A recent report of the Josiah Macy Jr. Foundation Conference on Ensuring Fairness in Medical Education Assessment promotes the idea that “Black and Hispanic” medical students who fail to successfully meet the demands of the rigors of learning assessments are victims of bias in the assessments themselves, and recommends “equitable” changes to assure more minority students are able to actually practice medicine.
The report, published in August at Academic Medicine, the flagship journal of the Association of American Medical Colleges (AAMC) – which assists in overseeing the Medical College Admission Test (MCAT) – says in its first sentence that “health equity” is dependent upon a “diversity” of races and ethnicities in the healthcare workforce.
“Health equity” is a narrative of diversity, equity, and inclusion (DEI) ideology, which, based in Critical Race Theory (CRT), claims “systemic racism” and “oppression” prevent minority individuals from obtaining access to sufficient health care. According to the radical dogma, if there are more minority physicians, more people from minority racial and ethnic groups will obtain higher quality health care.
The report of the Macy Foundation, which self-describes as “the only national foundation dedicated solely to improving the education of health professionals,” presents the problem of minority students who have been accepted into medical school with the use of DEI practices, but fail to make the necessary progress to advance through training to the actual practice of medicine:
Retention efforts so far have focused largely on addressing bias and discrimination broadly across the learning and working environment. A specific component of that environment—learner assessment—requires immediate, focused attention. Mounting evidence suggests that “bias plagues assessment” and can impede learners’ developmental progress and prevent some from advancing in the medical profession.
The report notes that one of the papers that became a “foundation” for the conference’s discussions on biased assessments was titled “The Long Shadow: A Historical Perspective on Racism in Medical Education,” a piece that described “the history of racism and oppression in American medicine” and explained “why understanding this history is crucial to advancing equity in medicine.”
According to the Macy report, the authors of the paper claim: “[W]e cannot meaningfully dismantle racial bias in medical education today without confronting its historic origins.”
The authors further described how “racism in contemporary medical education is a direct consequence of American medicine’s historical roots in European ideologies of White racial superiority, colonization, and slavery.”
The paper’s authors propose the following “actions” to confront racism in the field of medicine:
- Incorporate the history of racism into medical education and unmask institutional histories of racism.
- Create centralized reporting mechanisms and implement systematic reviews of educational and clinical activities for evidence of harmful bias.
- Adopt “mastery-based” assessment in medical education.
- Embrace holistic review and expand its possibilities in admissions.
- Increase faculty diversity by using holistic review principles in hiring and promotions.
- Leverage accreditation to combat harmful bias in medical education.
Another paper promoted in the Macy report addresses “harmful bias in the selection of medical residents.”
Proposed steps to ensure “historically marginalized” groups “will consider a certain specialty” include “thoughtful and strategic” outreach by residency programs to minority preclinical students, providing them with “specialized advising and sponsorship opportunities.”
Also recommended are “holistic applicant reviews,” ensuring interviewers are of various races and ethnicities who have been trained in “implicit bias reduction,” and “limiting interviewers’ access to normative learner assessment metrics, such as grades and exam scores.”
Despite numerous papers recommending modifications to guarantee more minority medical students can make it through to a residency program, the proposals applauded by the Macy Foundation all involve the potential of minimizing rigor while they attempt to ensure evaluators and interviewers are indoctrinated in CRT-inspired “implicit bias” ideology.
The foundation’s conference report suggests the following goals to achieve “fairness” in assessment:
- Create a culture that promotes fairness in learner assessment
- Design learner assessment systems that promote fairness and equity
- Equip faculty and other assessors with the knowledge, skills, and funds to create learner assessment systems that eliminate harmful bias
- Avoid overreliance on certain metrics; use holistic review for medical school admissions and residency selection
- All members of the medical education community must commit to and work toward achieving fairness and equity in learner assessment
While the Macy Foundation promotes diversity as a primary goal, a new study focused on the performance of emergency medicine residents raises concerns about the “danger” associated with “elevating diversity over quality in medicine.”
Do No Harm Chairman Stanley Goldfarb, M.D. cited the study in October at National Review, noting that its woke authors observed that all residents who participated in the research were found, by faculty, to have performed equally at the start of their training, but that, over the next three or four years, minority residents, especially women, were judged to have demonstrated less competent patient care.
“Naturally, the researchers conclude that so-called ‘intersectionality’ is to blame,” Goldfarb wrote, but challenged that conclusion with the common sense explanation that “the fact that all the residents were judged to perform equally at the initiation of their training is not surprising and is quite typical, indicating that the faculty is not suffering from bias.”
“The authors would have us believe that bias develops over trainees’ time in the program,” Goldfarb continued. “Yet it’s far more likely that, with time and experience, the faculty recognize which trainees are performing well — and which aren’t.”
An “unfortunate yet increasingly common reality,” he also pointed out, is that prior poor performance in medical school “is simply continuing into residency.”
And that, Goldfarb asserted, is what happens when “standards have been lowered in the name of diversity.”
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