Don’t Weaken Medical Residency Standards

The ACGME, the guiding body of graduate medical education, is obsessed with assessment. That makes sense, since it’s responsible for assuring that residents who complete training programs are ready to enter the independent practice of medicine. To ensure such readiness, the ACGME has decreed that training programs should establish a fairly uniform assessment system based on demonstration of competencies in a number of domains of practice.

But this is a problem for activists focused on woke identity politics. A coalition of training programs from Harvard, University of Virginia, and Emory University recently examined how their “underrepresented in Medicine” (URiM) trainees were performing. They studied 3,600 individual assessments of 703 residents, 13.4% of which were URiM. These residents consistently scored lower on five key dimensions including medical knowledge, systems-based practice, practice-based learning and improvement, professionalism, and interpersonal and communication skills.

Most people, when encountering such results, would conclude that either the assessment system might be flawed and unreliable or that these trainees were simply not performing as well as their peers. The authors of the study, Drs. Robin et al, ignore the latter possibility. They offered three explanations for the results. First, the faculty might be biased; second, the learning environment may not be “inclusive”; or third, the assessment system itself has “structural inequities”. Yet by not even considering the possibility that many of these trainees were actually performing poorly, the study authors should cause patients to worry that less capable students might be entering the medical profession.

Do No Harm chairman, Dr. Stan Goldfarb, had the temerity to point out this possibility on Twitter. He wrote, “Three possible explanations are provided. All are due to external agents. Could it be they were just less good at being residents?” The mob appeared. 

For them, every question must be viewed through the lens of Critical Race Theory. Thus, the only answer to the performance problems exposed by the study is racism. And questioning URiM trainees’ competence is apparently racist. So is worrying about the decline in meritocracy as the basis of acceptance into the most demanding training programs.

Do No Harm has now heard from hundreds of physicians and other healthcare workers – including prominent figures in academic medicine – who are distressed and concerned about this trend. We’re seeing more and more evidence that medical educators are withholding direct feedback and criticism to trainees because they fear being labeled as racist or sexist. This gives rise to even more concern. Is it possible trainees are not improving (to the same degree) without this constructive criticism? Is it possible that assessment is a necessary place for faculty to be honest about the performance of trainees? And why didn’t the study authors even consider that?

Medicine has always prided itself on its meritocratic ethos, hence the prevalence of honor societies, yearly award ceremonies, national and international prizes, academic advancement, and other forms of recognition for excellence. Abandoning meritocracy in the name of “equity” is profoundly depressing and will be harmful to physician expertise and patient well-being. And the many minority trainees who do excel deserve to be recognized, instead of being told they’re victims.