The Problem and Power of Professionalism: A Critical Analysis of Medical Students' and Residents' Perspectives and Experiences of Professionalism.

PURPOSE: Professionalism has historically been viewed as an honorable code to define core values and behaviors of physicians, but there are growing concerns that professionalism serves to control people who do not align with the majority culture of medicine. This study explored how learners, particularly those from historically marginalized groups, view the purpose of professionalism and how they experience professionalism as both an oppressive and valuable force. METHOD: The authors conducted a qualitative study with a critical orientation. In 2021 and 2022, they interviewed fourth-year medical students and senior residents at 3 institutions about their perceptions and experiences of professionalism. After cataloguing participants' stories, the authors combined critical theory with narrative and thematic analysis to identify mechanisms by which professionalism empowered or disempowered individuals or groups based on identities. RESULTS: Forty-nine trainees (31 medical students and 18 senior residents from multiple specialties) participated in interviews; 17 identified as a race/ethnicity underrepresented in medicine and 15 as people of color not underrepresented in medicine. Their stories, especially those of participants underrepresented in medicine, identified professionalism as an oppressive, homogenizing force that sometimes encoded racism through various mechanisms. These mechanisms included conflating differences with unprofessionalism, enforcing double standards of professionalism, and creating institutional policies that regulated appearance or hindered advocacy. Participants described deleterious consequences of professionalism on their learning and mental health. However, participants also described useful aspects of professionalism as a means of advocating for marginalized groups. Additionally, participants described how they reconceived professionalism to include their own identities and values. CONCLUSIONS: Trainees, especially those from historically marginalized groups, experience professionalism as a restrictive, assimilative force while also finding value in and constructive adaptations for professionalism. Understanding both the destructive and empowering aspects of professionalism on individual and institutional levels can help improve the framing of professionalism in medical education.

The Supreme Court Decision on Affirmative Action-Fewer Black Physicians and More Health Disparities for Minoritized Groups.

This Viewpoint discusses the US Supreme Court's June 2023 ruling on affirmative action and its repercussions for Black physicians and health equity for racial and ethnic minority groups.

The Validity of MCAT Scores in Predicting Students' Performance and Progress in Medical School: Results From a Multisite Study.

PURPOSE: This is the first multisite investigation of the validity of scores from the current version of the Medical College Admission Test (MCAT) in clerkship and licensure contexts. It examined the predictive validity of MCAT scores and undergraduate grade point averages (UGPAs) for performance in preclerkship and clerkship courses and on the United States Medical Licensing Examination Step 1 and Step 2 Clinical Knowledge examinations. It also studied students' progress in medical school. METHOD: Researchers examined data from 17 U.S. and Canadian MD-granting medical schools for 2016 and 2017 entrants who volunteered for the research and applied with scores from the current MCAT exam. They also examined data for all U.S. medical schools for 2016 and 2017 entrants to regular-MD programs who applied with scores from the current exam. Researchers conducted linear and logistic regression analyses to determine whether MCAT total scores added value beyond UGPAs in predicting medical students' performance and progress. Importantly, they examined the comparability of prediction by sex, race and ethnicity, and socioeconomic status. RESULTS: Researchers reported medium to large correlations between MCAT total scores and medical student outcomes. Correlations between total UGPAs and medical student outcomes were similar but slightly lower. When MCAT scores and UGPAs were used together, they predicted student performance and progress better than either alone. Despite differences in average MCAT scores and UGPAs between students who self-identified as White or Asian and those from underrepresented racial and ethnic groups, predictive validity results were comparable. The same was true for students from different socioeconomic backgrounds, and for males and females. CONCLUSIONS: These data demonstrate that MCAT scores add value to the prediction of medical student performance and progress and that applicants from different backgrounds who enter medical school with similar ranges of MCAT scores and UGPAs perform similarly in the curriculum.

Cultivating the physician workforce: Recruiting, training, and retaining physicians to meet the needs of the population.

