Trends in Medical Education: Online Learning

During the Harvard Medical School Office for External Education’s 2021 IMPACT Symposium, Adrienne Torda, the Associate Dean of Education and Innovation at the University of New South Wales, stated that “Digital teaching and learning are here to stay,” And most attendees, leaders in medical education agreed. The covid-19 pandemic has accelerated a movement towards online learning and technology that they expect will only grow in significance. 

Suzanne Rose, MD, MSEd, and Senior Vice Dean for Medical Education at Penn Medicine, called out technology’s impact on the delivery of medical education and patient care as one of the top five trends in medical education, noting that it can provide more interactive experiences for students that will aid in content delivery and retention. One area she is exploring is the use of shortened lectures on key topics followed by team-based learning experiences and/or small group discussions. Medhub also describes a shift to a more proactive engagement between students and technology that is “... aimed at more effectively engaging students, assessing them against measurable outcomes, and responding to individual learner needs.” 

In addition to collaborative learning, the role of Virtual Reality (VR), as well as augmented reality (AR), mixed reality (MR), and artificial intelligence (AI) are expected to grow. These tools can enhance training experiences for students as they develop an array of necessary, but difficult skills. Medhub says, “Case studies with online simulations, designed to build skills as diverse as having difficult patient conversations to making complex diagnoses, are becoming increasingly sophisticated. They are effective tools in medical education and we can expect enhancements to keep learners engaged, offer real-time feedback, identify areas of weakness, and even foster some healthy competition with performance comparisons to colleagues and leaderboards.” 

Many schools are already implementing these measures. University of Miami’s Miller School of Medicine, for example, takes advantage of AR, VR, and MR to train students on treating trauma patients. At the Gordon Center for Simulation and Innovation, students get the experience of working with stroke, heart attack, or gunshot victims, in addition to practicing cardiac procedures on Harvey, a mannequin who can simulate nearly any cardiac event. Students can wear VR headsets to get a visual of Harvey’s underlying anatomy.

While there is no doubt that many aspects of medical education must still be experienced using in-person training and experiences, technology will only grow in importance within medical education. 

Incoming 2021 Medical School Class Largest and Most Diverse Ever

The incoming 2021 class of medical students is the largest and the most diverse ever. Compared to 2020, the number of self-identified Black or African American first-year medical students grew by 21 percent, the number of Asian students increased by 8.3 percent, and Hispanic/Latino students increased by 7.1 percent. While the majority of matriculants are White (51.5 percent), there were increasing proportions of Asian (26.5 percent), Hispanic/Latino (12.7 percent) and Black or African American (11.3 percent) students. Women continue to make up the majority of the entering class at 55.5 percent, and of total medical school enrollment at 52.5 percent.

The large class comes at the end of a record-setting year for application submissions, with a 17.8 percent increase. In particular, there was an increase in the number of diverse candidates submitting applications, which was driven by a 41 percent increase in Black or African American candidates and a 25 percent increase in Hispanic/Latino applicants. Last year marked the first year that white candidates did not make up the majority of applicants at 49.7 percent; the next largest proportions of applicants were Asian (25.0 percent), Black or African American (11.7 percent) and Hispanic/Latino (11.7 percent).

The AAMC does not believe that the surge in applicants is expected to continue, and they note that the current year is trending closer to pre-pandemic levels. While there are many hypotheses regarding last year’s surge, many suggest that it was a confluence of factors including lowered application costs due to virtual interviews and expanded MCAT assistance, a dearth of available “gap year” experiences, and an increased awareness of social inequities related to health outcomes and access to health care. While many have considered the unlikely celebrity of Anthony Fauci and how he could have inspired more young people to consider medicine, there is now a real sense among the medical community that the pandemic and its key players did indeed prompt more applications, even from those initially “on the fence.”

Related blogs:

Long-Term Study of Medical School Demographics Shows “Persistent Failure” to Improve Diversity

Surge in Medical School Applications Attributed to the “Fauci Effect” and Virtual Interviews

Medical Schools Called to Increase Diversity as Pandemic Highlights Racial Disparities in Healthcare

Report Recommends Comprehensive Reforms to Improve Medical Students’ Transition to Residency

Last week the Coalition for Physician Accountability released a report recommending comprehensive reforms to improve the transition between medical school and residency. The Coalition’s Undergraduate-Graduate Medical Education Review Committee (UGRC) included 34 recommendations spanning nine themes. The report’s authors strongly encourage related stakeholders to work together to implement the recommendations in full, as together they will “create better organizational alignment, likely decrease student costs, reduce work, enhance wellness, address inequities, better prepare new physicians, and enhance patient care.”

The Charge

The UGRC’s initial charge was to address the following documented problems occurring in the transition between medical school and residency, as well as to uncover other existing issues. The report noted that the impact of these problems has grown over time resulting in significant stress to the system. 

• Disproportionate attention towards finding and filling residency positions rather than on assuring learner competence and readiness for residency training

• Unacceptable levels of stress on learners and program directors throughout the entire process

• Inattention to optimizing congruence between the goals of the applicants and the mission of the programs to ensure the highest quality health care for patients and communities

• Mistrust between medical school officials and residency program personnel

• Over reliance on licensure examination scores in the absence of valid, trustworthy measures of students’ competence and clinical abilities

• Lack of transparency to students on how residency selection actually occurs

• Increasing financial costs to students as well as opportunity costs to programs associated with skyrocketing application numbers

• The presence of individual and systemic bias throughout the transition; and 

• Inequities related to specific types of applicants such as international medical graduates

A Common Framework to Assess Students’ Clinical Skills 

At its core, the report calls for changes that promote standardized ways to evaluate and assess medical students in a meaningful and equitable way. More specifically, the report suggests that less weight should be placed on the USMLE numerical scores and the emphasis should shift to a standardized and comparable assessment of students’ performance in a clinical setting. The report recommends that medical schools and residency programs work together to define a framework and set of competencies with which to measure students as they make the transition from medical school to residency. 

The report’s recommendations also seek to increase efficiency in matching students with residency programs. The number of applications submitted per student continues to rise, as medical students fear that they will not find a placement so expand their reach. A recent AAMC article noted that the average number of residency applications per student in 2016 was 87.7 and in 2020 was 95. Among international medical student graduates, who often face a tougher time finding a spot, the average is 136. The process is a huge generator of stress for medical students, their advisors, as well as residency program directors. “This year, we received 5,800 applications for 24 positions. It’s just not possible to thoroughly review most of them,” explains Richard Alweis, MD, a UGRC committee member and associate chief medical officer for medical education at Rochester Regional Health in New York. Not surprisingly, the 2020 National Resident Matching Program Director Survey reported that just under half (49 percent) of applications receive an in-depth review. 

The UGRC’s recommendations seek to provide stakeholders involved in the application, selection, and placement processes with better information and support in an effort to reduce the number of submitted applications. Students, they contend, need access to better information to appropriately gauge their likelihood of acceptance while residency programs need better ways to cull their applicants by updating and improving technology to provide effective and equitable filters for applications. Additionally, the UGRC encourages the entire eco-system to innovate and implement pilot programs to reduce the friction associated with matching medical students to residency placements. 

