In their recent Medicine and Society commentary in NEJM, Kemi Doll, MD, and Charles Thomas Jr., MD provide both important personal narrative and describe structural solutions to address racism within academic medicine, specifically with respect to faculty. A companion Point of View by Anique Forrester, MD, further underscores both the emotional toll and deep commitment for URM faculty in academia.

Here is a brief list of *some* of the recent literature documenting racism experienced by faculty in academic medicine, and a few articles that also put forth recommendations. A key takeaway is that URM faculty should rightfully question whether their concerns will be met, given the documentation shows that their predecessors have tried, for years, to highlight these issues, using the currency of academic medicine: peer-reviewed journal publications. Why are personal narratives only being published now, by the most prominent journals? Conversely, what would this look like, had Academic Medicine not been consistently publishing this work over decades?

• Konuthula D, de Abril Cameron F, Jonassaint N, et al. Perspectives on Anti-Black Racism and Mitigation Strategies Among Faculty Experts at Academic Medical Centers. JAMA Netw Open. 2022;5(4):e228534. doi:10.1001/jamanetworkopen.2022.8534
• Odei BC, Jagsi R, Diaz DA, et al. Evaluation of Equitable Racial and Ethnic Representation Among Departmental Chairs in Academic Medicine, 1980-2019. JAMA Netw Open. 2021;4(5):e2110726. doi:10.1001/jamanetworkopen.2021.10726
• Alexis DA, Kearney MD, Williams JC, Xu C, Higginbotham EJ, Aysola J. Assessment of perceptions of professionalism among faculty, trainees, staff, and students in a large university-based health system. JAMA Netw Open. 2020;3(11):e2021452. doi:10.1001/jamanetworkopen.2020.21452
• Xierali IM, Nivet MA, Syed ZA, Shakil A, Schneider FD. Trends in tenure status in academic family medicine, 1977-2017: implications for recruitment, retention, and the academic mission. Acad Med. 2020;95(2):241-247.
• Erosheva EA, Grant S, Chen MC, Lindner MD, Nakamura RK, Lee CJ. NIH peer review: Criterion scores completely account for racial disparities in overall impact scores. Sci Adv. 2020;6(23):eaaz4868.
• Campbell KM, Hudson BD, Tumin D. Releasing the net to promote minority faculty success in academic medicine. J Racial Ethn Health Disparities. 2020;7(2):202-206.
• Wingard D, Trejo J, Gudea M, Goodman S, Reznik V. Faculty equity, diversity, culture and climate change in academic medicine: A longitudinal study. J Natl Med Assoc. 2019;111(1):46-53.
• Dixon G, Kind T, Wright J, Stewart N, Sims A, Barber A. Factors that influence the choice of academic pediatrics by underrepresented minorities. Pediatrics. 2019;144(2):e20182759. doi:10.1542/peds.2018-2759
• Campbell KM, Rodríguez JE. Addressing the minority tax: perspectives from two diversity leaders on building minority faculty success in academic medicine. Acad Med. 2019;94(12):1854-1857.
• Lett LA, Orji WU, Sebro R. Declining racial and ethnic representation in clinical academic medicine: A longitudinal study of 16 US medical specialties. PLoS One. 2018;13(11):e0207274.
• Kaplan SE, Gunn CM, Kulukulualani AK, Raj A, Freund KM, Carr PL. Challenges in recruiting, retaining and promoting racially and ethnically diverse faculty. J Natl Med Assoc. 2018;110(1):58-64.
• Kaplan SE, Raj A, Carr PL, Terrin N, Breeze JL, Freund KM. Race/Ethnicity and success in academic medicine: Findings from a longitudinal multi-institutional study. Acad Med. 2018;93(4):616-622.
• Abelson JS, Wong NZ, Symer M, Eckenrode G, Watkins A, Yeo HL. Racial and ethnic disparities in promotion and retention of academic surgeons. Am J Surg. 2018;216(4):678-682. doi:10.1016/j.amjsurg.2018.07.020
• Fisher ZE, Rodríguez JE, Campbell KM. A review of tenure for Black, Latino, and Native American faculty in academic medicine. South Med J. 2017;110(1):11-17.
• Andriole DA, Yan Y, Jeffe DB. Mediators of racial/ethnic disparities in mentored K award receipt among U.S. medical school graduates. Acad Med. 2017;92(10):1440-1448. d
