Below is the transcript of the following Academic Medicine Podcast episode:
The Consequences of Structural Racism on MCAT Scores and Medical School Admissions
August 16, 2021
Read more about this episode and listen here.
Toni Gallo:
Hi everybody, I’m Toni Gallo, I’m a staff editor with The Journal and I’m the host of the Academic Medicine podcast. And my co-host today is Dr. Paula Ross. Paula is one of the assistant editors at The Journal, and we’re going to be talking to Doctors Catherine Lucey and Aaron Saguil, about their article entitled The Consequences of Structural Racism on MCAT scores and Medical School Admissions: The Past is Prologue. And that article was published in the March 2020 issue of The Journal. And you can find it online now for free at academicmedicine.org. And the link to that article is going to be in the notes for this episode. Our discussion today is going to focus on the MCAT exam and its role in medical school admissions, as well as the effects of structural racism on admissions and diversifying the physician workforce. So I want to start with introductions, Paula, would you like to go first?
Paula Thompson:
Sure. Thank you. Hi everybody. I’m Paula Ross and I am the administrative manager of RISE at the University of Michigan, which is part of Michigan Medicine.
Toni Gallo:
Thanks Paula, Catherine?
Catherine Lucey:
Hello everyone. My name is Catherine Lucey. I’m a professor of medicine, vice dean for education, and the executive vice dean at the UCSF School of Medicine. And I have been the chair of the MCAT Validity Study since 2014, working with Dr. Saguil and really a tremendous team of educators across the country. Nice to be here.
Aaron Saguil:
And I’m Aaron Saguil, I’m the vice chair of that same committee working with Catherine, Dr. Lucey. And I’m currently the associate dean for regional education for the Uniformed Services University and a professor in the department of family medicine. It’s a pleasure to be here.
Toni Gallo:
I appreciate you all joining the podcast today. And I know Paula has some introduction/context/background to get us started today. So I’m going to turn it over to her.
Paula Thompson:
Yeah, thank you. So I was really interested in this article because one of the main things that really piqued my interest was part of the title, The Past is Prologue. And in the article, you really provide some historical context and examples of how the MCAT serves as … It’s not just about academic abilities, it’s also about access to opportunities. So I think that’s the sort of context and framing that, Toni and I really want to move forward with our conversation with the both of you today.
Catherine Lucey:
Terrific.
Toni Gallo:
Thanks Paula. So I think we’ll start today by talking a little bit about holistic review and admissions, and there’s a lot of research supporting the use of holistic review in admissions. But when we look at MCAT scores for students who are accepted into medical school, we still see that the applicants with the highest MCAT scores are accepted in the greatest numbers. So I wonder if you could talk a little bit about how schools can move beyond this practice because of the wealth of research supporting holistic review and the importance of other factors for being a successful medical student and physician.
Catherine Lucey:
Well, I’ll go ahead and start off. This is Catherine again. So I think one of the things we have learned through the MCAT Validity Study is that there is a wide range of MCAT scores that predict success in medical school. And that range is much wider than many of the people who populate admissions committees and also who oversee or are interested in admissions committees. Those are sometimes stakeholders at institutions like deans, chancellors, presidents, and boards that are interested in making sure that their schools stay at the top of U.S. News & World Report and other rankings have an interest in MCAT scores. So what we have tried to do in the MCAT Validity Committee is prove that there’s a very wide range of scores for which students will actually be successful in medical school and have encouraged people to move away from kind of a false premise that a higher MCAT score is a better medical student.
Catherine Lucey:
What is a great medical student is somebody who is committed to being a successful member of the type of workforce that our nation needs, which is going to be diverse, culturally humble, capable of interacting with people from all walks of life and all races and ethnicities, and also capable of mastering the very intense scientific and social science curriculum that our medical schools offer. So as we’ve worked on this project to increase the attention that people have towards individuals who are sort of mid-range MCAT scores, rather than just high-range MCAT scores, we’ve found really the success comes when admissions committees who may not be as savvy about what this new research on MCAT scores tells us is to not give them the MCAT scores after a decision has been made that the aspiring student is capable of mastering the curriculum that exists at your school.