Next Steps

While there is great optimism around the release of UGRC’s report, because of the comprehensive nature of the recommendations and the number of critical players involved, there is still considerable work to be done. Each of the 13 member organizations making up the Coalition is independently run; each organization will determine what recommendations they will enact and the timeline. And despite its support, the AAMC’s statement reacting to the final report emphasized a need to move with caution and carefully consider what, if any, unintended consequences may occur as a result of enacting recommendation(s). However, while the timing for change is unclear and the speed may be slow, there is unprecedented agreement within the member organizations around the need for change and improvement for students, residents, medical advisors, and resident program directors. “For the past 10 years or more, we've been stuck in the same place… The recommendations are a monumental step in breaking through that,” said Grant Lin, MD, PhD, a pediatric resident at Stanford Health Care in California and a member of the UGRC committee.

Post-MCAT Survey Shows Prospective Medical Students are Increasingly Interested in Schools that Provide Academic and Social Support

Earlier this year the AAMC released its 2020 Post-MCAT Survey results. This survey, administered annually, provides insight into the individuals who take the MCAT—their backgrounds, preparation strategies, career plans, and interests. In 2020, 39.2 percent of test-takers responded to the online survey, which equates to over 30,000 people. The survey is provided after the MCAT is submitted, but prior to the test-taker receiving results. This year’s findings show slight, but persistent shifts in the socioeconomic background of MCAT test-takers, an increased interest in the academic and social support provided by medical schools, and growing concern about the cost of applying to and attending medical school. 

Below, we provide selected findings from the latest survey:

Premedical Life and Experiences

To gauge socioeconomic status, the AAMC uses the Education Occupation (EO) indicator, which classifies test-takers as EO-1 through EO-5 based on a parent’s highest educational level and occupation. Every year since 2016, the largest proportions of MCAT test-takers have come from those categorized as EO-5 (a parent obtained a doctoral degree and/or is employed in an executive, managerial, or professional occupation) and EO-1 (a parent obtained less than a college degree and/or is employed in any occupation) at 25.4 percent and 24.1 percent, respectively. It is important to note, however, that the percentage of MCAT test-takers classified EO-1 has declined slightly each year since 2016, with a 2.6 percentage point decline over the last five years.

Most respondents, 61.9 percent, decided that they wanted to study medicine prior to entering college. And a large number reported having spent time volunteering in a healthcare setting (84.9 percent), shadowing a physician or other healthcare professional (80.9 percent), and just over half (50.7 percent) participated in a laboratory research internship program for college students. 

More respondents graduated from college prior to taking the exam (53 percent) than not (47 percent). But this percentage has shifted annually, with the exact opposite occurring in 2016 (53 percent taking the test pre-graduation and 47 percent taking it post). Most of those who had graduated did so recently: 42 percent within the last year and 31.9 percent within the last one to two years. Just 12 percent had taken five or more years between graduation and the MCAT. About 60 percent reported taking courses at a college or university in the three months prior to the MCAT, while just over a quarter (27.6 percent) said that they had not attended school in the past three months. 

MCAT Preparation Strategies

Most respondents reported that they started their preparation by reviewing the scope of topics that the MCAT covers (81.4 percent) and assessed their progress throughout their study period using practice exams (82.4). Over three-quarters of respondents created a study plan to fit their schedule (75.2 percent), identified their strengths and weaknesses using practice exams (78.3 percent), and assessed their readiness by taking a final practice exam (78.4 percent).

In terms of the concepts, most prepared by answering practice questions while studying each topic (87.8 percent), consistently reviewing content they had previously studied throughout their preparation (82.6 percent), and testing their understanding of concepts studied (80.7 percent). Slightly fewer made sure to review each answer choice in the practice questions to determine why they were correct or incorrect (74.7 percent) and mixed in their review of different topics throughout their studying (74.9 percent).

The most used resources were the Official MCAT Practice Exams (85.4 percent) and commercially published MCAT prep books (72.6 percent). In terms of utility, 73.1 percent of those who used the Official MCAT practice exams described them as “very useful,” and 61.7 percent of those who used the Official MCAT Section Bank found it “very useful”. While just 45 percent of those who used commercially published MCAT prep books called them “very useful,” another 38.4 percent labeled them “useful.”

Almost all (89.7 percent) respondents said that they prepped for the day of the test by taking a timed, online practice test with scheduled breaks to “mimic the exam day.” A large number also practiced pacing so that they could get through all the questions in each section in a timely manner (85 percent), and most (79 percent) made sure to get plenty of sleep the night before the exam. 

When asked to name their biggest challenges in preparing for the MCAT, over two-thirds said that they struggled with maintaining confidence in their ability to succeed on the MCAT (67.6 percent) and 60 percent noted their difficulty with getting through the large amount of material they needed to learn for the test. 

Career Plans and Interests

Most respondents noted that they are “very likely” to apply to an MD-granting medical program (86.8 percent), while just under one-third said that they are “very likely” to apply to a DO-granting program (32.4 percent). Both percentages have been relatively stable since 2016. 

When asked what would encourage their application to medical school, students were most likely to select: finding a school where I will feel comfortable (88.9) and a fit between my interests and a school’s mission (83.4). However, the number of students who selected availability of academic support in medical school (71 percent) and availability of social support in medical school (63.9 percent) both increased significantly from 2016 (+7.8 percentage points, +11.5 percentage points respectively).

When test-takers were asked to describe what would discourage them from applying, most students selected grades, MCAT Scores, and other academic qualifications (72.5 percent). The number of those who selected the cost of applying to medical school (53.1 percent) and the cost of medical school (68.9 percent) as deterrents has increased by 6.5 and 6.1 percentage points respectively since 2016.

For full survey results visit https://www.aamc.org/media/51241/download

Long-Term Study of Medical School Demographics Shows “Persistent Failure” to Improve Diversity

Last month, the New England Journal of Medicine published a forty-year review of medical school demographics. The analysis looked at both gender and racial/ethnic diversity within the medical student body, and found a “persistent failure to substantially improve racial and ethnic diversity.” Using data from 1978 to 2019, the study showed striking movement resulting in gender parity within medical schools, but no significant change in the proportions of underrepresented ethnic and racial groups. In particular, the number of Black men and Native American and Alaskan men and women have declined over the study period.

While American Medical Schools have often spoken of the need for a diverse physician workforce that reflects the nation’s population, the numbers produced by the multi-decade study suggest that recruiting efforts have not been effective. Black women made a moderate increase over the 40-year study period, growing from 2.2 percent of students in 1978 to 4.4 percent in 2019. But Black males actually saw a negative change. In 1978, Black men made up 3.1 percent of the student body, but just 2.9 percent in 2019. Additionally, the analysis points out the critical role that historically black universities play in educating the Black physician workforce; 15 percent of all Black men enrolled in medical school are educated at a historically Black medical school. Excluding these programs, Black men would have made up just 2.4 percent of the student body throughout the entirety of the study period. Similarly, men and women identifying as American Indian or Alaska Native or as Native Hawaiian or other Pacific Islander made up less than 1 percent of medical students. 

And progress in diversity recruiting remains slow. According to a Kaplan Medical Admissions Officers survey, just 48 percent of medical schools reported that they have a specific program in place to recruit Black students. The survey, which included 58 accredited medical schools across North America, also asked admissions officers to grade medical schools (as a whole), on their work to recruit and admit a diverse array of students and just 7 percent rewarded medical schools with an “A”. Most responses suggest that there is some, or perhaps considerable work to be done, with 41 percent choosing the grade of B, 38 percent a C, and 14 percent a D or F.

