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A Word From the President: Dedication to Diversity, No Matter the Outcome of the Fisher Case

AAMC Reporter: November 2012

All eyes are again on the Supreme Court after last month’s oral arguments in Fisher v. University of Texas at Austin. Abigail Fisher, a student who was denied admission to the university in 2008, is asking the court to invalidate the university’s admissions process under the court’s 2003 decision in Grutter v. Bollinger, or alternatively, to revisit the Grutter case’s holding. The Grutter decision allows consideration of race as part of a many-factored, individualized selection process to achieve a diverse student body.

Diversity in higher education is perhaps nowhere more important than in the health professions. Though we are making breakthroughs every day in medicine, the unfortunate truth is that not everyone benefits equally from these advancements. Significant health disparities persist along lines of socioeconomic status, urban or rural residence, and, most notably, race and ethnicity, with minority populations continuing to suffer disproportionately from numerous health conditions such as heart disease and diabetes.

The nation’s medical schools and teaching hospitals have a unique opportunity, as well as a responsibility to society, to produce culturally competent physicians equipped to care for an increasingly diverse population and to combat health disparities by addressing sociocultural barriers to care. Being educated in a truly diverse environment alongside students with different socioeconomic statuses, languages, nationalities, sexes, gender identities, sexual orientations, religions, geographic backgrounds, abilities, ages, racial identities, and ethnicities is fundamental to the development of a health care workforce fully prepared to meet the needs of our nation today and in the future.

As the Supreme Court recognized in Grutter, “Student body diversity promotes learning outcomes, better prepares students for an increasingly diverse workforce and society, and better prepares them as professionals.” Indeed, medical students who are educated in a diverse student body report that they are better able to work with patients of diverse backgrounds. A diverse learning environment also promotes effective problem-solving and teamwork. As demonstrated by the work of the University of Michigan’s Scott Page, Ph.D., groups of people with diverse backgrounds and ways of viewing the world outperform groups of people who have similar backgrounds and perspectives.

Composing a diverse student body results not from a mechanical exercise of selecting students based on isolated, sought-after features, but rather from a flexible, highly individualized admissions process through which balanced consideration is given to the multiple ways in which each applicant may contribute to the medical profession. Known as holistic review, this process considers an applicant’s academic abilities, as well as personal attributes such as perseverance, the ability to overcome obstacles, and compassion, thereby acknowledging that good grades and high test scores are only part of what makes a good physician. In many cases, race and ethnicity can shape an applicant’s experiences and cultural identity, and provide context essential to appreciating the personal attributes the applicant offers to the medical profession.

Considering an applicant as a whole, including in some cases the applicant’s relevant racial identity and ethnic background alongside other factors, permits medical schools to identify those applicants who not only will succeed in medical school, but also will contribute to a workforce that excels in diagnosing illnesses, advancing medical research, and providing care to an increasingly diverse population of patients in their most vulnerable moments.

In Fisher, the AAMC submitted an amicus curiae brief along with 29 other leading health professional and educational organizations emphasizing the importance of thoughtful consideration of race in admissions in improving our nation’s health. While no one can predict the outcome of this particular case, we will continue to work alongside our members to strive for excellence through diversity consistent with whatever constitutional framework the court applies and with each medical school’s unique mission.

Medical schools are developing new and exciting ways to get to know applicants to ensure that the students they admit are not only smart, but also will be good physicians. Some schools employ “multiple mini interviews,” which allow them to probe dimensions ranging from applicants’ responses to novel situations to their reactions to an ethical conflict. Other schools observe applicants’ interpersonal skills in mock interviews with patient-actors, while still others are designing hybrid interview approaches that allow them to probe a wide variety of attributes.

The AAMC is undertaking efforts to ensure the medical school application process is even more valuable to admissions committees. In an effort to make recommendation letters more uniform across applicants, next year we will issue a standardized set of guidelines for writers of letters of recommendation for the 2014 entering class application cycle. Additionally, we are looking into adding a new section to the American Medical College Application Service® (AMCAS®) to probe applicants’ intra- and interpersonal competencies by asking them to reflect on experiences in which they have demonstrated traits such as teamwork, cultural competence, or integrity and ethics, among others. We also are considering the development of a centralized, situation-based judgment test to probe students’ intra- and interpersonal competencies in response to situation-based prompts.

While an adverse decision in Fisher likely will make our work more difficult, it will in no way diminish our commitment to diversity in medical education. The innovation taking place every day at medical schools and teaching hospitals, as well as the work under way at the AAMC to transform admissions, will ensure that tomorrow’s doctors are prepared to lead our nation as we work to achieve health equity.

Darrell G. Kirch, M.D.
AAMC President and CEO