Catherine Lucey:
So we really encourage medical schools to start by screening individuals and say, “What is the MCAT range that we feel comfortable accepting students at? That tells us that that student is likely to be successful.” And we have some national data on that. And then after that point, take the MCAT out of the equation and instead encourage your admissions committees, your admissions interviewers, and anyone who is vetting people for admissions to look at the whole spectrum of experiences, attributes, and contributions that this person might make. So that’s one of the ways that I think we can do a better job in taking people from across the diversity of MCAT scores that will be successful. And what it turns out in fact is that when you do that, you will populate your class with more diverse candidates from all walks of life, all races, ethnicities, sexual orientations, gender identities, and more. Aaron?
Aaron Saguil:
I would agree with that 100% Catherine. I think that what we’re trying to do in the Validity Committee, at least one of our goals, is to provide the evidentiary base needed for admissions committees and administrators to feel comfortable looking at that wide range of scores. If we limit our attention to just those students that are at the very top portion of the scale, with respect to scores, then we’re limiting the types of students that they’re able to bring into their class. They may be missing on people from different demographic backgrounds or experiential backgrounds that would actually add quite a bit to their class, improve the education of everybody within that class, and actually go on to produce the workforce that’s needed for the population that they serve. So by demonstrating that students that are admitted from a wide range of scores progress normally through the four or potentially five year curriculum of medical school. We’re hoping to give the admissions committee yet another tool to create the class necessary to take care of those that their institution serves.
Toni Gallo:
So we’ve seen some arguments, and you talk a little bit about these in your paper, whether it’s getting rid of the MCAT exam altogether, or turning the MCAT score into a pass-fail rather than a number. And that is as a way to address differences between different groups in scores. And what would your response be to these suggestions for potential changes to the exam or to admissions generally?
Catherine Lucey:
These are important questions, and I think show us that people are really interested in figuring out a solution to the challenge that we see in the use of MCAT, sometimes misuse of MCAT, in medical school admissions. A couple of observations are important though. First off, the MCAT score is an achievement test. The MCAT is not an aptitude test. It’s not about could you ever become a doctor? The question is, have you achieved the necessary mastery of content that will allow you to succeed in medical school and not fail out? Frankly. Or not actually take 6, 7, 8, 9 years to go through medical school and incur a substantial amount of debt along the way. So what an MCAT score does tell us is something very important. It does show that there are levels above which students are likely to be successful and below which that they are likely to struggle or actually may even fail out.
Catherine Lucey:
And that’s the whole purpose of MCAT, is to actually say, “Has this person to date achieved the level of scientific understanding, psychologic, social, sociologic content information that they need to successfully navigate medical school?” Because medical school is unlike any other higher education, you don’t usually get a do over. If you go to college and aren’t quite ready yet, and you have to drop out because your grades are not acceptable, you can generally just go to another college. That isn’t really the case in medical school. Once you matriculate into a medical school, if you are unable to navigate that medical school, it’s very difficult for you to go to another medical school. So we don’t want people to go and start at a medical school before they have achieved enough to be successful there. And that’s why the MCAT itself is very valuable information. It tells you, as a student applicant, and it also tells us as medical schools, does this student have the knowledge they need to be able to succeed in a very rigorous and, actually, very fast paced curriculum that exists in most of our medical schools?
Catherine Lucey:
So dropping the MCAT would alleviate or would remove that, not alleviate, it would remove that very important message. You’re not quite ready for medical school yet, or yes you can do it, we’re convinced you can do it and we’re going to offer you a position. People say, “Well, what about using GPAs?” Well, it turns out that MCAT is a better predictor of who will succeed in medical school than as GPA, and the combination of MCAT and GPA is stronger than either of those alone. So we can use kind of triangulated data from your undergraduate GPA and your MCAT score to give us confidence, and to give you confidence, that if you start in medical school, you’re going to finish. So if we were to eliminate the MCAT, we would lose that valuable information. And we might see more people entering into medical school, who at the wrong time, before they’ve actually achieved what they need to achieve to be successful in this very, very intensive, informative type of education. Aaron, did you want to talk about the pass/fail?