Kaplan does point out, however, that its survey results follow an optimistic report from the Association of American Medical Colleges, which shows an increase in the number of Black first-year students in 2020: 9.5 percent of first-year medical students, up from 8.8 percent the previous year. Additionally, the number of Black men entering their first year of medical school increased 12.2 percent from the previous year, and total enrollment among Black men increased by 6.2 percent. The number of American Indian or Alaska Native first year students increased by 7.8 percent.

In conversation with Stat News about the long-term demographic study, Norma Poll-Hunter, Senior Director of Equity, Diversity, and Inclusion for the AAMC expressed her mixed emotions about the current spotlight on diversity efforts, “Even the National Academies have called this an American crisis and that’s not an overstatement. This is important for the health of our nation. On one hand, we feel we’ve been saying this for how long and people are finally paying attention, at the same time, we now have so many allies and we need to leverage this moment for the long haul.”

Covid Crisis Brings Attention to the Need for Humanities in Medical School Curriculum

Over the weekend, The New York Times published an opinion piece urging medical schools to more fully integrate humanities courses and themes into their curriculum. The op-ed, written by Dr. Molly Worthen, a historian at the University of North Carolina at Chapel Hill, notes that amidst the covid crisis and student transitions to distance learning, humanities classes proliferated. Worthen discusses the usefulness of these topics when addressing questions relevant to modern healthcare. “This is the moment for champions of the medical humanities to strike. To make sense of disproportionate Covid death rates in Black and Latino communities or white evangelicals’ vaccine resistance, researchers need to consider everything from the history of redlining to theologies of God’s judgment. They cannot afford to stay in highly specialized lanes or rely solely on the familiar quantitative methods of the medical sciences.”

Dr. Worthen’s piece is just the latest among recent efforts in the healthcare community to call attention to the benefits that humanities and the arts provide within the medical curriculum. Last year, the AAMC published a report titled, The Fundamental Role of the Arts and Humanities in Medical Education. The report identified four aspects of medical training that are improved by the integration of the arts and humanities: 1) Mastering skills – improving clinical care capabilities (e.g., case presentation, critical thinking); 2) Taking perspective – showcasing the sometimes contradictory perspectives of patients and others in clinical situations; 3) Personal insight – nurturing reflection and self-understanding to promote personal wellbeing and resilience; and 4) Social advocacy – urging students to assess and improve norms when identifying and rectifying potential inequities and injustices within health care.

While the report found that most medical schools have, to varying extents, incorporated arts and humanities into their curriculums, the potential benefits have yet to be fully realized because of inconsistencies. The report details “significant variation in the content, curricula integration, teaching methods, and evaluation methods” in MD programs, and recommends ways they could both improve and assess the benefits. A few of the recommendations direct medical schools to demonstrate the linkages between humanities coursework and core physician competencies, as well as increase the collaboration between faculty, students, patients, and partners in the arts and humanities to create and implement programs.

The report also details a few of the noteworthy humanities programs currently offered in medical schools.

-          Jazz and the Art of Medicine at Penn State: This four-week elective is offered to senior-level students. Students are asked to listen to jazz music, the give and take between the lead and accompanying musicians, then relate it to standard conversations facilitated by physicians with patients. At its core, the course is about how to listen and respond, rather than simply going through the motions. Students practice these improvisational techniques in clinical visits, which allows them to improve their listening and response skills while under real time constraints. The students are also encouraged to play to their strengths and thoughtfully and proactively build their communication style as care providers. A study that compared 30 of the students to a control group showed that they displayed statistically significant and meaningful gains in adaptability and listening.

-          My Life, My Story at VA Boston Healthcare System: This program is integrated into students’ clinical work, though it does require additional time outside of standard rounds. Students work with military veterans to help them compose a personal narrative which, with the patient’s permission, is entered into their electronic medical record. This promotes the idea of patient-centered care and demonstrates to the medical students the benefits of knowing and understanding a patient as a complex human being. In qualitative assessments, students described the power of the exercise as being the “best thing they’ve done in medical school,” with many stating that they wish they knew more of their patients so intimately.

-          Program in Bioethics and Film at Stanford: Events are integrated throughout the curriculum. Students watch documentaries and films about health issues and medical care. Faculty then lead small group discussions about how gaining additional insight into people’s lives and experiences may drive a physician’s thinking when working with patients, as well as in their role as care providers in a community. These small groups also delve into topics in medical ethics, culture and perspective, and communication. While the incorporation of the film events throughout the curriculum make it difficult to measure the program’s affect, faculty say that they can see the impact on students by the quality of the discussions and student conversations afterwards.

In 2019 Richard Ratzan, MD published a piece in JAMA, How to Fix the Premedical Curriculum – Another Try, in which he described the importance of taking humanities courses as a prerequisite for understanding the human condition, and thus medicine. He recommended that medical school admissions officers boldly look for students who majored in the humanities, with science classes as options on the side. He wrote, “... No premed majors need apply; the science training will come after acceptance.” While this provocative stance has not been wholly accepted by the medical community, the many proponents of the medical humanities are gaining attention. Admissions committees are looking for more well-rounded students who understand that there are many lenses through which a physician must look to see, hear, and heal a patient. Dr. Worthen’s editorial stated it potently, “… medicine is not a science but an art that uses science as one of many tools … The scale of the Covid crisis should force both scientists and humanists to ask new questions, to realize how much they don’t know — and perhaps to learn more from one another.”

Student Loan Forgiveness Receives New Attention Under the Biden Administration

Debt is top of mind for graduate students. A Bloomberg Businessweek survey found that among 2018 graduates of prestigious MBA programs, almost half had borrowed at least $100,000 to finance the degree. The American Medical Association has long advocated for legislative action intended to ease the burden of debt on medical providers, and the American Bar Association released a report in 2020 detailing the negative impact of student debt on young lawyers’ mental health and calling for greater legislative advocacy on students’ behalf.

Late last week, when President Biden signed into law a covid relief package, he also removed a critical impediment to enacting broad-based student debt forgiveness. The bill contains a provision that allows any loan cancellation acquired between December 31, 2020 and January 1, 2026 to be excluded from taxable income. Previously, debt forgiveness (including Public Service Loan Forgiveness) was treated as additional income and taxed as such, with few exceptions. This update ensures that recipients of student debt relief are not left with large tax liabilities and are also not thrust into new tax brackets, with associated implications, due to debt cancellation.  

The counting of debt forgiveness dollars towards taxable income was a primary obstacle to broad student loan forgiveness programs. With the update now signed into law, Congressional Democrats led by Elizabeth Warren and Chuck Schumer, as well as 17 state attorneys general and consumer rights advocates are calling on President Biden to take executive action to cancel $50,000 in federal student debt per borrower. Despite this pressure, the President does not support loan forgiveness at this amount for every borrower, which he directly expressed in a CNN Town Hall last month, as it would aid people who attended elite schools or obtained professional graduate degrees and have strong repayment prospects. The Biden Administration has noted that cancelling student loans above $10,000 should be dependent on the type of loan and current income of the recipient. The President does, however, support $10,000 in blanket, federal student loan forgiveness, and he has urged Congress to legislate this action. Legislative action, he argues, will make it harder to undo. Meanwhile, he has ordered a Department of Justice review to clarify if he has the authority to cancel student loan debt via executive action. This review will be done with the White House Domestic Policy Cancel, who will also consider the best way to target loan cancellation.