In the 10 years since the Lancet Commission on Education of Health Professionals for the 21st Century suggested the changes necessary to transform medical education, the United States remains plagued by shortages of physicians and maldistribution of the physician workforce. Minoritized and rural communities usually suffer the most, with widely documented health disparities across the United States by race, ethnicity, gender identity, education, and zip code. Medical schools can respond by recruiting students more likely to practice in these settings and training them to address the community needs. In 2013, the American Medical Association launched an initiative to trigger transformation in medical education and formed a consortium of schools representing a diversity of U.S. institutions. Consortium member schools highlighted in this article share lessons learned in their efforts to strengthen social accountability and develop needed sectors of the physician workforce. Development of the physician workforce involves recruiting and widening pathways of entry for diverse groups, providing training settings and competencies aligned with community needs, and explicit programming in retention, inclusion and well-being to mitigate against workforce losses.

How to Eliminate a Deficit-Centered Mindset About Medical Students of Color.

Approaches to responding to racial and ethnic health inequity in the United States have had limited impact over the past 40 years. Efforts to increase the number of medical students of color are undermined by hyperfocus and overreliance on and misinterpretation and misuse of standardized examination scores. Structural racism and persistence of deficit-focused interventions undermine appreciation of the value that students and physicians with minoritized identities bring to medicine and to US health care's systemic capacity to motivate equity.

Morehouse School of Medicine Case Study: Teacher-Learner Relationships Free of Bias and Discrimination.

Bias can impact all aspects of human interactions and have major impacts on the education and evaluation of health care professionals. Health care and health professions education, being very dependent on interpersonal interactions and learning as well as on the assessment of interpersonal behaviors and skills, are particularly susceptible to the positive and negative effects of bias. Even trained and experienced evaluators can be affected by biases based on appearance, attractiveness, charm, accent, speech impediment, and other factors that should not play a role in the assessment of a skill. At the Morehouse School of Medicine, elements in the curriculum and the milieu help decrease the burden of bias experienced by learners. In addition, many of the learners develop knowledge, skills, and attitudes that appear to assist them with navigating bias in other learning or practice environments. In this case study, the authors reflect on these elements and how they can be replicated in other settings. According to the authors, modifying the learning environment to enhance and sustain relationships is key in addressing toxic bias.

A Model Partnership: Mentoring Underrepresented Students in Medicine (URiM) in Emergency Medicine.

INTRODUCTION: Creating a racially and ethnically diverse workforce remains a challenge for medical specialties, including emergency medicine (EM). One area to examine is a partnership between a predominantly white institution (PWI) with a historically black college and university (HBCU) to determine whether this partnership would increase the number of underrepresented in medicine (URiM) in EM who are from a HBCU. METHODS: Twenty years ago Emory Department of Emergency Medicine began its collaboration with Morehouse School of Medicine (MSM) to provide guidance to MSM students who were interested in EM. Since its inception, our engagement and intervention has evolved over time to include mentorship and guidance from the EM clerkship director, program director, and key faculty. RESULTS: Since the beginning of the MSM-Emory EM partnership, 115 MSM students have completed an EM clerkship at Emory. Seventy-two of those students (62.6%) have successfully matched into an EM residency program. Of those who matched into EM, 22 (32%) have joined the Emory EM residency program with the remaining 50 students matching at 40 other EM programs across the nation. CONCLUSION: Based on our experience and outcomes with the Emory-MSM partnership, we are confident that a partnership with an HBCU school without an EM residency should be considered by residency programs to increase the number of URiM students in EM, which could perhaps translate to other specialties.

The Validity of Scores From the New MCAT Exam in Predicting Student Performance: Results From a Multisite Study.

