The post-George Floyd racial reckoning shook the field of medicine like an earthquake. Medical education and research, as well as competency parameters, have been destroyed by two related hypotheses: that systemic racism is responsible for both racial disparities in the demographics of the medical profession and racial disparities in health outcomes. Questioning these hypotheses is professional suicide. Vast amounts of public and private funding have been taken from basic science and earmarked for political projects aimed at dismantling white supremacy. The result will be a decline in the quality of medical care, as well as a shrinking of scientific progress.
Practically every large organization Medicine — from the American Medical Association (AMA) and the American Association of Medical Colleges (AAMC) to the American Association of Pediatrics — has embraced the idea that medicine is an inequality-producing enterprise. The Strategic Organizational Plan to Include Racial Justice and Promote Equity in Health is, in practice, indistinguishable from the stated missions of a department of Black Studies.
The authors of the plan, anonymous, seem to be aware of how its departure from the traditional purposes of medicine is radical. The preamble notes that “just as the wording of a business document differs from that of a physics document, so does an equity document.” (Such poor regency and grammar characterize the entire tome of 86 pages, making the preamble’s boast especially ironic: “the field of equity has developed a phrasing that provides both : authenticity, accuracy and meaning”.)
Warned in this way, the reader sinks into the tangle of social justice maxims: Physicians must “confront inequalities and dismantle white supremacy, racism and other forms of exclusion and structured oppression, as well as include racial justice and promote equality in all aspects of health care systems.” The country needs to drop the “euphemisms and go for explicit conversations about power, racism, gender and class oppression, forms of discrimination and exclusion.” (The reader may wonder how today’s “conversations” about racism can be even more “explicit.”) We need to discard “the American stronghold of false notions of hierarchy based on gender, skin color, religion, validity, country of origin, as well as other forms of privilege.”
A key solution to this supposed oppression is identity-based preferences through of the entire medical profession. The AMA’s strategic plan calls for “fair representation of Black, Indigenous, and Latinx people in medical school admissions, as well as in […]
According to the leaders of the medical and exacting areas, to be white is to be racist per se ); apologies and reparations for this offensive feature are now de rigueur. In June of 2020, the Nature identified itself as one of the unfortunate “white institutions that are responsible for bias in research and academia.” In January of 2020, the editor-in-chief of Health Affairs lamented that “our own staff and leadership are overwhelmingly white”. The AMA’s strategic plan blames “male and white lawmakers” for systemic racism in the US.
Schools and Medical societies must also discard traditional standards of merit in order to alter the demographics of the profession. The demolition of standards rests on an a priori
The US Medical Licensing Examination is a prime suspect. At the end of the second year of medical school, students take the First Step of the Exam, which measures knowledge about anatomical parts, their functioning and malfunctions. Topics include biochemistry, physiology, cell biology, pharmacology, and the cardiovascular system. High scores on the First Step suggest residency success; highly sought after residency programs such as neurosurgery and radiology use the notes in Step One to help select applicants.
The rate of black students admitted to competitive housing is below that of whites because of their average grade on First Step exams, which is one standard deviation below that of whites. Step One has already been modified to try to close this gap; now includes non-scientific components such as “communication and interpersonal skills”. But the standard deviation [de diferença] in the grades persisted. In the world of anti-racism, such persistence can only mean one thing: the test is to blame. It is the First Step which, in the language of anti-racism, “disadvantages” underrepresented minorities, not a lesser degree of medical knowledge.
The First Step exam has one more point against it. The pressure to get good grades diverts minority students from what has become a main component of medical education: promoting anti-racism. A fourth-year Yale medical student describes how the First Step spectrum affected his priorities. In his first two years of medicine, the student did an “immersion”, he said, in a student committee focused on diversity, inclusion and social justice. The student had a podcast on health disparities. All of his political work was made possible by Yale’s pass/fail system, which meant he didn’t feel obligated to put education ahead of concern for diversity. So, as he says, Step One “showed its ugly head.” Getting a real grade on an exam could corroborate “whoever suspected I didn’t deserve a spot at Yale as a black med student,” worried.
