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.

Competition for the most prestigious post-graduate medical residency programs is fierce, with a proven track record of elevating the best physicians. Yet anti-racist ideology is now corrupting the residency evaluation process. Not only will patient care suffer, but the most elite and privileged physicians stand to gain the most.

The United States Medical Licensing Examination is the test that future physicians take before being assigned to a residency. Earlier this year, it ditched a numerical grading score in its first section. Instead of receiving a numerical grade, future physicians would instead get a “pass” or a “fail.” Driven by woke activists, the organizations behind the exam argued that a pass/fail system would lead to a more diverse group of physicians chosen on a “holistic” basis. This fits with the anti-racist claim that meritocracy is merely a manifestation of systemic racism.

But a growing body of evidence proves the foolishness of this decision. Previously, the first part of the USMLE test gave residency evaluators the best gauge of a candidate’s abilities. Now, without any objective criteria for choosing residents, students are increasingly selected based on the ranking of their medical schools. This hurts minority applicants from the lower ranked medical schools, including those affiliated with historically black colleges and universities. It also hurts other outstanding students from other less prestigious medical schools.

What’s more, the pass/fail system discourages medical excellence by incentivizing medical students not to study hard, as various specialties have pointed out. Residency directors are also frustrated that it’s now much harder to ensure that they’re picking the best candidates who will provide the best care. In both cases, the result is worse patient care over time, driven by a decline in the quality of residency participants.

Even woke residency program directors are frustrated. A new study at the National Library of Medicine concludes that, given the failure of the new pass/fail system, “further changes are needed to promote equity.” Here’s an idea: Go back to the proven system of evaluating medical students, which is the best way to find talented physicians who provide the best care.