• Marsh J, Chod R. Recruiting faculty leaders at U.S. medical schools: A process without improvement. Acad Med. 2017; 92(11) 1564-1568
• Johnson TJ, Ellison AM, Dalembert G, et al. Implicit bias in pediatric academic medicine. J Natl Med Assoc. 2017;109(3):156-163.
• Mader EM, Rodríguez JE, Campbell KM, et al. Status of underrepresented minority and female faculty at medical schools located within Historically Black Colleges and in Puerto Rico. Med Educ Online. 2016;21:29535.
• Ginther DK, Kahn S, Schaffer WT. Gender, race/ethnicity, and National Institutes of Health R01 research awards: Is there evidence of a double bind for women of color?. Acad Med. 2016;91(8):1098-1107
• Rodríguez JE, Campbell KM, Pololi LH. Addressing disparities in academic medicine: what of the minority tax?. BMC Med Educ. 2015;15:6.
• Hassouneh D, Lutz KF, Beckett AK, Junkins EP, Horton LL. The experiences of underrepresented minority faculty in schools of medicine. Med Educ Online. 2014. 19:24768.
• Rodríguez JE, Campbell KM, Mouratidis RW. Where are the rest of us? Improving representation of minority faculty in academic medicine. South Med J. 2014;107(12):739-744.
• Yehia BR, Cronholm PF, Wilson N, et al. Mentorship and pursuit of academic medicine careers: a mixed methods study of residents from diverse backgrounds. BMC Med Educ. 2014;14:26.
• Yu PT, Parsa PV, Hassanein O, Rogers SO, Chang DC. Minorities struggle to advance in academic medicine: A 12-y review of diversity at the highest levels of America’s teaching institutions. J Surg Res. 2013;182(2):212-218.
• Pololi LH, Evans AT, Gibbs BK, Krupat E, Brennan RT, Civian JT. The experience of minority faculty who are underrepresented in medicine, at 26 representative U.S. medical schools. Acad Med. 2013;88(9):1308-1314.
• Sánchez JP, Peters L, Lee-Rey E, et al. Racial and ethnic minority medical students’ perceptions of and interest in careers in academic medicine. Acad Med. 2013;88(9):1299-1307.
• Nunez-Smith M, Ciarleglio MM, Sandoval-Schaefer T, et al. Institutional variation in the promotion of racial/ethnic minority faculty at US medical schools. Am J Public Health. 2012;102(5):852-858.
• Pololi LH, Krupat E, Civian JT, Ash AS, Brennan RT. Why are a quarter of faculty considering leaving academic medicine? A study of their perceptions of institutional culture and intentions to leave at 26 representative U.S. medical schools. Acad Med. 2012;87(7):859-869.
• Jeffe DB, Yan Y, Andriole DA. Do research activities during college, medical school, and residency mediate racial/ethnic disparities in full-time faculty appointments at U.S. Medical schools?. Acad Med. 2012;87(11):1582-1593.
• Ginther DK, Haak LL, Schaffer WT, Kington R. Are race, ethnicity, and medical school affiliation associated with NIH R01 type 1 award probability for physician investigators?. Acad Med. 2012;87(11):1516-1524.
• Pololi L, Cooper LA, Carr P. Race, disadvantage and faculty experiences in academic medicine. J Gen Intern Med. 2010;25(12):1363-1369.
• Mahoney MR, Wilson E, Odom KL, Flowers L, Adler SR. Minority faculty voices on diversity in academic medicine: perspectives from one school. Acad Med. 2008;83(8):781-786.
• Cropsey KL, Masho SW, Shiang R, et al. Why do faculty leave? Reasons for attrition of women and minority faculty from a medical school: four-year results. J Womens Health (Larchmt). 2008;17(7):1111-1118.
• Price EG, Gozu A, Kern DE, et al. The role of cultural diversity climate in recruitment, promotion, and retention of faculty in academic medicine. J Gen Intern Med. 2005;20(7):565-571.
• Peterson NB, Friedman RH, Ash AS, Franco S, Carr PL. Faculty self-reported experience with racial and ethnic discrimination in academic medicine. J Gen Intern Med. 2004;19(3):259-265.
• Fang D, Moy E, Colburn L, Hurley J. Racial and Ethnic Disparities in Faculty Promotion in Academic Medicine. 2000;284(9):1085–1092.
• Palepu A, Carr PL, Friedman RH, Ash AS, Moskowitz MA. Specialty choices, compensation, and career satisfaction of underrepresented minority faculty in academic medicine. Acad Med. 2000;75(2):157-160.

