Abstract
In the last 30 years, except for female participation, the enrollment of Latinx, African Americans, Native Americans, Alaskan natives, and disadvantaged students in medical school has been constant; however, increasing enrollment of these minority populations is feasible, if admissions committees make two changes in approach. First, the traditional belief that matriculation merit is a linear function of past academic performance must be rejected. Second, once the threshold needed to complete medical school in four years and to pass licensing examinations at the first attempt has been met, all candidates are equally qualified, and matriculation decisions must be based, in part, on societal interests. In Grutter vs. Bollinger, the United States Supreme Court determined that graduate admission committees can and should consider societal interests. Each admission decision represents a substantial government investment in each student, as the Medicare Act directly subsidizes much of the cost of medical education. As Grutter explained, there is a societal interest in the public having confidence in, and access to, the medical school training that will prepare tomorrow’s medical, professional, and political leaders. Our analysis suggests that medical school admissions are biased towards academic achievement in matriculants, beyond acceptable thresholds for graduation and licensure. We believe medical schools must shift their admissions strategies and consider noncognitive factors in all candidates as determinative once minimum acceptable academic standards have been met.
Highlights
Medical student selection shapes the quality and character of the medical profession
Using the United States as a case study, we briefly review the development of this ideology and examine the underlying evidence for past academic performance as a measure of medical school performance
While studies of medical student attrition better supported a threshold effect than a linear relationship between past academic achievement and graduation as early as the 1960s [2], medical schools have tended to prefer selecting among the highest scorers [1,3]
Summary
Medical student selection shapes the quality and character of the medical profession. As Flexner’s critics have noted, and the report itself conceded, adopting its whole body of recommendations would have the perverse effect of reducing participation from marginalized groups unless there were significant efforts to address underlying inequities in the social structure [4]. Both points were largely ignored, and in consequence the majority of medical schools supporting female and African American enrollment closed. Sharp improvements in the quality of medical care coincided with steep declines in medical training for females, minorities, and individuals from low-income households
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