Aaron Saguil:
Yeah, I wouldn’t mind doing that. Thank you for that opportunity, Catherine. I think part of what we’ve advocated for is for admissions committees to right-size the impact of the MCAT and their decision making. In many respects, MCAT is necessary, there’s a certain level of scientific and social science achievement you have to have before you attend medical school. At the same time, it’s not sufficient to point out all the things that are required to be a successful, caring, compassionate, dedicated to your population physician. So part of the difficulty that I think we run into is that the MCAT has a scaled, continuous score. It has discrete numbers, and just because we’re humans, we look at those numbers and always assume that bigger is better, right? When that’s not necessarily the case. I think that, at least in my opinion, the best way to use that MCAT is to look at your school, look at the students that have matriculated to your school in the past, see where the students who have done well, from what range of MCAT scores they come from, see the students who haven’t done so well, maybe where they came from. And maybe get a sense of, “Okay, what score really tells me that students are going to be successful in my curriculum?”
Aaron Saguil:
And then maybe when you are presented with those MCATs and the students that come with them say, “Okay, we need really for people to be here, but after that, it doesn’t tell us anything more.” So maybe as a result, knowing that your threshold is here, you can look at all the students that start off here, all the way up through here and decide what are the other characteristics that are going to indicate that these are going to be the people that go on to care for the people that you serve. So maybe a national pass/fail wouldn’t work, but I think that individually as institutions, we can think about it from a threshold standpoint, what’s the threshold score needed to reassure us, reassure the student that they’re going to progress through our curriculum unimpeded?
Catherine Lucey:
We know from the way medical schools have used the MCAT scores that there are schools using holistic review who are willing to say, based on the amount of resources they have, or the strategies they use to support students whose journey to medical school might not have been robust enough to allow them to get a higher MCAT score. They will often take students whose MCAT would be below a predicted national pass/fail. So at every level of cutoff, when we modeled this out in the MCAT validity, every level of cutoffs for. If we implemented that for the preceding years group of students, we would have left behind some students that some medical schools accepted. So what we prefer to do, as Aaron says, is to give all schools the information and encourage them to ask themselves internally, “What is the lowest MCAT score we can take that will predict success?” And not to make that a national pass/fail decision, because the minute we say, “You only pass if you get greater than 500.” For example, or 502, then any medical school who would have admitted somebody at 497 would no longer be able to do that because that person would have technically failed the MCAT.
Catherine Lucey:
So it’s a double-edged sword. It feels like the right thing to do. It’s just not exactly the same as the USMLE argument. But we feel the best thing to do is to continue using the MCAT and continue to provide the data and evidentiary basis, as Aaron says, to help medical schools be realistic in the way they incorporate MCAT scores into their total picture of the candidates.
Paula Thompson:
I have a follow-up question to that. What do you think are some of the barriers to moving from this, like you said Catherine, the focus on the U.S. News & World Report numbers and moving more towards a threshold pass for your institution?
Catherine Lucey:
Yeah, that’s interesting. A lot of it has to do with legacy practices. So admissions committees tend to be constituted of people who’ve been doing this for a very long time. They’re often senior medical professionals who really love this work. And perhaps actually came of age in their admissions committee work at a time when the population was much more homogeneous, you can read that as White, and often male. And one of the things that we see is that people reinforce their own beliefs, they will say, “Well last year, I really advocated for this person who had a super high MCAT score and they were great.” Or “I remember a time a few years ago when we admitted somebody whose MCAT was in the lower percentile and didn’t do well.”
Catherine Lucey:
So your own personal anecdotes tend to influence your bias. I will say that I think we are at a tipping point or at a strategic inflection point when it comes to admissions. I think that the events over the past five years, and particularly over the past year, that have raised our collective awareness of the impact of structural racism on the medical profession, not just on social systems outside the medical profession, are encouraging medical schools to take a deep and serious look at whether or not they are doing their part in diversifying this environment. And many are doing things like diversifying their admissions committee, making sure that people have education about unconscious bias, talking about the value of antiracism in achieving health care equity and health equity. And moving away from this idea that the only good candidate is the person with the highest MCAT that we stole from another medical school.
