This month, medical-school graduates will begin their postgraduate training positions and residencies nationwide. They’ll primarily work at teaching hospitals, which are charged with ensuring that these future physicians uphold the highest standards of patient care. Yet woke ideology is undermining this essential part of medical education in two ways. First, admissions and testing standards are being lowered in the name of diversity and equity. Second, victimization culture is making it harder to give low-performing and unqualified residents the feedback they need to avoid endangering patients.
This decline is being driven by trends in medical school, where activists have pressured administrators to drop strict testing standards on the grounds that testing is racist. At least 40 institutions and counting have given in, dropping MCAT requirements mainly for those who are “underrepresented in medicine.” The University of Pennsylvania’s Perelman School of Medicine, where I served as associate dean, now waives the MCAT for certain applicants from Historically Black Colleges and Universities and several other institutions. Studies show that lower MCAT scores predict poor performance in medical school, a greater likelihood of dropping out, and a lesser likelihood of comprehending the courses that matter most to patient care.
The lowering of standards on the front end of medical school is now matched by less grading at the back end. This year, the United States Medical Licensing Exam’s first section, which residency programs have typically relied on to select candidates, has replaced objective grades with a pass/fail system. The medical-school deans who approved this seismic shift away from merit explicitly did so to allow more minority students to qualify for competitive residency programs.
Residencies are now more diverse, but residents themselves appear to be less well prepared. Studies show that residents of certain races and ethnicities, on average, score worse on clinical-performance assessments. (To be clear, many also excel.) Yet these findings have sparked more calls for lowering standards and eliminating measures that demonstrate competence.
Consider a study published in the prominent journal Academic Medicine in May. It asserted that lower scores by minority residents on evaluations of professionalism, medical knowledge, and readiness for independent practice can be ascribed to only three things: bias from supervising physicians, a worse training environment, or racist testing. At no point did the study authors consider a more obvious conclusion: that lower scores reflect genuinely weaker performance, an unsurprising result of years of lowering standards.
Pointing out the obvious is an unforgivable sin in the activist-dominated world of academic medicine. When I tweeted about the study, I was accused of being a racist, and the chair of the Department of Medicine at my former employer — a friend of many years — sent a department-wide email denouncing my “racist statements.” Apparently, it is no longer acceptable to express concern about trainees who are underperforming and may continue to underperform as clinicians.
My experience points to the most dangerous trend of all. Having retired from academic medicine in 2019, I have the freedom to speak out. Yet the nonprofit I chair that opposes identity politics in health care, Do No Harm, is consistently hearing from physicians who are afraid of giving feedback to low-performing residents lest they be accused of bias. It’s a direct threat to residents’ future success as physicians — and more important, the well-being of their patients.
The harmful consequences are already playing out. An attending physician at a top medical school told us about a resident who left a tourniquet on a patient for too long, causing an above-the-knee amputation — yet the resident received no negative feedback. In another instance, an attending physician believed that a resident came to work in the emergency room while under the influence of drugs, yet after raising the issue, the physician backed down following accusations of racism. Another resident who did not know how to set a broken bone responded with physical threats to an attending physician who tried to step in and help, and the resident and received no punishment in return.
An attending physician at a prominent institution recently told my organization that residents now have the power — and they’re not afraid to use it against the physicians who are supposed to be their supervisors. Physicians rightly worry that administrators will take the residents’ side in a dispute: What they know to be a necessary corrective action, the medical diversity-industrial complex could easily see as grounds for termination. So the physicians often stay silent, except with the most egregious mistakes.
The result is a crisis of excellence across medical education and training. To be sure, the real failure doesn’t belong to unqualified students and residents. Medical schools and training institutions are failing them and society at large. These institutions should be recruiting and educating the best future physicians, many of whom are indeed from diverse backgrounds, and they should never lower standards or refuse to give residents the feedback they need to succeed in this lifesaving profession. If these trends continue, next July will see a larger crop of trainees and residents who are less capable and more likely to harm their patients, with the medical establishment pretending nothing is wrong.
Dr. STANLEY GOLDFARB, a former associate dean of curriculum at the University of Pennsylvania’s Perelman School of Medicine, is chairman of Do No Harm.
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