Importance

There has been disappointing progress in enrollment of medical students from racial and ethnic groups underrepresented in medicine, including American Indian or Alaska Native, Black, and Hispanic students. Barriers that may influence students interested in medicine are understudied.

Objective

To examine racial and ethnic differences in barriers faced by students taking the Medical College Admission Test (MCAT).

Design, setting, and participants

This cross-sectional study used survey data (surveys administered between January 1, 2015, to December 31, 2018) from MCAT examinees linked with application and matriculation data from the Association of American Medical Colleges. Data analyses were performed from November 1, 2021, to January 31, 2023.

Main variables and outcomes

Main outcomes were medical school application and matriculation. Key independent variables reflected parental educational level, financial and educational barriers, extracurricular opportunities, and interpersonal discrimination.

Results

The sample included 81 755 MCAT examinees (0.3% American Indian or Alaska Native, 21.3% Asian, 10.1% Black, 8.0% Hispanic, and 60.4% White; 56.9% female). There were racial and ethnic differences in reported barriers. For example, after adjustment for demographic characteristics and examination year, 39.0% (95% CI, 32.3%-45.8%) of American Indian or Alaska Native examinees, 35.1% (95% CI, 34.0%-36.2%) of Black examinees, and 46.6% (95% CI, 45.4%-47.9%) of Hispanic examinees reported having no parent with a college degree compared with 20.4% (95% CI, 20.0%-20.8%) of White examinees. After adjustment for demographic characteristics and examination year, Black examinees (77.8%; 95% CI, 76.9%-78.7%) and Hispanic examinees (71.3%; 95% CI, 70.2%-72.4%) were less likely than White examinees (80.2%; 95% CI, 79.8%-80.5%) to apply to medical school. Black examinees (40.6%; 95% CI, 39.5%-41.7%) and Hispanic examinees (40.2%; 95% CI, 39.0%-41.4%) were also less likely than White examinees (45.0%; 95% CI, 44.6%-45.5%) to matriculate at medical school. Examined barriers were associated with a lower likelihood of medical school application and matriculation (eg, examinees having no parent with a college degree had lower odds of applying [odds ratio, 0.65; 95% CI, 0.61-0.69] and matriculating [odds ratio, 0.63; 95% CI, 0.59-0.66]). Black-White and Hispanic-White disparities in application and matriculation were largely accounted for by differences in these barriers.

Conclusions and relevance

In this cross-sectional study of MCAT examinees, American Indian or Alaska Native, Black, and Hispanic students reported lower parental educational levels, greater educational and financial barriers, and greater discouragement from prehealth advisers than White students. These barriers may deter groups underrepresented in medicine from applying to and matriculating at medical school.

Background

The percentage of U.S. physicians who identify as being from an underrepresented racial or ethnic group remains low relative to their proportion in the U.S. population. How this percentage may have been affected by state bans on affirmative action in public postsecondary institutions has received relatively little attention.

Objective

To examine the association between state affirmative action bans and percentage of enrollment in U.S. public medical schools from underrepresented racial and ethnic groups.

Design

Event study comparing public medical schools in states that implemented affirmative action bans with those in states without bans.

Setting

U.S. public medical schools.

Participants

21 public medical schools in 8 states with affirmative action bans matched to 32 public medical schools in 24 states without bans from 1985 to 2019.

Measurements

Percentage of total enrollment from racial and ethnic groups underrepresented in medicine (Black, Hispanic, American Indian or Alaska Native, and Native Hawaiian or other Pacific Islander).

Results

The percentage of enrollment from underrepresented racial and ethnic groups was 14.8% in U.S. public medical schools in the year before ban implementation in states with bans. The adjusted percentage of underrepresented students in ban schools decreased by 4.8 percentage points (95% CI, -6.3 to -3.2 percentage points) 5 years after ban implementation relative to the year before implementation, whereas the adjusted percentage in control schools increased by 0.7 percentage point (CI, -0.1 to 1.6 percentage points), for a relative difference, or difference-in-differences estimate, of -5.5 percentage points (CI, -7.1 to -3.9 percentage points).

Limitation

Inability to account for the effect of these bans on undergraduate enrollment.

Conclusion

State affirmative action bans were associated with significant reductions in the percentage of students in U.S. public medical schools from underrepresented racial and ethnic groups.

Primary funding source

None.

General internal medicine (GIM) fellowships play an important role in the development of physician scientists and clinical educators, as well as leaders in academic medicine. Nevertheless, the challenges of developing another novel aspect to one's career, along with balancing coursework, research productivity, clinical duties, and personal life during fellowship, can be overwhelming. Similarly, successfully securing a job at the end of fellowship can be a daunting process. In this article, we discuss the foundational tenets and themes of the GIM fellowship. These themes include (1) finding your purpose and passion, with a focus on selecting research coursework and developing an area of study; (2) the role and importance of mentorship, including the various kinds of mentorship that fellows require (traditional and peer mentorship, sponsors, and coaches), as well as how to be an effective mentee; (3) securing research funding; (4) landing a job; (5) and protecting time to meet personal goals. There is an increased need for a vibrant, diverse, and successful generation of general internal medicine researchers to advance our understanding of complex issues in clinical medicine and healthcare delivery and to inform health policy. It is our hope that this piece helps to support that mission.

The coronavirus disease 2019 (COVID-19) pandemic is disproportionally affecting racial and ethnic minorities. In the United States, data show African American, Hispanic, and Native American populations are overrepresented among COVID-19 cases and deaths. As we speed through the discovery and translation of approaches to fight COVID-19, these disparities are likely to increase. Implementation science can help address disparities by guiding the equitable development and deployment of preventive interventions, testing, and, eventually, treatment and vaccines. In this study, we discuss three ways in which implementation science can inform these efforts: (1) quantify and understand disparities; (2) design equitable interventions; and (3) test, refine, and retest interventions.

Introduction

Anti-Black racism has strong roots in American health care and medical education. While curricula on social determinants of health are increasingly common in medical training, curricula directly addressing anti-Black racism are limited. Existing frameworks like the Presence 5 framework for humanism in medicine can be adapted to develop a novel workshop that promotes anti-racism communication.

Methods

We performed a literature review of anti-racism collections and categorized anti-racism communication practices using the Presence 5 framework to develop the Presence 5 for Racial Justice Workshop. Implementation included an introductory didactic, a small-group discussion, and a large-group debrief. Participants evaluated the workshop via an online survey, and we analyzed the resulting qualitative feedback.

Results

A total of 17 participants took part in two workshops, with nine of the participants responding to the evaluation survey. Themes that emerged from survey responses included strengths of and improvements for the workshop structure (protected time for anti-racism discussion, dialogue between learners and faculty) and content (specific phrases and language, practicing self-reflection).

Discussion

The workshop provides participants with a semistructured discussion around the five anti-racism communication practices. Barriers to implementation include incorporating the workshop into existing curricula and ensuring diverse learners. Barriers to evaluating the workshop include the low survey response rate. Recommendations to improve the workshop include using case-based discussion and varying the workshop structure according to institutional needs. Next steps include an implementation study to evaluate the acceptability, feasibility, and effectiveness of the workshop.