The solution to such academic pressure was obvious: abolish the First Step grades. As of January 2020, Step One works on a pass/fail basis. The fourth-year Yale student can return to his diversity activism without worrying about what a graded exam might reveal. Whether future patients will like the focus he chose is another story.
All other measurements of academic dominance have a disparate impact on blacks and are therefore in the crosshairs.
In the third year of medicine, professors grade students by assessing their clinical knowledge, in what is known as the Student Performance Assessment of Medicine (known by the acronym in English MSPE). The assessment uses qualitative categories such as Outstanding, Excellent, Very Good and Good. White students at the University of Washington School of Medicine received higher grades on the MSPE than underrepresented minority students from 2010 The 2015, according to an analysis by 2015. The disparity there followed that of the First Step notes.
The parallel between the MSPE and the First Step may suggest that what is being measured in both cases is real. But the truth a priori holds that no gap between academic skills exists. Therefore, the researchers proposed a national study of medical scores to identify the real causes of this racial disparity. The conclusion is the aforementioned: bias on the part of the faculty. As a Harvard medical student said on the website Stat News: “biases materialize in assessments of students from marginalized contexts”.
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on clinical performance scores anticipated this inescapable conclusion. Professors at Emory University, Massachusetts General Hospital and the University of California, San Francisco, among other institutions, analyzed the faculties’ assessments of medical residents on aspects such as medical knowledge and professionalism. By all ratings, black and Hispanic residents scored lower than whites and Asians. The researchers put forward three hypotheses: bias on the part of faculty assessment, effects of a non-inclusive learning environment, or structural inequalities in assessment. University of Pennsylvania professor of medicine Stanley Goldfarb tweeted a fourth possibility: “Is it possible that [estudantes minoritários] are less good at residency?”
Goldfarb violated the truth a priori . The punishment was immediate. Predictable tweets called him, inter alia, possibly “the biggest human trash I’ve ever seen with my own eyes,” and Michael S. Parmacek, chair of the Department of Medicine at the University of Pennsylvania, sent an email to the entire faculty regarding Goldfarb’s “racist claims.” The statements evoked “deep pain and anger,” Parmacek wrote. Consequently, the faculty would put the “whole leadership team” at your disposal to “support you,” he said. Parmacek took the opportunity to reaffirm that doctors have to recognize “structural racism”.
On the same day, the Executive Vice President of the University of Pennsylvania Health System and Senior Vice President of Medical Education at the same university assured faculty, staff and students via email that Goldfarb was no longer an active faculty member, but rather an emeritus. Both officials affirmed the university’s efforts to “cultivate an anti-racist curriculum” and promote “inclusive excellence.”
despite allegations of racism made by the faculty, disparities in academic performance are the predictable result of admissions preferences. In 2020, the average score of white applicants in the Medical School Admission Test (MCAT, in English) was in the 71th percentile, meaning it was equal to or better than 50% of all average grades. The average grade of black applicants was in the 35 th percentile — a whole standard deviation below the white mean. The MCAT has already been redesigned to try to reduce this gap; a quarter of the questions now focus on social issues and psychology.
Still, the gap persists. So medical schools use widely varying standards to admit white and black applicants. From 1953 to [gatekeepers] , only 8% of white college students with a final average and below-average MCAT won a place in a medical school; and less than 6% of eastern college students with these qualifications have achieved them, according to an analysis by economist Mark Perry. Medical schools saw these low grades only as disqualifying — except when presented by blacks and Hispanics. More of 56% of college students with a final average and MCAT below average and 16% of Hispanic students with these grades were admitted, making a black student in this range seven times more likely than an equal white classmate to be admitted to a medical school and more than nine times more likely than an equal Asian student. [Como “média final”, traduzo “GPA”, ou Grade Point Average. (N. t.)]