Catherine Lucey:
So I think that that’s what the News Report is all about, stealing the hot people or recruiting the people that have the highest MCAT scores. It’s not meaningful. I think we are increasingly understanding that. But we also need our institutional leaders who are getting this message and I think are doing important work in this realm to educate the people above them, that there is no ideal MCAT score and we are trying to educate a workforce for our nation, and that is a diverse workforce that’s going to really understand and help each other to provide the type of care we would all want for our loved ones.
Paula Thompson:
Catherine, that was a good segue into another topic is the structural racism that you talk about in the paper. Can you sort of summarize for the listeners what the impact of that is on people having access to entry into this profession?
Catherine Lucey:
So, as I mentioned earlier, the MCAT exam is an achievement exam. It tested the extent to which in the areas that we test, that we think are essential for success in medical school. And we think that because of surveys we’ve done of medical school faculty and medical school leaders through the MCAT redesign process that happens every 20 years. It requires that you have gone through rigorous K through 12 and then college education. And we know in fact that while talent is equally distributed across all races and ethnicities, opportunities to attend the very best schools and to have access to things like close mentorship through some challenging academic issues, like the higher-level math and science we begin to see in high school and college, calculus, physics, organic chemistry, biochemistry, molecular genetics, those types of things.
Catherine Lucey:
You need to have access to, for example, somebody who challenges you to really wrestle with those concepts, not just try and memorize them for a multiple-choice test. You need to have access to people who help you do some research projects so that you can apply this in the real world. And we know in fact that given … I believe that not only slavery, but in fact, the terrible housing decisions that were made in the 1930s that really prevented minority communities from having access to high-value housing in healthy and wealthy communities has had a long, long arm of negative impact on those communities. If you can’t have a house or if your house is a low house value, we know that actually education support for public schools depends on the property taxes.
Catherine Lucey:
So if you only allow students to attend schools that are supported by a low property tax value, because you intentionally redlined those neighborhoods, then you tend to have lower quality K through 12 education. And that actually may translate into lack of ability to go to a higher quality or more resourced college. We know in fact that minority communities are more likely to go to schools that are disproportionately underresourced for students, where teachers are less likely to have content expertise in areas like science and math, or teachers are more likely to change throughout the year. They’re less likely to have access to AP or gifted and talented programs. Often less likely to have access to testing that would allow them to have testing accommodations when they’re taking high stakes exams. And because family wealth is also tied into that housing, the house is the number one sort of source of family wealth, we often see that students who come from populations that are underrepresented in medicine may have often started off at a community college or a commuter college which may have less full-time faculty, more adjunct professors and more. So there is this really snowball impact that all stems back in many ways from federally sanctioned discrimination in housing back in the ‘30s.
Catherine Lucey:
And of course that actually snowballed from issues of slavery hundreds and hundreds of years ago. So there’s a long reach of those decisions that were made, and it is negatively impacting students now. And it’s not just for MCAT, it’s any of these high-stakes entry exams the LSAT or the GRE, GMAT. And one of the things that is really important is for us to try and recognize it and rectify it where we sit with the MCAT exam, hence the research that we’ve done. But also, work collectively as a group of citizens to kind of reverse and address these longstanding consequences of structural racism.
Paula Thompson:
You close the article really making some recommendations for mitigating the consequences of structural racism to improve the diversity of the physician workforce. One of them was … You’re talking about implementing interventions, not only at the point of medical school admissions, because it seems almost too late, but to have a meaningful impact, but one of the recommendations is related to pipeline programs. What recommendations do you have for how academic medicine can help address the barriers, the ones that it itself has not created?