Image: Medical schools grapple with upcoming year. MedPage Today. May 9, 2020

Med Twitter is erupting over the administrative debacle of this spring/summer MCAT administration. A group of premedical students, Students for Ethical Admissions, have taken it upon themselves to do the work of collecting and documenting applicants experiences with accommodations, the MCAT, AMCAS and other issues here.  It is worth reading the open-ended comments to see the myriad structural barriers that permeate the entire process of applying to medical school.

As we have seen with UME and GME, there is also a past & present literature on how medical school admissions perpetuates racism within medical education. Few of these studies explicitly call out racism, but together, various examinations of the procedures and metrics show how applicants of color are systematically excluded.

• Chatterjee A, Greif C, Witzburg R, Henault L, Goodell K, Paasche-Orlow MK. US medical school applicant experiences of bias on the interview trail. J Health Care Poor Underserved. 2020;31(1):185-200.
• Lucey CR, Saguil A. The consequences of structural racism on MCAT scores and medical school admissions: The past is prologue. Academic Medicine 95.3 (2020): 351-356.
• Girotti, Jorge A., et al. Investigating group differences in examinees’ preparation for and performance on the new MCAT exam. Academic Medicine 95.3 (2020): 365-374.
• Terregino CA, Saguil A, Price-Johnson T, Anachebe NF, Goodell K. The diversity and success of medical school applicants with scores in the middle third of the MCAT score scale. Acad Med. 2020;95(3):344-350
• Juster FR, Baum RC, Zou C, Risucci D, Ly A, Reiter H, Miller DD, Dore KL. Addressing the diversity–validity dilemma using situational judgment tests. Academic Medicine. 2019. 94 (8 1197-1203
• Harrison LE. Using holistic review to form a diverse interview pool for selection to medical school. Proc (Bayl Univ Med Cent). 2019;32(2):218-221.
• Grabowski CJ. Impact of holistic review on student interview pool diversity. Advances in Health Sciences Education.2018.23.3: 487-498.
• Gay SE, Santen SA, Mangrulkar RS, Sisson TH, Ross PT, Zaidi NLB. The influence of MCAT and GPA preadmission academic metrics on interview scores. Adv Health Sci Educ Theory Pract. 2018;23(1):151-158
• Capers Q 4th, Clinchot D, McDougle L, Greenwald AG. Implicit racial bias in medical school admissions. Acad Med. 2017;92(3):365-369.
• Hadinger MA. Underrepresented Minorities in Medical School Admissions: A Qualitative Study. Teach Learn Med. 2017;29(1):31-41.
• Wright S. Medical school personal statements: a measure of motivation or proxy for cultural privilege?. Adv Health Sci Educ Theory Pract. 2015;20(3):627-643.
• Terregino CA, McConnell M, Reiter HI. The Effect of differential weighting of academics, experiences, and competencies measured by Multiple Mini Interview (MMI) on race and ethnicity of cohorts accepted to one medical school. Acad Med. 2015;90(12):1651-1657
• Garces LM,  Mickey-Pabello D. Racial diversity in the medical profession: The impact of affirmative action bans on underrepresented student of color matriculation in medical schools. 2015.The Journal of Higher Education, 86:2, 264-294
• Ballejos MP, Rhyne RL, Parkes J. Increasing the relative weight of noncognitive admission criteria improves underrepresented minority admission rates to medical school. Teaching and Learning in Medicine. 2015. 27:2, 155-162
• Razack S, et al. Seeking inclusion in an exclusive process: discourses of medical school student selection. Medical education. 2015. 49.1: 36-47.
• Heller CA, Hurtado Rúa S, Mazumdar M, Moon JE, Bardes C, Gotto AM. Diversity efforts, admissions, and national rankings: can we align priorities? Teaching and Learning in Medicine. 2014. 26:3, 304-311
• Davis D, Dorsey JK, Franks RD, Sackett PR, Searcy CA, Zhao X. Do racial and ethnic group differences in performance on the MCAT exam reflect test bias?. Acad Med. 2013;88(5):593-602 (Makes a structural and institutional racism argument…without using those terms)
• Kondo DG, Judd VE. Demographic characteristics of US nedical school admission committees. 2000;284(9):1111–1113. d

One of the strongest signifiers of cultural validity, particularly in more liberal leaning circles, is when NPR covers your story. Which is to say, NPR posted a story today about racism in medical training, so it’s possible that these messages are filtering up to leadership in academic medicine.

To underscore the importance that Anthony Chin-Quee, MD, is far from alone, here is a short collection of evidence on graduate medical education (GME), i.e. residency and fellowship (recent articles, plus a few older to again remind ourselves that we are not discussing a new situation, but one that has been ongoing, i.e. how racism operates).