While the loan forgiveness policies under consideration would not directly benefit borrowers with private or commercially held student loans, those borrowers could still benefit from the tax relief provision included in the covid relief bill. Marketwatch notes that it may help borrowers benefit from current loan relief options provided by public or private lenders as a response to the pandemic.

In an interview on student debt with the AMA, Alex Macielak, who works in student-loan refinancing, urged students to pay attention to the political discourse, “There’s a new administration. Student-loan debt is a hot topic, ... There’s been talk about forgiving loans for some people. However, how much, who would be eligible, and other important details are still in doubt. So, monitor the legislation and debate, because student loans are consistently evolving.”

AAMC Physician Workforce Report Shows an Increasing Number of Women, Physicians Nearing Retirement, and Doctors of Osteopathic Medicine

The proportion of women within the active physician workforce continues to increase, as does the proportion of those nearing retirement age and those with a Doctor of Osteopathic Medicine (DO) degree.  Late last month the Association of American Medical Colleges (AAMC) released its 2020 Physician Specialty Report, which provides demographic and specialty trends within the active physician and resident/fellow workforces. It is important to note that the data used to populate the 2020 report was reflective of the 2019 physician workforce.

Active Physicians

In 2019, over one-third of active physicians were women (36.3 percent); this percentage has been steadily rising since 2007 when women made up just over a quarter of the workforce (28.3 percent). This growth reflects the steady increase in female medical students, with women making up the majority (50.5 percent) in medical school for the first time in 2019. The report notes, however, that women still tend to remain concentrated in specialties pertaining to women and children, including pediatrics (64.3 percent), obstetrics and gynecology (58.9 percent), and pediatric hematology/oncology (55.1 percent), and have marginal representation elsewhere. Women make up less than a quarter of the physician workforce in a great number of specialties, including various surgery sub-specialties where the number ranges from 22 percent in general surgery to just 5.8 percent in orthopedic surgery. About ten percent of physicians in pulmonary disease (12.3 percent) and urology (9.5 percent) are female. There are no specialties where male physicians make up less than 35 percent of the workforce.

Just under half of the physicians were 55 and over (44.9 percent) in 2019, which is a marginal increase from 44.1 percent in 2017 but a more significant increase from 37.6 percent in 2007. Over 50 percent of the following specialties are made up of physicians aged 55 and over: preventative medicine (69.6 percent), thoracic surgery (60.1 percent), orthopedic surgery (57.1 percent), and urology (50.5 percent). Several of the specialties which are populated with older doctors also have the highest percentages of males, and conversely several of those with the lowest percentage of older doctors are among the highest in female doctors.

Another slow-moving trend is the increase in practicing physicians with a DO degree. In 2019, 8.2 percent of physicians held the DO degree, while U.S. MDs made up 66.1 percent of the workforce and international medical degrees made up 24.7 percent. This is subtle, but real growth from 2007, when 69.5 percent of physicians held a U.S. MD, 24 percent held an international medical degree, and just 6.5 percent held a DO. In one of the fastest growing specialties, sports medicine, 18.9 percent of practicing physicians were DOs in 2019.

Residents and Fellows

Among the Residents and Fellows in 2019, 45.8 percent were women, like the 2017 figure (45.6 percent), and up slightly from 44.6 percent in 2007. As seen in the physician workforce, female residents/fellows tend to pursue the care of women and children in high percentages, with obstetrics and gynecology (83.8 percent), neonatal-perinatal medicine (74.9 percent), and pediatrics coming in at the top (72.4 percent). However, large percentages of women are also pursuing specialties in endocrinology (70.8 percent), allergy/immunology (68.2 percent), and geriatrics (67.8 percent).

Just as the percentage of DO graduates increased within the active physician workforce, it was also more prominent within the resident/fellow population. In 2019, 15.7 percent of the resident/fellow workforce had a DO degree, an increase from 12.5 percent in 2017 and 6.4 percent in 2007. The percentage of U.S. MDs showed a relative decline over the same period, with 61.1 percent of the 2019 population compared to 65.9 percent in 2007; similarly, international medical school graduates declined from 27.4 percent of the resident/fellow population in 2007 to 23.1 percent in 2019.

Surge in Medical School Applications Attributed to the “Fauci Effect” and Virtual Interviews

In September we shared that applications to medical school had risen significantly compared to the same period last year, with both the American Association of Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM) reporting double-digit increases. Last week, MedPage Today confirmed that the upward trend in applications has held throughout the application season with AAMC applications, now closed, up 18 percent over the previous cycle and AACOM schools up 19 percent over the same period last year and up 7 percent over last year’s total with two months remaining in the admissions cycle.

The increase in application volume is significantly larger than recent annual increases (less than 6 percent), which suggests this year’s cycle will be more competitive. Geoffrey Young, PhD, AAMC's Senior Director of Student Affairs and Programs, estimated that just 18 percent of applicants will be accepted to AAMC schools this year. Young, along with Jayme Bograd, AACOM's Director of Application Services, Recruitment, and Student Affairs, via MedPage Today, also suggest that the large number of applicants could have an impact on future application cycles. Noting that this cycle included a similar percentage of re-applicants to previous years, both Young and Bograd agree that, if the rate holds, next year may also bring a larger number of applicants.

Medical school admissions officers have attributed this year’s application uptick to the “Fauci Effect.” Kristen Goodell, Associate Dean of Admissions at the Boston University School of Medicine, which reported a staggering 27 percent increase in applications, told NPR last month that "It may have a lot to do with the fact that people look at Anthony Fauci, look at the doctors in their community and say, 'You know, that is amazing. This is a way for me to make a difference.'"

Young, however, questions the “Fauci Effect,” pointing out that competitive medical school applicants typically spend years amassing a portfolio of educational and extracurricular experiences, rather than making an impulse decision to submit. And Bograd points out that the average age of applicants is the same this year (23.9) as it was last year, suggesting that it was not simply due to applicants opting out of a gap year. Rather, MedPage’s sources, including Young and Bograd, look to a variety of anecdotal factors that may have contributed to this year’s larger number of applicants. Both AAMC and AACOM schools use of virtual interviews significantly reduced the cost burden on applicants. Relatedly, not having to travel for interviews may have allowed applicants to apply to a wider range of schools. Additionally, osteopathic schools have increased program awareness efforts with AACOM, hosting more open houses than usual, virtually, and increasing scholarship funds. And a new DO school in Utah is accepting applications for its first class, while a few other schools have been able to expand their class sizes.

Medical Schools Called to Increase Diversity as Pandemic Highlights Racial Disparities in Healthcare

Glaring disparities in health outcomes by race, of those individuals diagnosed with COVID-19, have prompted providers and administrators to look at how structural racism has taken root within health education, training, and practice.

Late last month, The Atlantic published an article, Five Ways the Health-Care System Can Stop Amplifying Racism. While the article describes a complex system, including the inner-workings of hospitals, government, and insurance companies, it directly advocates for medical schools, and other provider training programs, to increase diversity in their student bodies and create a curriculum that addresses existing bias and racism, common in medical practice.

