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Diversity better prepares Medical Students to care for Minority Patients

Newswise — White medical students who attend schools with greater racial and ethnic diversity among the student body are more likely to rate themselves as highly prepared to care for minority populations, according to a study in the September 10 issue of JAMA, a theme issue on medical education.

Most medical schools in the United States explicitly seek to create diversity within their student bodies, believing it exposes students to a broad array of ideas, experiences, and perspectives, and better prepares them to meet the needs of a multicultural American population, according to background information in the article.

There has been little evidence, however, that racial and ethnic diversity in medical schools produces educational benefits.

Somnath Saha, M.D., M.P.H., of Oregon Health and Science University, Portland, and colleagues conducted a study to assess whether the proportion of minority students within medical schools is associated with students’ perceived preparedness to care for diverse patient populations.

A Web-based survey was administered by the Association of American Medical Colleges to 20,112 graduating medical students (64 percent of all graduating students in 2003 and 2004) from 118 allopathic medical schools in the United States. Historically black and Puerto Rican medical schools were excluded.

The researchers found that white students within the highest quintile (one-fifth) for student body racial and ethnic diversity, measured by the proportion of underrepresented minority (URM) students, were 33 percent more likely to rate themselves as highly prepared to care for minority patients than those in the lowest diversity quintile (61.1 percent vs. 53.9 percent, respectively).

This association was strongest in schools in which students perceived a positive climate for interracial interaction. White students in the highest URM quintile were 42 percent more likely to have strong attitudes endorsing equitable access to care (54.8 percent vs. 44.2 percent, respectively). These associations became apparent as the proportion of minority students increased above the 60th percentile.

Underrepresented minority students were substantially more likely than both white and nonwhite/non-URM students to plan to practice in underserved areas (48.7 percent vs. 18.8 percent vs. 16.2 percent, respectively).

For nonwhite students, there were no significant associations between student body URM proportions and diversity-related outcomes.

“Our study lends empirical support for the Supreme Court’s rationale (i.e., that student body racial diversity is associated with measurable, positive, student outcomes).

"It also indicates that a diverse student body is likely to be necessary but not sufficient. Medical schools may need to actively foster positive interaction among individuals from different backgrounds to derive the benefits of diversity. Additionally, our analysis supports the concept of ‘critical mass,’ whereby a certain proportion of minority students is considered necessary to realize the benefits of diversity. These results can guide medical schools in shaping policies for recruiting, admitting, and retaining URM students as one component of achieving diversity to help them fulfill their educational missions,” the authors conclude.
(JAMA. 2008;300[10]:1135-1145. Available pre-embargo to the media at http://www.jamamedia.org)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Editorial: Diversifying the Medical Classroom - Is More Evidence Needed?

“The need for medical schools to re-examine their admission polices is further emphasized by the finding in the study by Saha et al …” writes Olveen Carrasquillo, M.D., M.P.H., of Columbia University Medical Center, New York, and Elizabeth T. Lee-Rey, M.D., M.P.H., of the Albert Einstein Hispanic Center of Excellence, Bronx, N.Y., in an accompanying editorial.

“… while approximately half of all URM graduates plan to care for underserved populations, less than 20 percent of white and nonwhite/non-URM individuals had such plans. In addition, less than half of all students in these anonymous surveys responded that access to care was a major problem, and only 42 percent responded that everyone is entitled to adequate health care. These findings alone indicate the need to evaluate the process of admitting and training students in U.S. medical schools.”

“However, even with an increasing evidence base, many medical schools are unlikely to prioritize increased URM diversity. For such schools, improvements may come only through changes in leadership or external pressure by community and political forces.”
(JAMA. 2008;300[10]:1203- 1205. Available pre-embargo to the media at http://www.jamamedia.org)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Most medical schools in the United States explicitly seek to create diversity within their student bodies, believing it exposes students to a broad array of ideas, experiences, and perspectives, and better prepares them to meet the needs of a multicultural American population, according to background information in the article. There has been little evidence, however, that racial and ethnic diversity in medical schools produces educational benefits.

Somnath Saha, M.D., M.P.H., of Oregon Health and Science University, Portland, and colleagues conducted a study to assess whether the proportion of minority students within medical schools is associated with students’ perceived preparedness to care for diverse patient populations. A Web-based survey was administered by the Association of American Medical Colleges to 20,112 graduating medical students (64 percent of all graduating students in 2003 and 2004) from 118 allopathic medical schools in the United States. Historically black and Puerto Rican medical schools were excluded.

The researchers found that white students within the highest quintile (one-fifth) for student body racial and ethnic diversity, measured by the proportion of underrepresented minority (URM) students, were 33 percent more likely to rate themselves as highly prepared to care for minority patients than those in the lowest diversity quintile (61.1 percent vs. 53.9 percent, respectively). This association was strongest in schools in which students perceived a positive climate for interracial interaction. White students in the highest URM quintile were 42 percent more likely to have strong attitudes endorsing equitable access to care (54.8 percent vs. 44.2 percent, respectively). These associations became apparent as the proportion of minority students increased above the 60th percentile.

Underrepresented minority students were substantially more likely than both white and nonwhite/non-URM students to plan to practice in underserved areas (48.7 percent vs. 18.8 percent vs. 16.2 percent, respectively). For nonwhite students, there were no significant associations between student body URM proportions and diversity-related outcomes.

“Our study lends empirical support for the Supreme Court’s rationale (i.e., that student body racial diversity is associated with measurable, positive, student outcomes). It also indicates that a diverse student body is likely to be necessary but not sufficient. Medical schools may need to actively foster positive interaction among individuals from different backgrounds to derive the benefits of diversity. Additionally, our analysis supports the concept of ‘critical mass,’ whereby a certain proportion of minority students is considered necessary to realize the benefits of diversity. These results can guide medical schools in shaping policies for recruiting, admitting, and retaining URM students as one component of achieving diversity to help them fulfill their educational missions,” the authors conclude.

Editorial: Diversifying the Medical Classroom - Is More Evidence Needed?

“The need for medical schools to re-examine their admission polices is further emphasized by the finding in the study by Saha et al …” writes Olveen Carrasquillo, M.D., M.P.H., of Columbia University Medical Center, New York, and Elizabeth T. Lee-Rey, M.D., M.P.H., of the Albert Einstein Hispanic Center of Excellence, Bronx, N.Y., in an accompanying editorial.

“… while approximately half of all URM graduates plan to care for underserved populations, less than 20 percent of white and nonwhite/non-URM individuals had such plans. In addition, less than half of all students in these anonymous surveys responded that access to care was a major problem, and only 42 percent responded that everyone is entitled to adequate health care.

"These findings alone indicate the need to evaluate the process of admitting and training students in U.S. medical schools.”

“However, even with an increasing evidence base, many medical schools are unlikely to prioritize increased URM diversity. For such schools, improvements may come only through changes in leadership or external pressure by community and political forces.”