Opinion: We must redesign medical education to support clinician diversity

New medical students across the country are participating in the white coat ceremony symbolizing the beginning of their journey to become a clinician. However, not all students will graduate and practice medicine. Systemic challenges play a role in disparate graduation rates, signaling a need for a redesign of medical education.

According to a recent study published in JAMA Internal Medicine, students are more likely to leave medical school if they are Black or members of other underrepresented populations, have low incomes or come from under-resourced neighborhoods. This finding is even more significant considering the impact the shortage of diverse clinicians has on the health of all communities.

According to the Institute of Medicine, even in the face of equal access to healthcare, people of color continually suffer differences in health outcomes. Having access to a provider with shared living experiences can help bridge that gap by establishing trust, yet less than 1 in 4 Black and Hispanic Americans have a physician who shares their race or ethnicity.

How can we make a difference? According to the JAMA study’s authors, “These experiences of social isolation, racism, and discrimination have been associated with burnout, depression and attrition, and highlight the need for medical schools to adopt a more proactive antiracism strategy.”

We know that cultural humility, a practice that helps develop a set of skills to approach any individual from any culture, improves patient satisfaction and outcomes. Proactive steps to eliminate bias, provide appropriate support, and institution of an antiracism curriculum are critical to graduating more underrepresented medical students. Moreover, medical schools must broadly adopt an emphasis of creating an atmosphere of inclusion and belonging, celebrating multiculturalism and diversifying faculty and staff.

These are core elements that we have incorporated as part of the More in Common Alliance, a partnership of the Morehouse School of Medicine and CommonSpirit Health to promote health equity in the U.S.

Among the 155 accredited medical schools in the U.S., the four historically Black medical schools—Morehouse, Meharry Medical College, Howard University College of Medicine, and Charles R. Drew University of Medicine and Science—graduate the

majority of the nation’s Black physicians. Many more qualified applicants could attend if given the opportunity.

That’s why Morehouse and CommonSpirit have invested more than $115 million to seed a 10-year effort to national diversify the healthcare workforce. The More in Common Alliance is expanding enrollment for students from underserved communities who will attend the Morehouse campus in Atlanta. We are establishing five new regional medical campuses where third- and fourth-year medical students continue training within CommonSpirit’s large national healthcare network of highly diverse patient populations informed by Morehouse’s strategic commitment to a cultural competency-centered curriculum, intense student support and experiential learning.

Creating a more diverse workforce does not begin or end with medical school. It is critical to create a pipeline for young people of color in middle school, high school and undergraduate programs who are interested in a career in healthcare, offering greater professional opportunities in their own communities and equipping them with the exposure and preparation necessary to be competitive medical school candidates. We are also expanding access to graduate medical education with new programs in at least 10 diverse markets so that more qualified candidates can match for residency programs.

Finally, we believe it is essential to promote a national model of training, knowledge creation and care informed by the tools, data and evidence-based research that supports culturally competent clinical decision-making, prioritizes innovation and drives health system change.

A diverse workforce that reflects the communities we serve is vital to addressing health disparities. This starts with incorporating an antiracism, culturally humble, active learning curriculum within a supportive environment throughout a student’s journey to becoming a clinician.

Note: The study, “Association of Sociodemographic Characteristics with US Medical School Attrition,” was published online July 11 in JAMA Internal Medicine.



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