Aaron Saguil:
Well, I was just going to say, you mentioned the idea of pipeline programs. And those pipeline programs, a lot of medical schools have linkages with undergraduate institutions, but also a lot of medical schools are getting involved with high schools in their local area and also with middle schools in their local area and beyond. And even you see medical schools being involved with folks in elementary schools also. And at any point along the educational continuum, we can help to provide access to role models, access to counseling, access to ideas that someone could potentially achieve enough to eventually become part of the profession. I think we do a service. And then also, not just donating our time, but also donating our resources as well. So those pipeline programs that you mentioned, one of the ones that we had set up at our university, and this is only one example of what multiple different schools are doing across the nation, we recognized that one of our target populations, at least in the military, is to try and keep the expertise and the diversity of our enlisted ranks into our medical corps.
Aaron Saguil:
So the medical corps in the military is all officers, but the backbone of the military are the enlisted. These are the people that you’ve heard referred to as “sergeants” or “petty officers.” So our pipeline program and trying to bring these people who tend to be racially and ethnically diverse, and also tend to come from very diverse backgrounds, we specifically allocated a sum of money to put them through pre-med basic science prerequisite courses, and also advanced science courses so that not only could they prepare for taking the MCAT but also be academically prepared to begin medical school. And we did it in such a way that they can actually devote their full effort towards their studies, which is a luxury that a lot of people don’t have when they’re serving in the enlisted ranks. That’s just one example of what a pipeline program could look like, but then a lot of schools across the United States, and also Canada as well, have done the same for their students. So with that I’ll stop and I’ll turn it over in case Catherine wants to add on to what we can do from our institutions.
Catherine Lucey:
Yeah, I think this is where the importance of physician and medical leaders as citizens comes into play. So I think there’s a couple of different strategies. One is, as Aaron said, there are things that we can do as individuals and as institutions to be more welcoming and to be empowering. I mean every physician who takes care of a child from a minority community should be saying to the child, “Hey, have you ever thought about going to medical school? What do you want to do?” So there’s lots of ways that we can actually interface with the communities we serve and begin to talk to children as young as elementary kids about the wonders of being a physician, a nurse, a pharmacist, any of the health professions, are really important for that.
Catherine Lucey:
A second thing for us to really think about though, is how do we advocate in our own communities to address inequities in education? How do we push for enhancing the resources? Not just making sure every student is equal, but those students who are going to schools that have been socioeconomically disadvantaged for decades, how do we push the citizens to elect the right people and to serve as a powerful voice to sort of say, “We can rectify this if we put our minds to it.” And then the last thing I will say is pipeline programs, and I will make a broad statement and recognize that not all are represented this way, but pipeline programs are historically somewhat ad hoc. They are often started on a grant by a passionate individual and might be directed towards a school that somebody had already had a connection to. I think we need to be much more systematic, and I think the AAMC might be a great place to sort of coordinate this, or maybe public institutions, public universities within each state. But we need to be more systematic about this, and we need to blanket all public schools with outreach and support for at least being aware, having our students be aware of what it takes to go through medical school and to also look at critical points.
Catherine Lucey:
I mean, for example, if you don’t go through higher math, if you don’t stick out math through high school, you’ll have a hard time with any advanced science, a lot of chemistry is math, a lot of physics is math, a lot of biology now is math, statistics and things like that. And yet we know that middle school is when people tend to drop out of math courses, sort of saying “It’s just too hard.” It isn’t too hard, it just requires a more dedicated teacher who can help you understand how to get through some of the stumbling blocks. So there are some pivot points that we really could target. But I would advocate strongly that we, in the medical profession, especially those of us in the academic medicine, take on a more systematic approach to developing and resourcing pipeline programs so that they reach everyone we need to reach and not just sort of selected few schools where we’ve had longstanding relationships.
Aaron Saguil:
I would also say it’s not just medicine that needs to be involved in this effort. It’s really any of us that put together professional programs to matriculate people into the science, technology, engineering and mathematics fields. So as a house of medicine, we don’t have to go this alone. There’s a lot of people that have a stake in diversifying the workforce and creating an overall science workforce that benefits the nation. I just think of the current example of how hard it is to communicate information about the coronavirus vaccine without having to deal with some of the misinformation that’s out there. And it strikes me that if we had a more diverse, inclusive workforce that represented more segments of the population, it might be that that’s an easier message to get across, and an easier message for people to receive as well. So really, yes, we start with the AAMC, but then we invite the folks that are the professional academy for physical therapist and for biomedical scientists and engineers, and make a real concerted effort to make sure that every child has the opportunity to become one of us, if that’s what they wish to be.