Such disparate admission fees apply across any combination and MCAT and final grade levels . Contrary to the AMA’s Strategic Organizational Plan to Include Racial Justice and Promote Equity in Health, blacks are not being “excluded” from medical training; are being catapulted ahead of their less valued white and Oriental peers.
Although mediocre MCAT scores eliminate few black students, some activists want to do away with the exam altogether. Admitting less qualified students to doctoral programs in the biological sciences will lower the caliber of future researchers and delay scientific advances. But the risk is highest in medical training, where insufficient knowledge can risk lives here and now. However, some medical schools offer early admissions to 2nd and 3rd grade high school students with no MCAT requirement, hoping to enroll students with, in the words of the Icahn School of Medicine at Mount Sinai, a “strong appreciation of human rights and justice.” Social”. The University of Pennsylvania Medical School guarantees admission of black students who score only 1300 on the SAT, maintain a final average of 3.6 in high school and complete two summers in the school’s boarding school. The school waives the MCAT requirement for these black students; University of Pennsylvania non-preferred medical students score in the top 1% of all MCAT scores. [O nosso ENEM é a cópia do SAT deles. (N. t.)]
According to racialist advocates, differences in MCAT scores must result from bias of the test itself. Yet the MCAT, like all standardized tests now under attack, is constantly purged of questions that might presume forms of knowledge peculiar to a class or race. This “cultural bias” spiel has been an irrelevance for decades; still, it maintains its importance with the anti-test movement.
The MCAT questions with the greatest racial variations in correct answers are removed. External bias examiners, with adequate diversity, check the MCAT internal reviewers’ checks. If, despite this onslaught of reviews, bias still held out on the MCAT, the test would err downwards in predicting medical school performance on the performance of minority students. In fact, they miss the mark upwards: Black medical students do worse than the MCAT predicts, as measured by First Step grades and graduation rates. (This upward error characterizes the SAT as well.) However, we expect an increasing number of medical schools to drop out of the MCAT in hopes of wiping out the test altogether and thus eliminating a persistent source of objective data about the specter of the skills gap. academics.
Meanwhile, medical professors need to be re-educated to ensure that their grades and hiring practices do not give more evidence of said ghost. Colleges are routinely subjected to workshops to combat their own racism.
As of May 3, 2022, the Senior Advisor to the NIH Executive Director for Scientific Workforce Diversity gave a seminar at the University of Pennsylvania medical school entitled: “Me, bias? Recognize and block bias.” Senior Advisor Charlene Le Fauve’s mandate at the NIH is to “promote diversity, inclusion, and equity in biomedical research through evidence-based approaches.” Yet the presentation itself relied too heavily on a supposed measurement of bias that the evidence discredited: the Implicit Association Test (IAT). The creators of the IAT themselves have recognized that it lacks validity and reliability as a psychometric tool.
An increasing time of time of college is spent on these anti-racism activities. In 16 of May 2020, the Manager of the Anti-Racism Program at the David Geffen School of Medicine at the University of California, Los Angeles, hosted the presentation by the Director of Equity Strategy and Education Programs at the Icahn School of Medicine at Mount Sinai entitled: “Anti-Racist Transformation in Medical Education”. The Mount Sinai Dean of Medical Education and a medical student joined the Director of Mount Sinai Equity Strategy and Education Programs for the presentation in Los Angeles, as spreading the message of diversity apparently takes precedence over academic obligations in New York.
Grand rounds is a centuries-old tradition for passing on the latest medical news [consiste em apresentar os problemas médicos e o tratamento de um determinado paciente a um público formado por médicos, residentes e estudantes de medicina N.d.T]. (The great Thomas Eakins painting of 480 , The Agnew Clinic, portrays a
grand rounds at the University of Pennsylvania.)
[gatekeepers] 
