Is DEI Undermining the Quality of American Medical Schools?

In recent years, many American medical schools have adopted Diversity, Equity, and Inclusion (DEI) policies with the goal of creating a more inclusive and representative medical community. While these intentions are noble, there is growing concern that these policies might be negatively affecting the quality of medical education and patient care. Additionally, despite a Supreme Court ruling intended to prevent race-based admissions, some universities are finding ways around it. Let's explore why some believe DEI initiatives are hurting American medical schools.

The Supreme Court Ruling and Its Circumvention

On June 29, 2023, the U.S. Supreme Court ruled that race-conscious affirmative action in college admissions violates the Equal Protection Clause of the Fourteenth Amendment. This decision was expected to end race-based admissions policies in higher education. However, some universities are reportedly finding ways to bypass this ruling by using proxies for race, such as zip codes or terms like "disadvantaged," to continue influencing the racial makeup of their student bodies.

Lowering Academic Standards for Admission

One major concern is that DEI policies might lead to admitting students who are not academically prepared for the rigorous demands of medical school. To increase diversity, some schools may give preference to certain groups, potentially overlooking candidates with stronger academic records. For instance, reports from prestigious institutions like the University of California, Los Angeles (UCLA), suggest that the academic preparedness of incoming students has declined. Exasperating the fact that current DEI considerations have significantly lowered overall grades and test scores. 

This DEI approach raises important questions:

• Is it fair to admit students who might struggle with the curriculum, possibly setting them up for failure?

• Is it fair to other applicants who have met the high standards traditionally required for medical school admission?

Impact on Student Performance and Competence

The consequences of admitting less-prepared students are becoming evident. At some medical schools, there's been a significant increase in the number of students failing essential standardized tests, known as shelf exams. These exams cover critical areas like emergency medicine, internal medicine, and pediatrics. For example, at UCLA, over 50% of students in certain cohorts failed these exams, compared to a national failure rate of about 5%. (Campusreform.org May 24, 2024)

These alarming statistics suggest that some students are not acquiring the necessary knowledge and skills. If future doctors are inadequately trained, this could have serious implications for patient safety and the overall quality of healthcare.

 Erosion of Meritocracy and Fairness

DEI policies, while aiming to promote inclusivity, may inadvertently undermine the principle of meritocracy—the idea that individuals should succeed based on their abilities and efforts. By giving preferential treatment based on race or ethnicity, schools might be discriminating against other qualified candidates. This could foster resentment and division among students and faculty, harming the collaborative environment essential for medical training.

Moreover, such practices might unintentionally stigmatize the very groups DEI policies intend to help. If peers and faculty question whether a student was admitted based on merit or to fulfill a diversity quota, it could lead to unfair assumptions about their abilities.

Attempts to Circumvent the Supreme Court Decision

Despite the Supreme Court's ruling against race-based admissions, some universities are reportedly using indirect methods to continue these practices. For example, they might consider applicants' zip codes, which can correlate with certain racial or socioeconomic groups, or use terms like "disadvantaged" as proxies for race.

This circumvention raises ethical and legal concerns:

• Are these universities respecting the spirit of the Supreme Court's decision?

• Does using proxies for race truly create a fair admissions process?

Voices of Concern from Within the Medical Community

Prominent figures in medicine have begun to speak out. Dr. Nche Zama, a Harvard-trained heart surgeon who immigrated to the United States from Cameroon, has expressed worries about current DEI policies. He argues that lowering academic standards is unfair to both students and patients.

Dr. Zama emphasizes that excellence should not be compromised in the pursuit of diversity. He believes all medical students, regardless of their background, should meet the same high standards to ensure they are fully prepared to provide exceptional care.

This brings to mind a quote by Johann Wolfgang Von Goeth (1749-1832) "We only see what we know."  This emphasizes that our perception and understanding of something depends on our knowledge of it.  Less knowledge yields less understanding and a lesser quality of diagnosis and treatment.

Potential Risks to Patient Care

The primary goal of medical education is to produce competent physicians who can deliver high-quality care. If DEI policies result in the graduation of underqualified doctors, patient care could suffer. Medical errors might increase, and public trust in the healthcare system could be weakened.

Patients deserve confidence that their doctors have met stringent educational and professional standards. Compromising these standards could have serious, even life-threatening, consequences.

The following studies listed underscore how this affects the performance outcome in the field:

·       BMJ 2024,33 p 109-120 shows that an estimated 800,000 people annually develop permanent disability or died.  This was because of failure to diagnose or misdiagnosing a disease.  

·       Modern Healthcare July 11, 2019 summarizes that Diagnostic error accounts for 1/3 of severe harm malpractice claims.

·       JAMA Nov 25 2013- Shows that physicians who are most confident in their diagnostic skill tend to be the least accurate.  (Basically- unskilled and unaware of it.)

·       BMJ Qual Saf. Aug 2013 (8); 672-80-  25 year Summary of US Malpractice Claims for Diagnostic Errors (National Practitioner Databank)-  Conclusion:  Among malpractice claims, diagnostic errors are most common, most costly and most dangerous.  In that 25-year period- 38.8 billion dollars were paid out in claims for diagnostic errors.

The Slippery Slope of Prioritizing Equity Over Excellence

Focusing on equity over excellence sets a concerning precedent. It suggests that outcomes should be equalized, even if it means lowering the bar for some. This approach can devalue hard work and discourage students from striving for excellence if they believe factors other than merit will determine their success.

Additionally, it risks creating a cycle where underprepared students struggle in medical school, leading to higher dropout rates or extended education periods, which can be financially and emotionally burdensome.

Seeking a Balanced Approach

While diversity in medicine is important—patients often benefit from having doctors who understand their cultural backgrounds—the solution should not involve compromising educational standards. Instead, efforts could focus on:

• Improving access to quality education at all levels.

• Providing mentorship programs for underrepresented groups.

• Offering resources to help all students meet rigorous academic demands.

The integration of DEI policies into medical school admissions and curricula is a complex issue with significant implications. While promoting diversity and inclusion is a positive goal, it should not come at the expense of educational excellence and patient safety. The recent Supreme Court ruling underscores the need for fairness in admissions, but reports suggest some universities are sidestepping this decision.

Finding the right balance between inclusion and excellence is crucial for the future of healthcare in America. Upholding high standards while addressing barriers for underrepresented groups can help ensure that all medical professionals are competent and that patient care remains of the highest quality.

 To sum it up, physicians that have the least knowledge are often more susceptible to bias errors and misdiagnosis.  Common bias errors for medical students and physicians include anchoring and premature diagnostic closure that is often related to knowledge deficits.  So please let us not lower our entry and performance standards in the medical field.

Lewis A. Humble MD

The AKAR Institute