Paula Thompson:
Awesome. The other recommendation that you focus on is actually the medical school curriculum. And I’m sure you probably both remember the whole push for cultural competency some years ago. Now, as Catherine had mentioned, a lot more people, over the last year or so, have gotten into antiracism work and really focusing on that sort of thing. But how can we really include these things in the curriculum for the sole purpose of expanding people’s thinking and for the intent of future behavior?
Catherine Lucey:
This is a really important issue and something I feel quite committed to, and we’re doing a lot of work at UCSF on anti-oppression as a core element of our entire curriculum in medical school and residency. So a couple of things I would say, one is that curriculum is just one part of the puzzle, and as an educator, I always feel bad about saying this, education is only one element. You have to realize that you can have the best educational program, and yet there’s still going to be people who have bias because that’s the way humans work.
Catherine Lucey:
And so in addition to optimizing the likelihood that people recognize their bias might be influencing them and helping them understand some of the key issues, which I’ll talk about in a minute, we have to make sure that we build the right systems to protect our learners and our patients from those times when bias might harm them. Whether that’s in the way we grade them in clinical clerkships, the way we deal with reports of student mistreatment, the way we promote, advance, and acknowledge excellence in our medical schools, the way we recruit into residency programs, all of those systems need to be designed to be antiracist as a core element to an antiracism curriculum. I will say that I think one of the challenges with the cultural competency movement in the ’90s was really based on behaviors, like this is what this typical population behaves. This is how you should behave and respond to them. As opposed to deep understanding. And I think one of the things we have to realize in medical school is structural racism should have been taught about all along, through K through 12, with different levels that was tiered to the individual, more intense as you get more senior. It hasn’t been.
Catherine Lucey:
So we do owe it to everyone in our classes, those who come from populations that are well-represented in medicine and underrepresented in medicine, to make sure everyone understands how racism has been engineered into old laws that still have some prolonged impact as we talked about earlier. And what we can do in the medical profession to recognize and mitigate those things. So we need to teach, for example, where health and health care disparities come from and move away from this idea that they occur because of lifestyle choices, they don’t occur because of lifestyle choices, they occur because someone engineered those lifestyle requirements based on race or ethnicity.
Catherine Lucey:
So I think it really requires us to take a much deeper dive into these essential concepts. What is structural racism? How has it manifested in the medical profession? How does it manifest in society around us? And what can we do to mitigate that? And it has to be seen as a relevant element to everything we teach, not just psychology and sociology, but also how we look at, for example, health care disparities and cancer care, or health care disparities in the care of patients with cardiovascular disease, or delayed diagnoses that cause an increase of maternal and fetal demise in minority populations. So we have a lot to work with to illustrate really important reasons why you should know about this. We just need to take that next leap as educational leaders to sort of say, “This is a critical element we haven’t been teaching well about.”
Catherine Lucey:
We have a lot of motivating examples that can encourage us to embed antiracist and anti-oppressive teaching into our curriculum. And we need to do this because the lives of our patients depend on it, as well as the careers of our students who come from groups that have historically been excluded by medicine. So this isn’t content that only minority students need to learn about, this is content that 100% of doctors need to learn about so that they can do their part in not only redesigning the medical profession against racism but can also speak out as physician citizens, which is one of the things we emphasized in that article.
Aaron Saguil:
I think at the same time, also, in addition and amplifying off of what Catherine said, we have to also look at the informal structures with which we surround our students as well. So how good are we as administrators creating medical school classes that actually embrace the different aspects of student-shared lives? How well, as medical schools and as administration, do we do in making sure that our most senior ranks aren’t populated entirely by people that look exactly like each other? How do we surround our students with all these, not just the formal learning that we offer as part of the curriculum but also the informal learning that they gain by looking around and seeing the structure of the medical school, seeing booths and those administrative posts. And also by allowing for them to have the space and time to share their experiences with each other.