Medical schools have long sought to increase diversity, as diversity in providers means significant improvement in patient outcomes—A study out of Oakland, CA showed black doctors’ involvement with black patients increased preventive care and reduced the cardiovascular mortality gap between black and white men by 19 percent. Another study of black newborns in Florida showed that the newborns treated by black physicians had a mortality rate that was half that of babies cared for by non-black physicians.

But the number of minorities in medical school has remained low. A congressional report released last month by Democrats on the Senate Committee on Health, Education, Labor, and Pensions, reported that as of 2019, only 5.8 percent of physicians identified as Hispanic, 5 percent as Black or African American, 0.3 percent as American Indian or Alaskan Native, and 0.1 percent as Native Hawaiian or Other Pacific Islander. Further, among 2019 medical school graduates, 5.3 percent were Hispanic or Latino, 6.2 percent were Black, 0.2 percent were American Indian or Alaskan Native, and 0.1 percent were Native Hawaiian or Other Pacific Islander.

Why? Perhaps it is because there are barriers to medical education: substantial costs, the time and attention required to prep for and take the MCAT, apply to medical schools, travel to interviews, as well as a hostile learning environment. A report released early this year found that underrepresented minorities, including Hispanic, Black, and Native American students, were more likely to experience bullying or harassment during medical training than white students at 38 percent and 24 percent respectively.

Providing medical students with a curriculum that exposes bias and the roots of structural racism is vital. The Atlantic article points out that, “To this day, medical textbooks still depict mostly white skin tones. Many medical students hold empirically false beliefs about race-based physiological differences—including the notion that black patients have a higher tolerance for pain than white patients. These beliefs affect the kind of decisions that doctors make.” 

While people can change over time, schools must proactively work to diminish racism in future doctors. This summer, a team of professors at Yale Medical School published an article in the Journal of General Internal Medicine that proposed schools seek to filter out racist applicants and withhold admittance. While acknowledging the difficulty of evaluating racist attitudes, the professors suggest using additional essays, interview scenarios, and evaluative questionnaires to adequately provide admissions teams insight into where an applicant falls on a “continuum of racial attitudes.”

Medical School Enrollment Growth Limited by Space Constraints in Clinical Training and Residency Programs

Last month, MedPage Today reported that applications to medical school have risen significantly compared to the same period last year, according to both the American Association of Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM). AAMC reported a year-over-year increase of 14 percent in early August, and AACOM reported an uptick of 17.7 percent as of mid-August.

Sources speaking to MedPage Today pointed to the pandemic as a reason for the spike, suggesting that the current high-profile nature of medical personnel may be inspiring applications to medical school. Other applicants may be taking advantage of idle time to submit their applications early, while some may be seeking alternative paths to mitigate economic uncertainty. Geoffrey Young, AAMC’s Senior Director of Student Affairs and Programs, told MedPage that the early indicators may not necessarily indicate a more competitive year, noting that the pandemic has created “an unconventional time.”

While both AAMC and AACOM schools are expanding their capacity where possible, both note that their growth is limited due to a lack of corresponding residency spots. The AAMC has launched a few new schools, which has increased overall enrollment, and remains optimistic that many schools will be able to make incremental increases in class size. Larger updates to class sizes, however, would have to be approved by the accrediting agency. Osteopathic school enrollments are growing faster, with a 6.6 percent increase approved for the upcoming year by the accrediting agency, up from a 5.6 percent increase the year before.

This capacity constraint suggests that many qualified candidates may not find a place in medical school, despite a national need to grow the physician workforce. Results released last week from the AAMC Annual Survey also focus on the significance of the clinical experience constraint. In the survey, which was administered in November 2019 to 154 medical schools, school leaders voiced apprehension about the number of residency positions and clinical training sites available to students.

Just under half of the schools reported “major or moderate” concern about their students finding post-graduate residency positions of their choice. While medical school enrollment has seen significant growth over the last two decades, an increase of 33 percent since 2002, residency availability has grown much more slowly. Federal support for Graduate Medical Education (GME) provided through Medicaid, has been capped for the last two decades, effectively leaving funding for GME at teaching hospitals at 1996 levels. The National Resident Matching Program reports that this year 40,084 MD and DO graduates applied for only 37,256 residency positions though the Main Residency Match.

In addition to concerns about residency, a large majority of medical school leaders reported concern over the availability of clinical training sites for students. As demand increases for clinical experiences from other medical trainees, including nurse practitioners, physician assistants, and DO programs, AAMC medical schools are feeling more stretched to meet their students’ needs. Most of the survey respondents reported concern about clinical training sites and qualified primary care preceptors, 84 and 86 percent respectively, and just under three-fourths, 71 percent, mentioned concern about students having access to qualified specialty preceptors.

Early MCAT Registration Numbers Show Significant Interest in Medical School

The AAMC announced a positive outlook for future medical school classes. When the MCAT registration opened in early May, after having been closed in March and April due to stay-at-home orders, 62,000 people registered online. This is a significant increase from the typical 10,000 to 12,000 on the opening day of registration. Similarly, registration for the American Medical College Application Service in early March showed an increase of 50 percent (in the number of applications started in the same period last year) in the first three days. While not all these prospective students will submit applications, it does provide reason for optimism about the future.

President and CEO of the AAMC, David Skorton, MD, said, "We're very encouraged by students' strong interest in registering for the MCAT exam. We're starting to see hints of strong interest in people entering the field overall, even though it's quite early in the medical school application process. It is a great sign if this preliminary trend continues, because our country needs more doctors."

Medical Schools Plan to Resume Clinical Learning Experiences

In May, the AAMC provided an update on medical schools’ plans to resume operations.

For medical students working in clinical care, most schools plan to resume work this summer.  As of early May, 103 of 155 total schools had reported their plans to the AAMC; 15 percent planned to restore students’ clinical care work by the end of May, 55 percent (cumulative) by the end of June, and 77 percent (cumulative) by the end of July. An additional 15 percent were still finalizing plans.

The AAMC noted the delicate balance necessary for returning students to clinical care. Patient safety and containing COVID-19 must be parallel goals alongside allowing students access to the patient-centered learning hours they need for a timely graduation. Medical schools are also struggling to create meaningful learning opportunities due to the diminished capacity of many supervising physicians to teach and the fact that routine surgeries and visits have been limited or restricted.

According to an article published in Crain’s Health Care Forum over the weekend, during this period, many schools have front-loaded virtual course work. The article also mentioned that some schools, such as the Cleveland Clinic Lerner College of Medicine, were able to allow students’ access to patients using virtual clinics and virtual hospital rotations.

As many students prepare to return to clinical care, obstacles will remain. Many schools and hospitals are not going to allow students to work directly with confirmed or suspected COVID-19 patients and some hospitals are limiting the number of people who can enter a patient’s room simultaneously. This suggests that training will continue to require creativity and a dependence on technology, with schools working with state boards and accrediting bodies to determine what will be approved.

Proposed Federal Budget Will Negatively Impact Medical Students in Need of Loans

The average cost of medical school tuition, fees, and health insurance for the 2019-2020 academic year ranged from just under $38,000 for an in-state, public institution to $62,000 for private school or public school for non-residents, according to the Association of American Medical Colleges (AAMC). The median debt for students at graduation totaled $200,000. As such, prospective and current medical students should pay particular attention to how student loan funding and forgiveness will change as a result of the President’s recently proposed Fiscal Year 2021 budget. Below, are a few proposed budget changes that would directly impact medical students and residents.

