Should consumers decide the fate of medical school applicants?

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Minorities are not only underrepresented in the medical profession — they are underrepresented in admissions committee who select future doctors. But if it were possible to increase the minority composition of medical school admissions committees, would it be possible to increase the diversity of the medical workforce. Better yet, what if it were possible to include members of the community on medical school admissions committees? How would this change the landscape of physicians? After all, we constantly hear how patients prefer to see a doctor who looks and talks like them and shares a similar cultural background.

Even without community members, the fact is that newly graduating and graduating medical school classes have become increasingly demographically and socioeconomically diverse, with greater representation women and racial and ethnic groups – Blacks, Latinx and other people of color. Insofar as a diverse physician population can better serve the diverse patient population in the United States, it is understandable that admissions committees go to such lengths to ensure diversity among their membership and practice “conscious admissions of race”, recruiting students from a variety of backgrounds and backgrounds. of life.

The idea of ​​incorporating people from the community to serve on medical school admissions committees is intriguing. My alma mater, the Lewis Katz School of Medicine at Temple University in Philadelphia, is leading the way. As reported in the Philadelphia plaintiff and one Temple Press Release, five people who live and/or work in the community surrounding the impoverished North Philadelphia Medical School campus and its hospital helped interview hundreds of applicants for the medical class entering this fall. And one of those members — a 33-year-old mentor and doctoral student in Temple’s Department of Geography and Urban Studies — was a decision-maker on the 25-member admissions committee, along with professors and doctors from the medical school.

Medicine School partnerships with community members are nothing new – they usually exist to improve the health of the community. People with lived experience in the community may be able to identify social barriers to health and help suggest solutions. However, direct partnerships with admissions committees are rare. Temple is the only medical school I know of that includes longtime residents or neighborhood activists on its board. Community investigators have over 30 years of combined experience living or working around Temple, and they often have a background in social work.

Medical schools need to ensure they have a diverse student body to carry out their community missions and build their capacity to treat underserved populations locally. In the case of Temple, 86% of hospitalized patients have government health insurance, Medicare or Medicaid, according to a hospital report. Two-thirds of those living in the hospital’s service area are black or Hispanic, and the median household income is $35,405. It’s no surprise that Temple has one of the most diverse medical student bodies in the country — tied for sixth, according to US News & World Report Ranking.

Community members whom Temple asked to be part of the admissions process received interview training and, for approximately 7 months, participated in virtual interviews with applicants that lasted approximately 4 hours per week. Prospective students were asked why they chose Temple, what community means to them, how they would engage with marginalized groups and communities with disparities, and how they would handle sensitive clinical interactions – for example, conversations end of life with family members. Community members were also attentive to whether the candidates’ answers seemed authentic or rehearsed.

Race and ethnicity are definitely considered when applying to medical school, making it an incredibly hot topic. Some people worry about the under-representation of minorities while others worry about students who seem to be “over-represented” in medicine. The latter are predominantly white and Asian American (e.g. Chinese American, Korean American, Indian American) and may be subject to greater scrutiny than applicants of other ethnic or racial backgrounds to prevent their influx into medicine.

The addition of community members to medical school admissions committees also raises some concerns. What makes these people qualified to judge the achievements and merits of medical school applicants? How will community members be reached, and will the process be fair and equitable? What will be the criteria for their selection? What biases, if any, do community members bring to the discussion? Will they be more severe in their evaluations of non-minority students who apply for admission? Will their recommendations try to compensate for the fact that black doctors are being forced out residency training programs more often than white residents? How will community investigators deal with the reality that medical student career priorities may not include practicing primary care medicine in their backyard – and will applicants be honest about their career aspirations, or will they be intimidated and lie?

The medical profession has been skeptical of the value of community members in some cases – for example, the deployment of “mystery” or “secret” agents the buyers in physicians’ offices to provide feedback on the quality and nature of physician services. Similarly, online consumer reviews of doctors’ services have appeared on many different public websites, not to mention social media platforms such as Facebook, Twitter, and Instagram. Doctors’ reputations are now at the mercy of keyboard warriors who criticize doctors without ties and usually without the benefit of Quality control surveillance.

On the other hand, the pharmaceutical industry has seen positive results using community members. Member input into the design of clinical trials has helped promote diversity and inclusion in controlled trials and participation in health research. Consumer involvement in the conduct of clinical trials is not only growing, but appears to be welcomed by most researchers, who have been encouraged by the FDA to recruit and retain diverse study populations through “sustained community engagement.” Ensure that diverse and inclusive clinical research is seen as a existential imperative.

Including community members on medical school admissions committees is a bold experiment and a work in progress. The initial experience at Temple was overwhelmingly positive. About 90% of prospective students who responded to an anonymous survey said the community surveyor added value to their experience and helped them better understand the school. The goal, according to Temple’s associate dean of admissions, is to facilitate a match so the right students choose Temple as much as it helps Temple choose the right students. It’s a perfect fit, a win-win combination – as long as everyone agrees on what constitutes the “right” student.

Arthur Lazarus, MD, MBA, is a member of the Physician Leadership Journal editorial board, Doximity Luminary Fellow 2021-2022 and assistant professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia.

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