Should consumers decide the fate of medical students?

Not only are minorities underrepresented in the medical profession, they are also underrepresented on the admissions committees that select future doctors. But if it were possible to increase the minority composition of medical school admissions committees, it would be possible to increase the diversity of the medical profession. Better yet, what if it were possible to include members from the community on medical school admissions committees? How would that change the medical landscape? Finally, we hear time and time again that patients prefer to see a doctor who looks and speaks like them and has a similar cultural background.

The fact is, even without community members, the classes of recently matriculated and graduated medical schools have become increasingly demographically and socioeconomically diverse, with greater representation of women and racial and ethnic groups—Black, Latinx, and other people of color. Since a diverse physician population can better serve the diverse patient population in the United States, it is understandable why admissions committees go to such lengths to ensure diversity in their membership and practice “racially aware admissions” by recruiting students from diverse backgrounds and resumes life.

The idea of ​​involving 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 a leader. As reported in Philadelphia investigators and a press release from Temple, five people who live and/or work in the community around the impoverished North Philadelphia medical school campus and its hospital helped interview hundreds of candidates for the medical school class that will start this fall should be included. And one of those members — a 33-year-old youth mentor and graduate student in Temple’s Department of Geography and Urban Studies — was a decision-maker on the 25-member admissions committee, along with faculty from the medical school and physicians.

Partnerships between medical schools and community members are nothing new – they generally 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 their committee. The community interviewers have a combined experience of more than 30 years living or working in the Temple area and often have a background in community service.

Medical schools need to ensure a diverse student body fulfills its role in the community and strengthen its capacity to treat underserved local populations. In Temple’s case, according to a hospital report, 86% of hospital patients have government health insurance, either Medicare or Medicaid. Two-thirds of the people living in the hospital’s catchment 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 — ranked sixth according to US News & World Report rankings.

The community members who were asked by Temple to participate in the admissions process received interview training and participated in virtual interviews with candidates lasting approximately 4 hours per week for approximately 7 months. Prospective students were asked why they chose Temple, what community means to them, how they would interact with marginalized groups and communities suffering from inequalities, and how they would handle sensitive clinical interactions—for example, end-of-life conversations with family members . Community members were also attuned to whether the candidates’ answers seemed real or rehearsed.

Race and ethnicity definitely play a role when applying to medical school, making it an incredibly hot topic. Some people worry about under-representation of minorities, while others are concerned about students who appear to be “over-represented” in medicine. The latter are primarily White and Asian Americans (e.g. Chinese Americans, Korean Americans, Indian Americans) and may be screened more closely than applicants from a different ethnic or racial background to discourage their influx into medicine.

The addition of community members to medical school admissions committees also raises some concerns. What makes these individuals qualified to assess the performance and merit of medical degree applicants? How will community members be reached, and will the process be fair and equitable? What will be the criteria for their selection? What prejudices, if any, do community members bring to the discussion? Will they be tougher on judging non-minority students applying for admission? Will their recommendations seek to compensate for the fact that black doctors are more likely to be pushed out of residency programs than white residents? How will community interviewers deal with the reality that medical students’ career priorities may not be practicing family medicine in their backyard—and will candidates be truthful about their career aspirations, or will they be intimidated and lie?

The medical profession has been skeptical about the value of community members in certain cases – for example, the use of undercover “mystery” or “secret” shoppers in doctors’ offices to provide feedback on the quality and nature of medical services. Similarly, online consumer reviews of medical services have appeared on many different public websites, not to mention social media platforms like Facebook, Twitter, and Instagram. Doctors’ reputations now depend on keyboard warriors criticizing doctors without shackles and usually without the benefit of quality control oversight.

On the other hand, the pharmaceutical industry has achieved positive results through the engagement of community members. Members’ contribution to clinical trial design has helped promote diversity and inclusion in controlled trials and participation in health research. Consumer participation in conducting clinical trials is not only increasing, but seems to be welcomed by most investigators, who have been encouraged by the FDA to enroll and retain diverse study populations through “sustained community engagement.” Ensuring diverse and inclusive clinical research is seen as an existential necessity.

Involving community members on medical school admissions committees is a bold experiment and work in progress. Initial experiences at Temple have been overwhelmingly positive. Approximately 90% of prospective students who took part in an anonymous survey said the community interviewer enhanced their experience and helped them better understand the school. According to Temple’s Associate Dean of Admissions, the goal is to enable a match so that the right students choose Temple, as this will help Temple select the right students. That fits perfectly, a win-win combination – as long as everyone agrees on what makes the “right” student.

Arthur Lazarus, MD, MBA, is a member of Journal of Physician Leadership Editorial Board, 2021-2022 Doximity Luminary Fellow and Associate Professor of Psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia.

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