Medical Schools Need to Keep Pace With a Changing Society
Future demographics create urgency for more campus diversity
By David Sheets
Britani Martinez Kessler knew from childhood that her future involved science. The idea of a career in biology appealed to the Coral Gables, Fla., native, so she headed to college with that in mind.
Soon, the interest in biology evolved into a passion for medicine, and when that happened, Kessler became fearful. She was the first in her extended Hispanic family to attend college, which was difficult enough. Medical school seemed like a costly dream.
“I was lucky. I had my family, my friends, and I had wonderful mentors encouraging me the whole way,” she said. “I can’t imagine where I would be if even one of those things was missing.”
According to the Association of American Medical Colleges, too few among underrepresented minority groups live the same dream. The AAMC estimates that while minorities make up just over a quarter of the U.S. population, they constitute less than 10 percent of its physicians.
A key reason, the AAMC and other medical advocacy groups say, is that underrepresented populations lack the support or encouragement to pursue medicine as a career. And that lack of support threatens to diminish the overall quality of care in this country.
This makes diversity one of the most pressing issues in medical school education today.
“The real goal should be to ensure that the physician in front of the patient really understands that person fully from a cultural and linguistic standpoint so that they can optimize care,” said Marc Nivet, chief diversity officer for the AAMC. “One way to ensure that folks become culturally competent is to have a classroom that itself is more diverse. If you have students who are different from you, it adds to the classroom experience.”
First, medical schools have to get underrepresented students in the door, and showing them the way starts at an early age.
“We understand the demographic shift. We recognize that this country will truly be a colored nation within the next 10, 20 years, with Hispanics and AfricanAmericans being a combined majority group,” said Dr. Andre Churchwell, senior associate dean for diversity affairs at the Vanderbilt University School of Medicine.
“We also recognize that these are our disadvantaged groups, and we have to build a really codified pipeline for public education in science, technology, engineering, and mathematics down deep into those communities at the K-12 level,” he said.
Among communities that are aware of the need for STEM-oriented education and attempt to meet it, public education standards vary widely. This is why many medical schools have taken on this responsibility by establishing their own pipeline programs into neighboring and regional communities, Churchwell says.
These programs help identify STEM-minded students early and put them on academic courses that mirror their interests.
“Everybody has something like that in place now,” Churchwell said. “It’s part of the accreditation process. You have to show that you have a process in place and that you have pipelines that you are constructing, and you have outcomes to show what you have done with those pipelines. It challenges us to be part of the solution, not just stand on the sidelines and criticize the education process.”
Not everyone agrees that the effort is uniform or that the reality of cultural change is sinking in. Speaking about higher education and diversity in general, Raynard Kington, PhD, president of Grinnell College and former deputy director of the National Institutes of Health, told INSIGHT Into Diversity in the March issue, “The majority of births in this country now are non-white. And that means 18 years from now, that’s who will be graduating from high school. But the majority of elite institutions in this country are unprepared for that.”
He said many leading educational and research institutions still believe “diversity is what you do after all the important stuff.”
Once the students have made it down the pipelines Churchwell described and through the medical schools’ doors, retention becomes the next challenge, and the next most important tool for developing and maintaining a diverse medical school enrollment is mentoring—faculty and staff showing an interest in student progress by being available to answer questions and lend moral support.
Underrepresented minorities constitute about 15 percent of all medical school applicants; according to AAMC research, their actual enrollment numbers are far smaller. Meanwhile, graduation numbers have increased only slightly.
In the most recent figures available, compiled between 2010 and 2011, African American and Hispanic or Latino students made up nearly 15 percent of all medical school enrollees. Among other groups such as Native Americans and Pacific Islanders, the matriculation rate was less than 1 percent for each group.
In 2011, there were just over 2,064 underrepresented minority graduates from medical schools around the country, compared with almost 2,169 in 2002, the AAMC says.
“When you’re first getting into these medical programs, you feel unsure and almost unsafe at times because this is completely new territory for you and your family,” said Kessler, who is the incoming president of the American Medical Student Association, a student-governed national association that speaks to the concerns of physicians-in-training.
“Being in medical school is something the whole family experiences, not just the students,” she said. “There should be mentorship programs with faculty who are committed to helping the students, and even mentorships with other students who went before you and are able to speak to the experience with understanding.”
Those mentors should be familiar with the culture of the students, if not actually part of their culture. But that, too, is another pressing issue for medical schools. A study led by researchers at Children’s Hospital of Philadelphia and released in December found that the total number of minority medical school faculty in the United States rose to only 8 percent from 6.8 percent between 2000 and 2010.
Furthermore, minority faculty were rarely promoted or elevated to senior and administrative positions, the study said.
Dr. Carmen Green, associate vice president and associate dean for health equity and inclusion for the University of Michigan Health System, agrees that culture is just as important in effective mentoring as kindness.
“We know that diversity helps people think more broadly, to hear different viewpoints, to get comfortable hearing different stories, and then we get a complete picture and see more clearly,” she said. “We’ve got to figure some of this out, and some of that comes just from interacting with people who have had different experiences. … We’re going to need all of those types and viewpoints in order to change and transform health care.”●
David Sheets is the editor of INSIGHT Into Diversity. Published in our April/May 2014 issue.