• The capping of GradPLUS loans to $50,000 per year and no more than $100,000 in a lifetime. The AAMC says that 47 percent of medical students rely on these loans to fund their education. Capping the total amount allowed per annum and over a lifetime at these values, which are lower than the full cost of medical school, will force students to seek funding through private financing, which typically carries less favorable lending terms.

• The elimination of public service loan forgiveness programs. Currently, an AAMC survey of graduates estimates that about one-third of them are interested in pursuing public service loan forgiveness programs, which allows graduates—who work to benefit the community and make timely loan payments for ten years—to receive loan forgiveness. These programs are an important recruiting tool for many public-facing organizations, including inner-city hospitals, community health centers, and teaching hospitals, and is critical to providing healthcare services to communities in need.

• The cutting of Medicare funding for Graduate Medical Education (GME). The budget proposes funding GME solely through new grant programs from general revenues, rather than Medicare’s trust fund. However, the cuts to Medicare are so substantial that even given the new proposed funding stream, hospitals would be asked to absorb cuts of over $50 billion in funding, which could result in fewer physicians and resources at teaching hospitals.

Doctors Seek Additional Training as Technology and Big Data Converge with Patient Care

Classes in data analytics, artificial intelligence, and technology may sound like the course load of an MBA student, but a recently released report shows the immense value of this subject matter for medical students as well. The Stanford Medicine Trends in Health 2020 report entitled “The Rise of the Data Driven Physician” describes a future for physicians where data and technology are increasingly intermingled with effective patient care.

The report, which includes a survey of physicians (n=523), residents (n=133), and current medical students (n=77), analyzes how trends in medicine impact those on the front lines of patient care.  The health care sector, the report claims, is undergoing “seismic shifts, fueled by a maturing digital health market, new health laws that accelerate data sharing, and regulatory traction for artificial intelligence in medicine.”  And the report’s findings show that while there is acceptance and even enthusiasm around the benefits of data and technology among providers, there is also a real gap that exists between the training that physicians, residents, and students receive, and the demands of the evolving profession. Lloyd Minor, MD and Dean of the Stanford University School of Medicine says, “We’ve found that current and future physicians are not only open to new technologies, but are actively seeking training in subjects such as data science to enhance care for their patients. We are encouraged by these findings and the opportunity they present to improve patient outcomes. At the same time, we must be clear-eyed about the challenges that may stymie progress.”

The respondents appear keenly aware of the changes occurring within medicine and both physicians and residents say that they expect about a quarter of their current duties to be automated using technology over the next 20 years. Students predict that, on average, 30 percent of their duties will be automated. Further, just under half of the physicians surveyed (47 percent) and about three-quarters of the students surveyed (73 percent) say that they are currently seeking out training to better prepare themselves for innovations in health care. Among physicians who said they are currently attending training, the most popular subjects are genetic counseling (38 percent), artificial intelligence (34 percent), and population health management (31 percent). Students seeking additional training courses are taking advanced statistics and data science (44 percent), population health management (36 percent), and genetic counseling (30 percent) at the highest rates.

When asked about which innovations have the most potential to transform health care in the next five years, physicians as well as students and residents (grouped) were both most likely to respond with personalized medicine, followed by telemedicine. Both groups also see potential in artificial intelligence, wearable health monitoring devices, and genetic screening.

When the groups were asked about how helpful their education has been in preparing them for new technologies in healthcare, just under 20 percent of both students and residents (18 percent) and physicians (19 percent) responded “very helpful.” Current students and residents were more positive overall, with 58 percent responding that their education was “somewhat helpful.” Only 23 percent responded negatively. Among physicians, 36 percent found their education somewhat helpful, and the remaining 44 percent replied negatively.

The most notable gap, perhaps, is the one highlighted below, which showcases the difference between the perceived benefits of medical innovation for patients and how prepared the provider is in implementing that innovation. The two charts, students and residents (grouped) and physicians, show the group that agreed an innovation will be “very beneficial to future patients” compared to the group that said they feel “very prepared to use the innovation in practice.” Some of the gaps are marked. For example, over half of students and residents (55 percent) and physicians (51 percent) believe that personalized medicine will be very beneficial to future patients, yet only five percent of students and residents and 11 percent of physicians feel prepared to deliver it. Personalized medicine showed the largest gap between perceived benefit and preparedness for both groups, while virtual reality showed the smallest. Both groups feel very prepared to work with electronic health records, but there were lower levels of perceived benefit to the patient.

Gap Between Perceived Benefits to Patients and Provider Preparedness

This report demonstrates the changing nature of the medical profession, its current and continuing intersection with technology and big data, as well as the need to provide opportunities and training to medical providers so that they can use these innovations to improve patient care. Prospective and current medical students will want to carefully consider how they are using their time prior to and during medical school. It may be beneficial for them to spend time speaking with physicians and residents to gauge what technologies and research are driving change. Taking classes prior to medical school, in statistics and data modeling, as well as technology and AI may have a positive impact on their ability to bridge the gap between present demands and the traditional medical school curriculum.

Positive Learning Environments and Regular Feedback Result in Lower Levels of Depression Among Medical Residents

The impending physician shortage, coupled with the problem of physician burnout, has led to important discourse over the treatment and training of future physicians. Medical training programs are looking to improve wellbeing among medical students and residents through various avenues including reduced tuition, investments in wellbeing programs, and mental health resources. But are they doing enough? A recent op-ed published by the AAMC, by Srijan Sen, MD, PHD, suggests medical residency programs need systemic changes on top of the current efforts focused on building individuals’ resilience and wellbeing.  

Dr. Sen, along with collaborator Connie Guille, MD, analyzed data collected via the Intern Health Study to highlight the negative impacts of residency on interns’ health and propose data-based solutions for a healthier environment. The Intern Health Study, a longitudinal study that includes responses from more than 20,000 medical trainees, shows that the rate of depression increases “Five-fold within the first few months of residency” and remains higher throughout training with “about one out of four residents screening positive for depression at any given time during residency.” Dr. Sen goes on to note that beyond the questionnaire responses describing stress, there are physical indicators as well. “Telomeres, a cellular marker of aging, shorten five times as much during internship as during a typical year of life…” And, what’s more, a compromised physician is more likely to make medical errors and to provide lower-quality care to patients.

Dr. Sen references a 2019 study that reviewed over 50 internal medicine programs using residents’ feedback and information collected in national databases. The findings show variation in the depression rates between programs; more importantly, the variation showed consistency with some programs regularly registering high and others low. When Dr. Sen compared the programs, the findings showed that while the volume of hours, type of work (administrative versus patient care), and work-family conflict all impact the rates of depression, another critical component differentiating the high and low depression programs was the type of learning environment.  “A key factor among low-depression programs was residents reporting that their inpatient rotations were a positive learning experience. Another was receiving timely and appropriate feedback from faculty. Both of these factors indicate that a focus on education, and specifically directed education from faculty, makes a major difference.”

