial injustice among participants placing these institutions in danger of reproducing, consciously or unconsciously, the negative racial structures and biases that diversity initiatives are meant to address. To see meaningful change, we must achieve “critical diversity” in medical schools .…”

“…Ko et al also indicate that improving racial and ethnic diversity calls for the examination of processes and elimination of those that are not aligned with stated organizational goals to advance diversity . For example, participants indicated that an overemphasis on the Medical College Admission Test (MCAT) was a barrier to advancing diversity, equity, and inclusion in admissions.…”

“…The description provided by Ko and colleagues clearly suggests that medical schools can be social institutions in which racism can become institutionalized. However, it is important to acknowledge that medical schools can also be potent catalysts for change.…”