Martinez-Strengel A, Balasuriya L, Black A, Berg D, Genao I, Gross CP, Keene D, Latimore D, Sotto-Santiago S, Boatright D. Perspectives of internal medicine residency program directors on the Accreditation Council for Graduate Medical Education (ACGME) diversity standards. J Gen Intern Med. 2021 Sep;36(9):2539-2546.

de Bourmont SS, Burra A, Nouri SS, et al. Resident Physician Experiences With and Responses to Biased Patients. JAMA Netw Open. 2020;3(11):e2021769. doi:10.1001/jamanetworkopen.2020.21769

Jarman BT, Borgert AJ, Kallies KJ, et al. Underrepresented minorities in general surgery residency: Analysis of interviewed applicants, residents, and core teaching faculty. J Am Coll Surg. 2020;231(1):54-58. doi:10.1016/j.jamcollsurg.2020.02.042

Williams M, Kim EJ, Pappas K, et al. The impact of United States Medical Licensing Exam (USMLE) step 1 cutoff scores on recruitment of underrepresented minorities in medicine: A retrospective cross-sectional study. Health Sci Rep. 2020;3(2):e2161.

Yuce TK, Turner PL, Glass C, et al. National evaluation of racial/ethnic discrimination in US surgical residency programs. JAMA Surg. 2020;155(6):526-528. doi:10.1001/jamasurg.2020.0260

Dyrbye L, Herrin J, West CP, et al. Association of racial bias with burnout among resident physicians. JAMA Netw Open. 2019;2(7):e197457. doi:10.1001/jamanetworkopen.2019.7457

Jarman BT, Kallies KJ, Joshi ART, et al. Underrepresented minorities are underrepresented among general surgery applicants selected to interview. J Surg Educ. 2019;76(6):e15-e23. doi:10.1016/j.jsurg.2019.05.018 https://pubmed.ncbi.nlm.nih.gov/31175064/

Agawu A, Fahl C, Alexis D, et al. The influence of gender and underrepresented minority status on medical student ranking of residency programs. J Natl Med Assoc. 2019;111(6):665-673. doi:10.1016/j.jnma.2019.09.002

Khan NR, Taylor CM 2nd, Rialon KL. Resident perspectives on the current state of diversity in Graduate Medical Education. J Grad Med Educ. 2019;11(2):241-243. doi:10.4300/JGME-D-19-00062.1

Osseo-Asare A, Balasuriya L, Huot SJ, et al. Minority resident physicians’ views on the role of race/ethnicity in their training experiences in the workplace. JAMA Netw Open. 2018;1(5):e182723. doi:10.1001/jamanetworkopen.2018.2723

Lightfoote JB, Fielding JR, Deville C, et al. Improving diversity, inclusion, and representation in radiology and radiation oncology part 2: challenges and recommendations. J Am Coll Radiol. 2014;11(8):764-770. doi:10.1016/j.jacr.2014.03.008

Yehia BR, Cronholm PF, Wilson N, et al. Mentorship and pursuit of academic medicine careers: a mixed methods study of residents from diverse backgrounds. BMC Med Educ. 2014;14:26. doi:10.1186/1472-6920-14-26

Liebschutz JM, Darko GO, Finley EP, Cawse JM, Bharel M, Orlander JD. In the minority: black physicians in residency and their experiences. J Natl Med Assoc. 2006;98(9):1441-1448. https://pubmed.ncbi.nlm.nih.gov/17019911/

Edmond MB, Deschenes JL, Eckler M, Wenzel RP. Racial bias in using USMLE step 1 scores to grant internal medicine residency interviews. Acad Med. 2001;76(12):1253-1256. doi:10.1097/00001888-200112000-00021

Recommendations:

Gonzaga AMR, Appiah-Pippim J, Onumah C, Yialamas M. A framework for inclusive Graduate Medical Education recruitment strategies: Meeting the ACGME standard for a diverse and inclusive workforce. Acad Med. 2020; 95(5) 710-716 doi: 10.1097/ACM.0000000000003073

Castillo EG, Isom J, DeBonis KL, Jordan A, Braslow JT, Rohrbaugh R. Reconsidering systems-based practice: Advancing structural competency, health equity, and social responsibility in Graduate Medical Education. Acad Med. doi: 10.1097/ACM.0000000000003559

p.s. Check out this list for a brief review of undergraduate medical education (UME)