As the gatekeepers to their institutions, medical school admissions committees wield a powerful influence over the health care of the nation. Because of this, they have an ethical obligation to be as objective as possible.
The Association of American Medical Colleges issued a report in 2015 that showed racial disparity in medical school acceptance rates nationwide. Black applicants had only a 34 percent medical school acceptance rate compared to 44 percent for Caucasians and 42 percent for Asians and Latinos.
Are admissions committees unconsciously biased against minorities? At The Ohio State University College of Medicine, we set out to determine the answer to that question.
We already knew that health-care disparities exist. Women and underrepresented minorities in the United States don’t necessarily receive the quality of care that they should. For example, when discharged from the hospital after a heart attack, women are less likely than men to be discharged on medications proven to prevent a second heart attack. Blacks are less likely than whites to be treated with high-tech procedures to repair blocked arteries or prevent future cardiac arrests.
And the Center for Disease Control and Prevention’s most recent Health Disparities & Inequalities Report in 2013 revealed significantly higher rates for stroke and coronary heart disease, drug-induced deaths, asthma, infant mortality, diabetes, obesity, preventable hospitalization and other health conditions among racial minorities compared with non-Hispanic whites. Studies suggest that implicit racial bias may be one factor contributing to these disparities.
One important strategy to correct these disparities will be diversifying the medical workforce. That begins with removing the unconscious biases that minority applicants could encounter in admissions and enrollment by getting medical school admissions committees to recognize their own implicit bias.
It’s important to recognize that we all have implicit biases. It is a normal response of the brain, which is bombarded by millions of stimuli and takes shortcuts. Implicit or unconscious bias isn’t the same as racism or sexism and holding an unconscious bias doesn’t necessarily mean that you’ve discriminated against a group.
The important word is “unconscious” – it’s unintentional. But that bias still could affect behavior. Implicit biases have been associated with behaviors in education, criminal justice and health-care systems.
For health-care providers, bias could change how they share information with patients or families of patients. And it could tint the lens through which they process symptoms that patients share with them. In admissions, implicit biases could affect the way committee members evaluate objective data and rate non-cognitive attributes observed in a face-to-face interview.
A road to success
During the past year, I’ve led dozens of educational workshops to help increase the awareness of unconscious bias in admissions committees at medical schools across the nation. Medical schools that want to increase diversity should begin by testing admissions committees for implicit bias and training their committees in ways to reduce the impact of their biases.
Our workshops for faculty, students and staff conclude with an anonymous survey asking participants to describe exactly how they’ll reduce the effects of bias in the future.
After we put this process in place at Ohio State, we were surprised that our increased number of candidates from diverse backgrounds wasn’t a result of the fact that we accepted more underrepresented minorities. Rather, more of the minority students that we interview are now choosing to study here. A possible explanation is that a committee trained in implicit bias interacts differently with candidates and that minority students sense a more inclusive environment.
Importantly, enrolling progressively more diverse classes hasn’t led to a drop in academic metrics. Our most diverse classes have had our school’s highest average Medical College Admissions Test (MCAT) scores.
While one of our goals in examining implicit racial bias in medical school admissions is to make the process more objective, our intent is to improve diversity in medicine because the current lack of diversity contributes to health care disparities. When barriers like unconscious race, gender and sexuality biases are removed, more students can bring their diverse backgrounds to health care, ultimately improving care for our diverse patient populations.
From a public health perspective, it’s imperative that all medical schools screen for unconscious bias and take steps to mitigate its impact.
Dr. Quinn Capers IV is the associate dean for admissions and an associate professor of cardiovascular medicine at The Ohio State University College of Medicine.