The findings are particularly pertinent given an article published last week in the NY Times by Perri Klass, MD. The article, which is in response to a recently published JAMA Pediatrics article (Walking on Eggshells With Trainees in the Clinical Learning Environment), speaks to the difficulties that many faculty members feel providing feedback to trainees. While the medical community is working hard to end the harassment and bullying of residents that typified many interns’ experiences historically, some feel the pendulum has swung too far and that they are unable to provide criticism, tough feedback, or make interns feel discomfort without retribution or poor evaluations.

Dr. Klass quotes Dr. Janet R. Serwint, professor emerita of pediatrics at Johns Hopkins, who says, “When I look back at my career and my life and how important some of that feedback was, and it was hard for the giver to give to me, I’m sure, but they did it in a respectful way… I worry that the balance is swinging in such a way that it’s all about, oh, you are wonderful.” During her time as the vice chairwoman of education and the residency program director, she said that some faculty would mention problem residents, but often they had not broached the issues directly with them. “It’s the discomfort, or the worry of retaliation and evaluation.” Furthermore, Dr. Melanie Gold, lead author of the JAMA article, goes on to say that she has also struggled with interns unwilling to experience discomfort during medical training. Her examples include a student who complained to a course director about transgender health’s inclusion in the curriculum and others who, due to religious objection, were unwilling to even observe a patient consultation. Dr. Gold went on to say that many faculty members feel ill equipped to engage in the resulting difficult conversations.

While these articles are written from differing perspectives, they describe a shared desire by residents and faculty for meaningful feedback and instruction. Given that discomfort is an inherent condition of medical training, the data would suggest that some programs are able to navigate this discomfort better than others. Dr. Sen says that “Faculty members also need to learn trainees’ specific strengths and weaknesses and then provide thoughtful, specific feedback that truly supports their learning. Programs ought to encourage faculty to invest the time necessary to support learners and reward them for doing so.”

Following this discourse is important for future medical students and interns who are applying to medical school or residency programs. Applicants can distinguish themselves by showing that they understand the role that feedback—positive and negative—plays in preparing for a medical career. Demonstrate this understanding by using interviews and essays to describe situations where negative feedback spurred improvement, learning, and connection with others despite discomfort. Just as faculty must be willing to consider how best to promote learning, trainees must demonstrate an openness to the criticism and discomfort necessary and inevitable in the preparation for a medical career.

Further, when evaluating programs, applicants should take into consideration the learning environment. Observe the interactions between faculty and interns, and question current and former program participants about how and at what frequency feedback is offered. It may also be worthwhile to engage administrators or admissions representatives on how the program structure trains and supports faculty in providing feedback, facilitating difficult conversations, and creating a positive learning environment. While more visible wellbeing investments can be compelling, it is critical to look closely at the structural elements of a program that data shows matter to the lives of residents: hours worked, tasks performed, work-life balance, and the learning environment.

Top Medical Schools Take on Student Debt in Bid to Increase Diversity and Encourage Broader Specialty Selection

Recently, Washington University in St. Louis announced that it was going to commit $100 million over the next ten years for scholarships for medical students and to “enhance and modernize the school’s medical education program.” Up to half of the program’s future students will be able to attend the school tuition-free, with many others receiving partial tuition support. The program will begin with the 2019-20 entering class.

Washington University is the latest in a string of schools working to reduce the student-debt burden associated with medical school. Last August, New York University Medical School shocked and delighted students when it announced that all current and future medical students would be attending tuition-free. Kaiser Permanente, the following February, made a similar offer for its first five graduating classes. Additional schools, including Columbia University’s Vagelos College of Physicians and Surgeons and the David Geffen School of Medicine at UCLA also have created substantial scholarship funds to ease student loan burdens.

The rising cost of medical school debt negatively impacts not only medical students but also the greater public. Students graduating from public medical school programs carry a mean debt of just under $189,000, while those graduating from private medical schools have a mean debt closer to $209,000. This debt load can impact many aspects of public health, including deterring promising students from entering medical school, encouraging those in medical school to opt for higher paying specialties post-graduation, and creating higher stress and lower wellbeing for physicians and those in training. In late April, the AAMC published updated physician shortage numbers, with the projected shortfall of primary care physicians, a lower-paying specialty, ranging between 21,100 and 55,200 by 2032.

The schools offering reduced and tuition-free opportunities for their students believe that reducing student debt will encourage a more diverse applicant pool as well as empower graduates to pursue a broader range of medical specialties. “For most medical students, debt is a significant factor in selecting a school and a career path,” said Eva Aagaard, MD, Senior Associate Dean for Education and the Carol B. and Jerome T. Loeb Professor of Medical Education at Washington University in St. Louis. “We want to help alleviate that financial burden and instead focus on training the best and brightest students to become talented and compassionate physicians and future leaders in academic medicine….This is an investment in our students and in our institution, as well as in the health of St. Louis and the greater global community.”

 While many schools have adjusted their admissions processes to attract more minority applicants, using a combination of pipeline programs, more holistic admissions standards, and a focus on diverse representation on admissions committees, the problem has thus far remained. “From 2014 to 2018, the percentage of black students enrolled in medical school rose from 6 percent to 7.12 percent, according to the AAMC. Additionally, Latino medical students increased from 5.3 percent to 6.4 percent of total enrollment while Native Americans still account for less than one-half of a percent of all medical students.”

While it is still too early to gauge success, NYU has seen promising results in its first application wave since it eliminated tuition. While overall applications to medical schools in the United States have increased by 47 percent, African American, Hispanic and American Indian applicants only increased by two percentage points. At NYU, however, almost 9,000 applications were submitted for the 102 seats in the 2019 incoming class. There was a 103 percent increase from the previous year in applicants who self-identify as disadvantaged, a 140 percent increase in black applicants and a 40 percent increase in Pell Grant recipients. Dr. Rafael Rivera, Associate Dean for Admission and Financial Aid at NYU said, “The accepted pool that we have thus far reflects increased diversity in socioeconomic status, which is an important facet of diversity in the physician workforce that hasn’t gotten the attention it deserves.”

 The other objective of tuition-free and reduced medical school programs is the freedom that it affords graduates to select less lucrative specialties or career paths. The relationship between student debt and specialty preference is well-documented. An article reviewing research on the impact of student debt on primary care physicians, included references to a 2012 study that showed students with larger amounts of student debt are “more likely to switch their preference for a primary care career to a high-income specialty career over the course of medical school” as well as a 2016 qualitative study which found that, “students described their debt as making them feel more cynical, less altruistic, and entitled to a high income.” These findings suggest that reducing the debt, through reduced tuition or increased scholarships, will positively impact graduating students’ ability to select a specialty based on preference rather than need.

 Though only time will fully show the impact of these schools’ commitments to reducing student debt on the physician workforce, there is reason for optimism about the benefits that will be seen for medical students, physicians, as well as the public.

Medical Schools Limited on Use of Race in Admissions Decisions but Still Seek to Promote Diversity

Last week, The Wall Street Journal reported that the U.S. Education Department is requiring the Texas Tech University Health Sciences Center medical school to discontinue its practice of factoring race into its admissions decisions. The medical school agreed to a deal with the Education Department in order to end the long-running federal investigation into its use of affirmative action. In 2003, after the Supreme Court ruled that race was admissible as a factor in admissions decisions in Grutter v. Bollinger, the Texas Tech University Health Sciences Center resumed use of race as a criteria in admissions decisions. In 2004, the Center for Equal Opportunity filed a complaint against the school, and the next year the Education Department began the investigation, which this agreement concludes.

