An article published in the medical education-themed September 10 issue of JAMA finds that white medical students are more likely to consider themselves highly prepared to provide care for minority populations if they attended schools with racial and ethnically diverse student bodies.

Under the belief that diversity exposes students to a broader field of ideas, experiences, and perspectives, most medical schools in the United States explicitly try to keep their student bodies racially and ethnically varied. The schools also believe that diversity in the classroom better prepares student to provide services to the multicultural American population. However, little research exists to support the claim of educational benefits from diversity in medical schools.

Further analyzing this issue, Somnath Saha, M.D., M.P.H. (Oregon Health and Science University, Portland) and colleagues conducted a study that investigated a potential relationship between the proportion of minority students within medical schools and students’ self-reported preparedness to care for patients from diverse populations. Data came from a web-based survey administered by the Association of American Medical Colleges consisting of 20,112 graduating medical students (64% of graduating students in 2003 and 2004) from 118 allopathic medical schools in the United States, excluding historically black and Puerto Rican medical schools.

The authors found that compared to white students who came from a school with a student body in the lowest diversity quintile (lowest 20%), white students within the highest quintile for student body racial and ethnic diversity were 33% more likely to rate themselves as highly prepared to care for minority patients (61.1% compared to 53.9%). Diversity was measure by the proportion of underrepresented minority (URM) students at the medical school. The strongest association appeared in schools where students perceived a positive environment for interracial interaction. Further, white students in the highest URM quintile were 42% more likely to strongly believe in equitable access to care (54.8% compared to 44.2%) – associations that became apparent as the proportion of URM students rose above the 60th percentile.

Finally, the researchers found that students who plan to practice in underserved areas are more likely to be underrepresented minority students rather than white or nonwhite/non-URM students – 48.7% of URMs, 18.8% of white students, and 16.2% of nonwhite/non-URM students). The effects of a diverse student body seemed to have little impact on nonwhite students, as the researcher found no significant links between student body URM proportions and diversity-related outcomes for these students.

“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,” conclude the authors.

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

“While approximately half of all URM graduates plan to care for underserved populations,” they write, “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,” conclude Carrasquillo and Lee-Rey.

Student Body Racial and Ethnic Composition and Diversity-Related Outcomes in US Medical Schools
Somnath Saha; Gretchen Guiton; Paul F. Wimmers; LuAnn Wilkerson
JAMA (2008). 300(10):1135-1145.
Click Here to View Abstract

Written by: Peter M Crosta