PURPOSE: The new Medical College Admission Test (MCAT) was introduced in April 2015. This report presents findings from the first study of the validity of scores from the new MCAT exam in predicting student performance in the first year of medical school (M1). METHOD: The authors analyzed data from the national population of 2016 matriculants with scores from the new MCAT exam (N = 7,970) and the sample of 2016 matriculants (N = 955) from 16 medical schools who volunteered to participate in the validity research. They examined correlations of students' MCAT total scores and total undergraduate grade point averages (UGPAs), alone and together, with their summative performance in M1, and the success rate of students with different MCAT scores in their on-time progression to the second year of medical school (M2). They assessed whether MCAT scores provided comparable prediction of performance in M1 by students' race/ethnicity, socioeconomic background, and gender. RESULTS: Correlations of MCAT scores with summative performance in M1 ranged from medium to large. Although MCAT scores and UGPAs provided similar prediction of performance in M1, using both metrics provided better prediction than either alone. Additionally, students with a wide range of MCAT scores progressed to M2 on time. Finally, MCAT scores provided comparable prediction of performance in M1 for students from different sociodemographic backgrounds. CONCLUSIONS: This study provides early evidence that scores from the new MCAT exam predict student performance in M1. Future research will examine the validity of MCAT scores in predicting performance in later years.

Effect of a small-group, active learning, tutorial-based, in-course enrichment program on student performance in medical physiology.

Physiology is one of the major foundational sciences for the medical curriculum. This discipline has proven challenging for students to master due to ineffective content acquisition and retention. Preliminary data obtained from a survey completed by "low-performance" students (those maintaining a grade average below the passing mark of 70%) at Morehouse School of Medicine reported that students lacked the ability to adequately recognize and extract important physiological concepts to successfully navigate multiple-choice assessments. It was hypothesized that a specially designed, small-group, active learning, physiology in-course enrichment program would minimize course assessment failure rates by enhancing the ability of low-performance students to effectively identify important course content, successfully perform on multiple-choice assessments, and, thereby, improve overall course performance. Using self-report surveys, study skills and test-taking deficiencies limiting successful comprehension of course material and examination performance were identified. Mini-quiz assessments and assignments in formulating multiple-choice examination questions were given to help students recognize and solidify core concepts and improve test-taking ability. Lastly, self-report surveys evaluated the effectiveness of the enrichment program on overall course performance. Results showed a marked improvement in student confidence levels with regards to approaching multiple-choice assessments, and a significant improvement in grades achieved in the physiology component of the first-year curriculum, as 100% of participants achieved a final passing grade average of ≥70%. It was concluded that students became more proficient in identifying, understanding, and applying core physiological concepts and more successful in mastering multiple-choice questions.

Shifting the Curve: Fostering Academic Success in a Diverse Student Body.

PROBLEM: Diversity in the health care workforce is key to achieving health equity. Although U.S. medical schools have worked to increase the matriculation and academic success of underrepresented minority (URM) students (African Americans, Latinos, others), they have had only limited success. Lower standardized test scores, including on the Medical College Admission Test (MCAT), have been a barrier to matriculation for many URM applicants. Lower subsequent standardized exam scores, including on the United States Medical Licensing Exam Step 1, also have been an impediment to students' progress, with mean scores for URM students lagging behind those for others. APPROACH: Faculty at the Morehouse School of Medicine developed and implemented interventions to enhance the academic success of their URM students (about 75% are African American, and 5% are from other URM groups). To assess the outcomes of this work, the authors analyzed the MCAT scores and subsequent Step 1 scores of students in the graduating classes of 2009-2014. They also reviewed course evaluations, Graduation Questionnaires, and student and faculty interviews and focus groups. OUTCOMES: Students' Step 1 scores exceeded those expected based on their MCAT scores. This success was due to three key elements: (1) milieu and mentoring, (2) structure and content of the curriculum, and (3) monitoring. NEXT STEPS: A series of mixed-method studies are planned to better discern the core elements of faculty-student relationships that are key to students' success. Lower test scores are not a fixed attribute; with the elements described, success is attainable for all students.