This blog is authored by Do No Harm chairman, Dr. Stanley Goldfarb.
I recently tweeted about an article in the journal Academic Medicine. The article found that a group of minority residents (who are referred to as “underrepresented in medicine”) scored worse than a group of white residents on all dimensions of the assessment system used by the faculty at three academic medical centers. The authors entertained only three possible explanations for this finding: attending bias, a less hospitable training environment, or a racist assessment system.
My tweet posed an obvious question: “could it be they were less good at being residents?”
It’s a logical question. In the name of diversity, medical schools have lowered admission standards for years, to the point of abandoning standardized tests and changing candidate evaluation systems. This has led to a situation in which some minority students come to medical school with marginal academic records and then struggle when they enter medical school. Moreover, assessments have become less rigorous, so identifying struggling students has become more difficult.
This raises the possibility that the assessments in the Academic Medicine journal are correct: While many minority students could be excelling, many others could be performing less well. It’s the obvious explanation and research should examine whether it’s the correct explanation, which it may not be. Yet the study authors did not allow for the possibility—even for the purpose of debunking it.
In the absence of any analysis to the contrary, my question points to a plausible reality. Yet instead of debating the merits of my argument or doing a deeper dive on the underlying research, I received an onslaught of criticism—including from medical leaders who should know better.
Dr. Michael Parmacek, the Chairman of the Department of Medicine at the Perelman School of Medicine (where I served as associate dean until 2019), wrote to the faculty and staff of the department. He was surely responding to the predictable and unremarkable anger on Twitter and presumably from some students, staff, or faculty at Penn. Yet instead of showing leadership or standing up for medical standards and academic freedom, he engaged in ad hominem attacks and called my words “racist.”
His statement was as unacademic as it was cowardly. He refused to engage with the question of why some students perform worse in evaluations. Nor did he attempt to substantiate his accusation that I made racist statements. Most disturbingly, he failed to reflect on whether his institution’s own admissions policies could degrade the quality of medical students and therefore the care that current and future patients receive from them.
Instead, Dr. Parmacek simply denounced me and genuflected before his own constituents—the administrators and students determined to reorient medical education away from science and rigor and toward their own view of social justice.
The practice of medicine demands that the practitioner first Do No Harm. By refusing to ask hard questions, let alone obvious questions such as the one I posed, the Perelman School of Medicine (and most medical institutions, for that matter) are threatening patient well-being and the excellence of the entire medical system.
What if lower standards in medical school admissions are producing quantifiable decreases in the quality of the residents those schools produce—as the study seems to suggest? What if these admissions policies are actually hurting minority students, and for the many who succeed, casting a cloud over their success? And is it really better to ignore these questions in service of “social justice”?
Surely not. The patients we serve deserve better. The physicians we’re training deserve better. It is incumbent on medical schools and researchers to address these questions honestly and fairly. Burying their heads in the sand and attacking those who refuse to do so as racist is appeasement—and a total abandonment of the critical thinking that scientific and medical progress depend on.
As a long-time medical educator and practitioner, I will not be deterred by slanders and acts of intimidation. I will continue to ask uncomfortable questions in pursuit of the truth and improved outcomes for patients, not least because I’ve heard from countless other medical professionals who are deeply concerned yet afraid to speak out. The pursuit of truth must be the lodestar of medical education—not the feelings, political agendas, and employment prospects of health care providers.
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