Diversity efforts, admissions, and national rankings: can we align priorities?

BACKGROUND: Increasing student body diversity is a priority for national health education and professional organizations and for many medical schools. However, national rankings of medical schools, such as those published by U.S. News & World Report, place a heavy emphasis on grade point average (GPA) and Medical College Admissions Test (MCAT) scores, without considering student body diversity. These rankings affect organizational reputation and admissions outcomes, even though there is considerable controversy surrounding the predictive value of GPA and MCAT scores. SUMMARY: Our aim in this article was to explore the relationship between standard admissions practices, which typically aim to attract students with the highest academic scores, and student body diversity. We examined how changes in GPA and MCAT scores over 5 years correlated with the percentage of enrolled students who are underrepresented in medicine. In a majority of medical schools in the United States from 2005 to 2009, average GPA and MCAT scores of applicants increased, whereas the percentage of enrolled students who are underrepresented in medicine decreased. CONCLUSIONS: Our findings suggest that efforts to increase the diversity of medical school student bodies may be complicated by a desire to maintain high average GPA and MCAT scores. We propose that U.S. News revise its ranking methodology by incorporating a new diversity score into its student selectivity score and by reducing the weight placed on GPA and MCAT scores.

Perspective: Medical school admissions and noncognitive testing: some open questions.

Medical schools use a variety of criteria in selecting applicants for admission, attempting to assess both the academic preparation and the personal characteristics suitable for a career in medicine. While assessing academic preparation is fairly straightforward, assessing applicants' personal characteristics is difficult and controversial. The possibility of implementing standardized testing of personal characteristics, so-called "noncognitive testing," has been proposed as part of the admissions process. Such a proposal, however, raises numerous questions about the validity, fairness, and cost of such testing and the impact of commercial test-preparation services on test performance and reliability. Therefore, before noncognitive testing is adopted for screening applicants to medical school, open discussion among all stakeholders in the admissions process is critically important.

Pilot of direct observation of clinical skills (DOCS) in a medicine clerkship: feasibility and relationship to clinical performance measures.

PURPOSE: To assess the feasibility of Direct Observation of Clinical Skills (DOCS), a program for formative assessment of students' clinical skills during a medicine clerkship and to determine relationships between DOCS measures and other clinical performance measures. METHOD: From August, 2004 through June, 2005, Medicine Clerks assigned to the primary on-campus clinical site were asked to participate in the pilot phase of the DOCS program. Students were asked to complete at least one DOCS exercise focused on interviewing, physical examination, or oral case presentation. RESULTS: Of the 79 students who rotated on the Medicine Clerkship during the pilot period, 79% (n = 62) participated in DOCS, and 163 forms were submitted for evaluation. Seventy-seven percent (77%) of the clinical observations occurred while on-call or during daily rounds. Seventy-three (73%) of observations were completed in 30 minutes or less. In 89% of encounters students received at least 5 minutes of verbal feedback. Satisfaction ratings from both students and observers were "moderately satisfied" or better. Global ratings from DOCS physical exam and case presentation sections were strongly correlated with both faculty ratings of clinical performance and final clerkship grade. DOCS measures were not statistically related to clerkship written examination scores. CONCLUSIONS: These data support the feasibility of the DOCS session for formative assessment of student interviewing, physical examination, and oral case presentation skills during a medicine clerkship. Observer ratings from DOCS physical examination and case presentation sections were found to be predictors of final clerkship grade.

Is medicine flat?

The biomedical model, attempting to explain health and disease in terms of the physical sciences, tends to eliminate or ignore other aspects of sickness phenomena. Medicine and medical education have sought to assert the importance of the patients subjectivity, including psychological makeup, social context, illness framework, beliefs, culture, and other forces. These offer an added dimension to the flat biomedical surface. The metaphor of flatness and dimensionality may help to conceptualize the role of patient experience in clinical care and in medical education.

Is medicine altruistic? A query from the medical school admissions office.

BACKGROUND: Applicants to medical school often state that they are motivated by a desire to help others. Admissions officers must evaluate these claims, but assessment of altruism is difficult and imprecise. SUMMARY: A purely utilitarian moral philosophy denies the possibility of altruism. However, the Enlightenment philosopher Hume described a force, sympathy, that engages channels of communication between persons and rewards benevolence. Although there are many pretenders to altruism, the medical school interview provides an opportunity to create a channel of sympathy and to assess its authenticity. CONCLUSIONS: By probing for evidence of clinical sympathy, the medical school interviewer may be able to verify whether the applicant's claims of altruism are authentic. Claims of altruism that have not been borne out in action should be viewed with skepticism.

Specifying student-patient encounters, web-based case logs, and meeting standards of the liaison committee on medical education.

Standard ED-2 of the Liaison Committee on Medical Education (LCME) requires medical schools to specify the types of patients that students should encounter, the student's level of responsibility, and the appropriate setting for the encounter. The authors describe the process at Joan and Sanford I. Weill Medical College of Cornell University in New York City for meeting this standard through the development of a Web-based case log. The log permits the medical college to specify expectations for patient encounters and allows the students to record their encounters in an efficient, brief, and user-friendly manner. By downloading the student's reports directly into a database, the medical college can track successes and deficiencies in the student's clinical experiences. However, in response to a questionnaire administered in 2005, students generally expressed dissatisfaction with the case logs, which they described as intrusive busywork.

Teaching, digression, and implicit curriculum.

BACKGROUND: Although medicine resides within contexts that have historical, cultural, and societal determinants, these are rarely addressed explicitly in current medical teaching. SUMMARY: The article describes a method of teaching in which mainstream biomedical learning is linked to digressions, which serve as the medium for considering the contexts of medicine, unmasking hidden messages, and broadening the scope of medical instruction. CONCLUSION: Teaching by digression encourages students to learn core clinical science while considering such otherwise neglected areas such as medical values, contexts, habits, and history. Integrating this consideration of the hidden assumptions of medical practice into mainstream medical learning allows students to understand modern biomedicine as a system that is historically, culturally, and socially conditioned.