Aaron Saguil:
So if we create a diverse class of medical students, that informal education that they’re going to receive from each other as they learn about the different places from which they come, the different backgrounds that they live, the different experiences that they bring to the table, that’s a very powerful signal and opportunity for them to engage with each other and also the world in which they hope to advocate as future physicians.
Toni Gallo:
So a lot of what we’ve talked about today, a lot of the challenges can seem insurmountable or impossible to be able to address. And with the last few minutes, I wanted to ask if there was anything you wanted to leave listeners with, a key takeaway, a piece of advice, something to help folks start to think about how can we address these really important but huge challenges that we’re facing.
Aaron Saguil:
This system produces the result for which this system was built. So if we don’t like the result, we have to change our system. And I know that sounds like a cliche, but Einstein said it very, very well that, “Insanity is doing the exact same thing over and over again, expecting something different to happen.” So if we don’t like the emphasis that’s put on the MCAT above and beyond all the other factors that we have that help to produce student success, then we need to right-size the impact of the MCAT in the decision making process for who comes to medical school. If we don’t like the structural inequities that produce the disparity and performance on the MCAT and limit the group of people that can successfully go on to matriculate in medical school, then we have to intervene proximal to the admissions process to make for a more equitable distribution of opportunity and support, as well as the rigor and challenge needed to prepare a future medical student. And not just medical students but all different scientific fields.
Aaron Saguil:
So if we’re happy with the system as is, there’s really nothing we need to do. If we’re unhappy with it, then we have to find ways to change the system, both within our zone of control, which is a favorite saying of Catherine, as well as trying to influence where we have that influence in other people’s zones as well. So with that, I’ll stop and turn it over to Catherine.
Catherine Lucey:
Yeah. I mean, I think that this is not an impossible task. It’s difficult, it’s complex, and it will require all of us to work together. And I think that’s one of the challenges we face is that American medical education is a loose federation of very talented individuals. And I think part of the work we need to do is to come together and say, “This is important enough for us to do because we exist purely to provide a well-rounded, very capable workforce of physicians for the nation.” And I would just remind people that it was just a little over a year ago when we pivoted suddenly to deal with a devastating pandemic that unfortunately killed hundreds of thousands of Americans. But if you think about it, health care disparities kill hundreds of thousands of Americans too, on a regular basis, they just go more quietly than they did during the pandemic, without the big headlines and CNN reports.
Catherine Lucey:
So if we’re really committed to addressing the health needs of our communities, we have to do this. I am always impressed by the wisdom of Martin Luther King, and one of the things he said, which I think is relevant to this is, “You just have to take the first step in a medical school. You don’t have to see the whole staircase, just take the first step.” And if we first take the step and realize that holistic review allows us to populate our class with a more diverse and still very talented group of individuals, that’s a great first step. A second step might be assessment changes that eliminate discrimination based on bias that exists in our environments. And a third might be to redesign the way we work with our communities around pipeline programs. Some of these things are harder than others, but I’m a big fan, take the first step and let’s see how far up that staircase we can go.
Toni Gallo:
That’s a great call to action to end today’s discussion with. Thank you all for joining the podcast. And I want to encourage our listeners to read Aaron and Catherine’s article in The Journal. And if you’re doing work to this end, thinking about holistic review, how to educate physicians, what the curriculum looks like, how to mitigate the effects of structural racism, submit your work to Academic Medicine. We want to hear about what’s happening across the community. And remember to visit academicmedicine.org for the latest articles from The Journal, as well as our complete archive dating back to 1926. And you can access additional content like free ebooks and article collections. Be sure too to check out our blog AM Rounds at academicmedicineblog.org. Follow us and interact with The Journal staff on Twitter @AcadMedJournal. And subscribe to this podcast through Apple Podcasts, Spotify, and wherever else you get your podcasts. While you’re there, please leave us a rating and a review, let us know how we’re doing. Thanks so much for listening.
