Kenneth Poole Jr., MD

I am the lead author of a peer-reviewed manuscript that details how U.S. medical school diversity initiatives are leaving us behind. This is a summary of the article, which was published in Academic Medicine, and a call to action to improve our representation and the health of our communities

U.S. medical education diversity initiatives were born out of the Civil Rights Movement in an effort to increase the representation of African Americans in the physician workforce. Over the last 50 years, these efforts have evolved to include other minority groups that are underrepresented in medicine, and efforts to specifically identify and recruit African-American students have become obscured. African Americans thus remain significantly underrepresented in medicine, accounting for just 6 percent of graduates from U.S. medical schools and 3 percent of U.S. medical school full-time faculty.

Further complicating matters, demographic shifts resulting from recent immigration of black people from Africa and the Caribbean have both expanded the definition of “African-American medical students” and shifted the emphasis from those with a history of suffering under U.S. oppression and poverty to anyone who meets a black phenotype. Thus, while the majority of blacks in this country are African Americans – defined as blacks born in the United States whose ancestors suffered under slavery and Jim Crow laws – over half of black students entering medical schools are members of other black subgroups, i.e. African, Afro-Caribbean, and mixed race. African Americans have now become underrepresented amongst the underrepresented.

Besides being emblematic of a glaring scholastic achievement gap, why does all of this matter?

African Americans have a higher age-adjusted death rate than whites for 9 of the 15 leading causes of death in this country, and the life expectancy for African Americans (74.8 years) continues be lower than white Americans (78.5 years). The life expectancy for African-American men is 71.5 years.

Medical literature has consistently shown that black patients rate their healthcare experience as higher when paired with a black physician. This in turn has been proven to yield greater utilization of health services and improved compliance to plans of care. It can thus be asserted that the underrepresentation of African Americans in healthcare is a public health problem, and any health disparity initiative aimed at improving the health of African Americans should include African American physician pipeline programming at the core. 

Diversity initiatives in U.S. medical school need refocusing. Educational environments with students of varying experiences and a myriad of backgrounds are certainly valuable, but identity-oriented initiatives that seek to improve African-American student presence and right societal wrongs should be underscored. In doing so, medical school admissions committees must consider and contextualize the genealogical heritage and ancestral legacy of minority students, particularly blacks.

Additionally, the corrosive effects of financial and social deprivation of African Americans should be considered, including those from high-income, two-parent homes. Simply competing for any phenotypically black student that clears lowered academic thresholds is incomplete and contributes to African Americans being underrepresented in medicine.

The responsibility should not fall solely on medical school admissions committees, which are largely white. The African-American community also needs to be called into action to adequately prepare African-American students to compete in the mainstream.

Here are some detailed solutions.

Academic expectations for African-American boys and girls need to be raised. The bar needs to be much higher than staying out of trouble and having good manners. Strong classroom performance, high standardized test scoring, and achievement of professional and STEM-based graduate degrees should be routine and normalized as opposed to seeming foreign.

We need to start educating African-American boys and girls outside of traditional school systems, which have largely proven to be insufficient in terms of helping us make collective academic progress. Just as athletic teenagers rely on AAU and club sports teams alongside their high school teams for preparation and showcasing of talent, schools should simply augment the academic efforts of African-American children. This is not uncommon amongst many Indian and Asian populations in the United States. Parental efforts and programs that teach and stretch the core academic potential of African-American youth should be created and prioritized.

African-American youth need immersion into the language of U.S. standardized tests. Once thought to be primarily related to economic status, race has become a greater predictor of SAT performance than parental education and family income. Blacks continue to lag behind all minority groups in ACT and SAT scoring, the Medical College Admissions Test (MCAT), and other graduate school entrance exams. Reading assignments for African-American adolescents and teens should routinely include publications such as Time Magazine and the Wall Street Journal.  Familiarity with National Public Radio and related content should also be incorporated.

Collegiate selection needs to be more intentional. Parents and high school students need to look towards schools that have a proven track record of successfully preparing African-American students for academic success. The medical school application process is very complex, and medical school admissions committees look for specific scholastic and extracurricular profiles. The American Association of Medical Colleges lists the institutions with the highest numbers of African-American applicants to U.S. medical schools each year. Parents and high school students should reference this regularly in looking for and selecting the right institution of higher learning.

Finally, African-American students should be guided, mentored, and supported through college, medical school, residency, and beyond. Pre-medical and other students destined for graduate and professional school require nuanced financial support and experiences to be successful applicants for the next level. Pipeline programs should include parental education on the type of support African Americans need to clear hurdles along the way. 

These are simple solutions, but they require a deliberate investment and collective effort. None of it is showy. None of it looks good on Instagram, Facebook, or LinkedIn. It does not make for good pictures or hashtags. It’s not magic. Much like medical school admissions committees, our community-based efforts need to be about impact and not optics. 

Dr. Kenneth Poole Jr. is the medical director of Patient Experience for Mayo Clinic Arizona, chair of the Mayo Clinic Enterprise Health Information Coordinating Subcommittee, and a member of the Mayo Clinic Alix School of Medicine admissions committee. He is a North St. Louis County native and a product of the Mathews Dickey Boys and Girls Club, Hazelwood Public Schools, Lutheran North High School, and Tennessee State University. The views expressed above are his own and do not represent those of the Mayo Clinic.

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