January 2002 Reporter

"First Contact, First Response" The AAMC Responds to the Threat of Terrorism

Paying the Price to Become a Doctor: The Impact of Medical School Debt

AAMC Releases Guidelines: Financial Conflicts of Interest in Human Subjects Research

Viewpoint: CDC and "First Contact, First Response"

A Word from the President

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Managing Editor Scott Harris sharris@aamc.org Staff Writer Elissa Fuchs efuchs@aamc.org

A Word From the President

Defining Who We Are

On Nov. 15 the California Board of Regents took a bold step. To more comprehensively evaluate applicants to the University of California's eight undergraduate campuses, it instituted a system that will allow admissions committees to consider a variety of personal characteristics - including special talents, leadership skills, and accomplishments in the face of personal adversity - in addition to academic criteria when evaluating all potential students. Previously, each campus was required to admit 50-75 percent of its entering class solely on the basis of aca-demic achievement. Without violating the state's ban on affirmative action instituted by Proposition 209, University of California officials hope that this revised admissions policy will bring new racial and socioeconomic diversity to campuses that have seen significant drops in the number of minority students admitted in recent years.

The rippling effects of UC's recent decision remain to be seen. But it does provide a compelling example of the potential power of policy changes made by respected academic institutions to initiate social change. An opportunity to implement such a change now lies before the AAMC.

In 1970, the first AAMC task force on minority medical education identified four racial and ethnic groups as then underrepresented in medicine - black, Mexican American, Puerto Rican, and American Indian. Flagrant discriminatory practices of the preceding decades had systematically denied educational opportunities to individuals from these groups and had culminated in a virtually all-white medical profession. The AAMC's definition of "underrepresented minorities" (URM) has not only directed the numerous diversity initiatives within the AAMC but has also guided the affirmative action programs of our constituent medical schools. Formulated before the vast majority of today's medical school applicants were born, that definition remains unchanged.

Given the shifting demography of the United States over the past three decades, the growing recognition of racial and ethnic health disparities and increased national interest in eliminating them, and revised federal guidelines governing the collection of racial and ethnic data, we felt it was time for the AAMC to reexamine who an underrepresented minority is in 21st-century America.

In April 2001, I appointed an Advisory Committee on the Definition of Underrepresented Minorities composed of representatives from a wide range of AAMC councils, groups, and committees. The committee is chaired by Theresa Bischoff, president of the New York University Hospitals Center and chair-elect of the AAMC. In order to stimulate thoughtful deliberation and feedback from all who are interested in this important topic, committee members have prepared a discussion document that provides an overview of the issue and outlines possible policy changes. The document may be downloaded at www.aamc.org/urm.

As a point of departure, the discussion document outlines four policy options: 1) maintaining the current definition and its four categories (i.e., no change); 2) adding racial and ethnic groups, thereby extending the reach of the definition to other individuals who also are clearly underrepresented in medicine; 3) eliminating a definition that attempts to specify the groups that are underrepresented and substituting a strong statement on the critical need for diversity in medicine; and 4) maintaining an explicit commitment to the four historically identified groups (who remain severely underrepresented and continue to experience a legacy of blatant discrimination in our society) and issuing a strong statement on diversity. Each of these options has its pros and cons, which are also outlined in the document. They are clearly not exhaustive; other options exist. At a town meeting held at the AAMC's annual meeting in November, a packed house offered numerous valuable suggestions, such as including in the definition migrant workers (a medically underserved group of many ethnicities), considering the needs of rural populations regardless of race, and defining "underrepresented" on the basis of socioeconomic status rather than race.

Continued constituent and public comment is critical to the success of this project. Comments on the proposals set forth by the discussion document may be sent to urm@aamc.org through May 15, 2002. The committee plans to issue its final report to the AAMC Executive Council in June 2002. As Theresa Bischoff noted in her comments at the AAMC's annual meeting, "It's hard to imagine a 'perfect' answer to this question, but we definitely can provide a better one."

This effort is, in my view, one of the most important of the AAMC's current undertakings. In addition to guiding the association's own diversity policies and initiatives, our new URM definition will be looked to by our member schools and teaching hospitals to formulate their admissions policies, recruitment activities, and outreach programs and will likely be adopted by other organizations committed to redressing the unhealthy skew in the racial and ethnic makeup of America's medical profession. Definitions themselves can only do so much, but this one has the potential to do more than most. Please share your thoughts with us.

Jordan J. Cohen, M.D.
AAMC President

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