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    How can medical schools boost racial diversity in the wake of the recent Supreme Court ruling?

    The court’s rejection of considering race in college admissions leaves academic leaders worried, but hopeful about other diversity strategies.

    A group of medical students in training gather around to look at a tablet screen while studying.

    The recent ruling by the U.S. Supreme Court on race-conscious admissions programs in higher education has left medical school administrators scrambling to figure out how to maintain their commitment to racial diversity among their students and, subsequently, in the medical field. Under the ruling, schools may not consider an applicant’s race in admissions, something that some colleges have taken into consideration to increase diversity.

    “We’re feeling like a lot of the work that’s being done will get pushed away,” says Anthony Williams, MD, assistant dean for admissions at the Robert Larner, M.D. College of Medicine at the University of Vermont. “There’s still a lot of energy” for diversification, “but it’s distressing.”

    Medical school administrators are talking with each other and with other medical education leaders about what the ruling prohibits as well as what it allows. The gist of those conversations: Keep working for diversity by investing more in strategies that remove barriers and increase opportunities for all socially and economically disadvantaged applicants.

    “Nothing in the Supreme Court decision compels us to deviate from our goal of diversifying the health care workforce,” David Skorton, CEO of the AAMC, said during a webinar with medical school leaders this month. “Lives depend on us diversifying the health care workforce.”

    Here are some of the main questions about the decision and its impact on medical school admissions.

    What does the court decision say, in essence?

    The core of the decision, which reviewed programs at Harvard College and the University of North Carolina, is that those universities’ consideration of a person’s race or ethnicity — that is, their status as a member of a group — in admissions decisions is unconstitutional. (Specifically, it was ruled to be a violation of the Equal Protection Clause of the 14th Amendment.)

    “The court describes college admissions as a zero-sum game, with absolute winners and losers for every spot,” says Heather Alarcon, JD, senior director of legal services at the AAMC. “The majority opinion sees any consideration of race as a factor in admissions as harmful to any applicant who doesn’t benefit from their racial status.”

    What is the reaction of medical schools that have been trying to increase student diversity?

    Many medical school administrators worry that the decision will significantly set back their efforts to increase the racial and ethnic diversity of their student populations.

    “While we looked at all of their lived experiences, race in and of itself was a measure of diversity for us,” says Leila Amiri, PhD, associate dean of admissions at the Larner College of Medicine. “We’ve removed that as a diversity measure.”

    This CNN commentary by Skorton and Frank Trinity, JD, chief legal officer of the AAMC, lays out the implications of the decision for medical schools and health care.

    Will the decision decrease diversity in medical schools?

    Recent history offers sobering assessments. Before this decision, nine states had prohibitions on affirmative action in college admissions. A study of public colleges in four of those states found “persistent declines in the share of underrepresented minorities among students admitted to and enrolling in public flagship universities.” The University of California and University of Michigan public college systems report that their enrollment of Black students dropped after the laws took effect.

    Nevertheless, medical colleges and associations are working on ways to maintain diversity efforts within the confines of the court ruling.

    “This is going to be an obstacle, but hopefully not an absolute one,” Alarcon says. “There’s a lot that we can still work with” to achieve diversity goals.

    Can race play any role at all in admissions decisions?

    “There’s a legal tenet that you can’t do indirectly what you’re prohibited from doing directly,” Alarcon says.

    She explains that the court has cautioned against determining an applicant’s identification with a particular racial group through other information provided in the application, then relying on that racial identification to assess the applicant.

    However, Alarcon adds that considering an applicant’s actual experiences — even those related to the applicant’s race — is permissible, as long as the applicant is being “treated based on his or her experiences as an individual — not on the basis of race.” See more on that below.

    Does the decision prohibit efforts to make student populations more diverse?

    The decision recognizes the value of developing a diverse student population. “The majority opinion said universities may define their mission as they see fit,” says Trinity. “Schools may continue to focus on improving the diversity of our health care workforce, and doing that in their mission statements, strategic plans, and messaging.”

    Having made clear their focus on improving diversity, schools can pursue a variety of strategies to fulfill that objective.

    What strategies remain for medical schools to advance diversity?

    Several practices that are intended to increase opportunities and remove barriers as a means of increasing diversity of all types were not challenged in these cases, so the court didn’t rule on them. These include measures that take into account an individual’s lived experiences, which might be related to their race. For example:

    Holistic review, explained this way by Geoffrey Young, the AAMC’s senior director of transforming the health care workforce:

    “Balanced consideration is given to experiences, attributes, and academic metrics, in combination with how the individual might contribute to the school’s mission, goals, and learning environment, and succeed not only as a medical student, but as a physician.”

    Adds Alarcon: “The decision was an endorsement of individualized, holistic review — which has long been the preferred method for selecting future physicians.” She points to Justice Sonia Sotomayor’s dissenting opinion, which observed that “today’s decision leaves intact holistic college admissions and recruitment efforts that seek to enroll diverse classes without using racial classifications.”

    Trinity sees that as an upside for most medical schools. “The fact that most medical schools have established processes for holistic review, and interview virtually all admitted students, could mean that they’re in a better position to adapt to the individualized approach that’s contemplated by the court’s ruling,” he says.

    Considering essays to evaluate character strengths, career aspirations, or commitments to the school’s mission areas in ways that might include experiences or perspectives related to the applicant’s race.

    “An applicant might refer to how their racial identity affected their life when describing their motivation to be a doctor. The majority opinion says that’s okay,” Trinity says. “It also says you can look at challenges that were overcome, skills development, paths to leadership roles, achievements that the applicant takes pride in. An applicant or a recommendation writer can discuss how race might have affected any of these factors.”

    Using pathway programs in K-12 schools, especially those where students have not had histories of going into health professions. These programs introduce young students to medicine as a possible career choice down the road, which might encourage them to pursue classes in science and seek mentors in the field.

    “We need to reach further upstream to help build the diversity of the physician workforce,” says Amiri. “This ruling has made that even more urgent.”

    Expanding recruitment to, or building relationships with, undergraduate institutions and community-based organizations with high levels of diversity among their students and participants.

    “Medical schools have wide latitude in forming relationships with educational and community-based organizations around academic enrichment, mentoring, and the like,” Trinity says. “It is going to require some review based on the nature of the program: whether there’s any exclusion on who can participate, and if there is any type of race-based consideration for eligibility.”

    Considering background factors tied to the school’s mission, such as whether an applicant …

    • was raised in a medically underserved area
    • has demonstrated a willingness to practicing with medically underserved populations or studying health inequities
    • speaks multiple languages
    • is from a family with moderate educational attainment

    Allowing student groups to encourage people from specific populations to apply to medical school. “Student interest groups are free to continue to do the type of recruitment that speaks directly to their self-identity,” Amiri says. “Our students are our best partners in recruitment.”

    Does the decision apply beyond admissions (like to recruitment, financial aid, or pathway programs?

    The majority opinion addressed only the question of whether a university may make admissions decisions that turn on an applicant’s race, Alarcon says. She cautions, however, that “the new legal framework” undergirding the decision could affect other processes in the future.

    Where can I get more information about how the decision will impact medical schools?

    The AAMC has developed resources and information for the academic medicine community.