Texas Tech had previously ceased using its affirmative action policy for admissions in the pharmacy school in 2008 and for undergraduate programs in 2013. However, the medical school contended that, “It must continue weighing race in its admissions process because a cohort of doctors from different backgrounds could best serve Texas’ racially and ethnically diverse communities.” However, the recently signed agreement stipulated that the school was not providing an annual review of the necessity of race-based admissions and therefore could not rule out that other factors may provide similar diversity-levels. The agreement also suggested that the medical school use other “race-neutral factors” to meet diversity aims, “such as recruiting students from low-income areas and favoring bilingual or first-generation college students.”

Earlier this week and just following news of this agreement, Kaplan Test Prep released survey results showing that 80 percent of 245 pre-med students surveyed in January 2019 say that “It’s important for the American medical profession to be more demographically representative of the general patient population.” Among the students who agreed with this statement, one commented, “While it is certainly possible to be empathetic and ‘tuned in’ to your patients despite differences in language, culture, etc., it is important for patients to feel like they can relate to and trust their clinician…If American clinicians were more demographically representative of the population as a whole, patients would likely find it easier to connect with a care provider they are most comfortable with.” Those in the 20 percent who did not agree with the statement were more likely to focus on the importance of drive and technical ability in becoming an effective doctor.

Additionally, an earlier Kaplan study with medical school admissions officers showed that many felt competent with their school’s diversity efforts. When the admissions officers were asked to grade his/her medical school on diversity, the majority gave themselves a B (35 percent) or C (34 percent), while fewer rewarded themselves with an A (18 percent) and even fewer a D or F (5 percent).

While it is clear that prospective medical students and doctors see the value in diversity in medical school admissions, the process by which the schools will implement these diversity goals is changing based on the views of the current administration. And these changes should be noted, especially by prospective medical students.

For future applicants: Overall, it is wise to seek experiences that improve your ability to work with others, particularly those unlike yourself. And throughout your application, you will want to speak to these experiences in a manner that showcases your commitment to serving a diverse population of patients, highlights areas where you will bring diversity into the program, and show how you have thrived and what you have learned in diverse environments in the past.

Medical Schools Focus on Student Wellbeing and Mental Health to Reduce Burnout

In our recent newsletter, we highlighted the topic of burnout among today’s working population. Burnout, or the experience of chronic stress which leads to physical and emotional exhaustion, cynicism and detachment, and feelings of ineffectiveness and lack of accomplishment, remains a pressing issue within the medical student population. A literature review published in late 2018 “confirmed that suicidal ideation in medical students remains a significant concern” and cites studies showing that “medical students in their first year of studies have similar rates of psychological morbidity to the age-matched general population, but experience a worsening of their mental health as they progress through medical studies.”

Medical students and residents, who are often under intense pressure physically and emotionally, suffer from a lack of sleep, extremely long hours of work and study, as well as the emotional, life and death decision-making involved in the work. This is often compounded with a subconscious need to avoid seeking mental health professionals for fear of negative judgment from those around them or even endangering their medical licenses.

The accumulation of data on the mental health of medical students, coupled with the recent high-profile losses of medical students in New York City and California have spurred action and a recognition of the need for additional support for physicians in training. The Accreditation Council for Graduate Medical Education is promoting the importance of wellbeing, which goes beyond addressing burnout, and has compiled and posted a tools and resources page on its website: https://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being/Resources.

Moreover, many medical schools are showing that they too are committed to changing the culture of medical education to improve students’ wellbeing. Prospective students should pay particular attention to the following when further evaluating the schools on their list:

• Commitment to wellbeing: Many schools have codified their commitment to their students by creating wellbeing mission statements and making significant investments in wellbeing resources. At the Icahn School of Medicine in NYC, a wellbeing task force was created in 2016. In addition to creating a mission statement to focus momentum and drive steady action, the school has renovated student housing to include a wellness center.

• Accessible, confidential, and judgment-free mental health resources: This may include access to psychologists or psychiatrists, confidential check-in surveys or interviews, and/or counseling sessions during hospital rotations. At USC Keck Medical School and the University of Pittsburgh School of Medicine, mental health teams have been put in place to ensure the schools do not lose sight of the mental health and wellness needs of their students. Both are working to decrease the stigma around using mental health resources as well as increasing confidential mental health evaluations and services.

• Culture promoting a healthy academic environment: Some schools are taking tangible actions to create an academic environment that promotes rigor but not burnout and depression. Many programs also encourage collaboration, provide wellness curriculums, and promote comradery within the classes through social activities (appropriate for various personality types) and occasional days off. Examples include Duke School of Medicine’s wellness curriculum starting with a resiliency course at orientation, USC’s requirement for students to take several “mental health” days to combat burnout, and Icahn’s assessment and restructuring of grade distributions.

In September of this year, Weill Cornell is partnering with AAMC, AMSNY, and the American Foundation for Suicide Prevention to put on the National Conference on Medical Student Mental Health and Well-Being. It is billed as being the “first comprehensive, multidisciplinary forum to examine the mental health needs of medical students.” Change is underway and it is an exciting time to be considering medical school. However, prospective and current students must engage in the dialogue, stay informed, and ultimately commit to making their wellbeing and health a priority.

Want to Achieve Your Goals? First, Define Your Personal Brand.

In a Forbes article, writer Greg Llopis said that people often confuse the notion of a personal brand with having a curated social media page. In truth, however, social media is just one portion of a much larger idea. Your personal brand is how you express the compilation of experiences you’ve had, what you have to offer, and your intentions going forward. While social media accounts should align with your brand, they do not define it.

Llopis says, “Every time you are in a meeting, at a conference, networking reception or other event, you should be mindful of what others are experiencing about you and what you want others to experience about you.” This awareness of others’ experience allows you the freedom to put forward your most authentic self, rather than letting nerves or other outside influences change how you respond in a situation.

Spending time defining your personal brand will pay dividends as you move forward in your career, whether that means creating an exceptional grad school application, building a compelling resume, prepping for an interview or career-fair, or working towards the next promotion. It will not only allow you to be a proactive planner and decision maker, it will also act as a filter when you evaluate various career options.

To begin defining your personal brand, consider the following:  

1.       Your past experiences

Have you ever been so engaged in a pursuit that time seemingly disappeared? What have you found most difficult?  Which experiences stand out as those which prompted an evolution in your perspective? What are you most proud of? When have you felt most fulfilled?

2.       How you engage with others and the world

What strengths have you developed over time? What are your greatest weaknesses? How have you dealt with adversity? What feedback do you consistently receive when working with others? How do think others experience you? What five adjectives would you use to describe yourself? Do you think others would use the same five adjectives? If not, which would they use?

3.       Your future goals.

What type of work do you enjoy? What type of work do you aspire to do? What would you like your professional relationships to look like? What sort of environment do you think you would thrive in? What is your ideal work-life balance? What aspects of a position are most important to you and where are you willing to compromise? What are your short- and long-term goals?

Once you’ve refined your brand, you can start to put it into action to determine which opportunities will (and will not) be a good fit for you. Just remember to express a consistent message everywhere, including on social media. Recruiters or admissions officers should never be surprised by what they see online, rather the content should provide further depth on the person they know.