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Evidence for Educational Value of Diversity

September 10, 2008

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A relationship exists between the diversity of medical schools and the perceived preparation of white medical students to care for diverse groups of patients, according to a study being published today in the Journal of the American Medical Association.

The study found that white students who attend medical schools with greater racial and ethnic diversity in the student body are more likely to rate themselves as highly prepared to care for minority populations. Those white students within the highest quintile for student body diversity, measured by the proportion of underrepresented minority students, were 33 percent more likely to rate themselves as highly prepared to care for minority patients than were those in the lowest diversity quintile. The correlation between diversity and preparedness to care for minority patients was highest at medical schools where students perceived a high degree of interracial interaction.

The findings were based on a survey by the Association of American Medical Colleges to 20,112 graduating medical students (64 percent of graduating students in 2003 and 2004) from 118 medical schools in the United States. Historically black and Puerto Rican medical schools were excluded. For non-white students, the study did not find correlations between student body diversity and preparedness to serve diverse populations.

Generally, the study found that underrepresented minority students were much more likely than other students to plan to practice in areas not well served by medical services. Nearly half of underrepresented minority students plan to do so, while less than 20 percent of other medical students have such plans.

The findings about medical school -- and particularly about the impact of diversity on white students -- are being praised by supporters of affirmative action as strengthening a crucial legal argument in favor of allowing colleges and universities to consider race and ethnicity in admissions decisions. The Supreme Court's 2003 decision in Grutter v. Bollinger, upholding the right to consider race, specifically noted the argument that diversity has educational value and said that affirmative action is not intended simply to help individuals who gain admission under such policies. Similarly, the 1978 Supreme Court decision upholding affirmative action (while barring quotas) in admissions, Regents of the University of California v. Bakke, cited educational values -- and was decided with regard to medical school admissions, in that case at the University of California at Davis.

The new study's authors write that their work "lends empirical support for the Supreme Court's rationale" for upholding affirmative action in admissions. The study "indicates that a diverse student body is likely to be necessary but not sufficient.... Additionally, our analysis supports the concept of 'critical mass,' whereby a certain proportion of minority students is considered necessary to realize the benefits of diversity."

The authors are Somnath Saha of the Oregon Health and Science University, Gretchen Guiton of the University of Colorado at Denver, Paul F. Wimmers of the University of California at Los Angeles and LuAnn Wilkerson of UCLA.

Roger Clegg, president and general counsel of the Center for Equal Opportunity -- a group that opposes the consideration of race or ethnicity in admissions -- said in an e-mail that he found the new study "very unpersuasive." He said that the use of self-reporting was "dubious," but that -- even if accurate and linked to diversity -- he would reject this defense of affirmative action. "It does not follow that the only way to achieve these cross-cultural skills is through a diverse student body (versus, for instance, simply teaching the cross-cultural skills, which are not rocket science -- or brain surgery, if you like -- in class)." And even if the diversity does lead to better skill with treating a diverse group of patients, he said, that does not mean "that the improved cross-cultural skills are worth the price of discrimination."

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Comments on Evidence for Educational Value of Diversity

  • Posted by Roger Clegg , President and General Counsel at Ctr for Equal Opportunity on September 10, 2008 at 7:30am EDT
  • I appreciate IHE's quoting my email (and doing so quite fairly). Here's the whole thing:

    I find this research very unpersuasive. Some of the flaws: (1) The fact
    that it is based on self-rating makes it dubious; (2) even if the
    self-ratings are accurate, it does not follow that the diversity of the
    student body is what causes the higher self-rating (indeed, artificial
    diversity created by double standards and preferences may create friction
    that makes the "positive interaction"--which the article says is
    essential--harder); (3) even if the self-rating is accurate AND the
    diversity of the student body causes the higher self-rating, it does not
    follow that the only way to achieve these cross-cultural skills is through
    a diverse student body (versus, for instance, simply teaching the
    cross-cultural skills, which are not rocket science--or brain surgery, if
    you like--in class); and (4) even if 1 and 2 and 3, it does not follow that
    the improved cross-cultural skills are worth the price of discrimination
    (which includes not only the unfairness of admitting less qualified
    students, but that those students may not even graduate/pass the medical
    exams, and the fact that, even if they do, these students may not provide
    the quality of care that students selected on the merits would).

    A separate argument is made in the penultimate paragraph [of the news article I was sent] (that is, not that
    the white students are better trained, but that URM students are more
    likely to practice in underserved areas), but that argument is
    unpersuasive, too. It was rejected by Powell as not empirically shown in
    Bakke; even if the new data are more persuasive, it does not follow that
    the only or best way to improve service in underserved communities is by
    admitting students who are less qualified, in the hopes that they will end
    up there. The poster student for affirmative action in Bakke [Patrick Chavis: see http://www.jewishworldreview.com/michelle/malkin080702.asp] ended up
    butchering women in underserved areas, and eventually lost his medical
    license. A better approach would be to admit the best qualified students,
    and provide them incentives (through, for instance, scholarships) if they
    agree to begin practice in underserved areas; or medical schools could
    themselves open clinics and provide residencies in such areas -- but,
    again, for the best qualified students.

  • But are they better doctors?
  • Posted by ACF on September 10, 2008 at 8:25am EDT
  • So, do they save more lives after having been exposed to "diverse" groups of students? What about doctors who are exposed to fewer "diverse" groups of students - do they save fewer lives?

    Do students from "diverse" groups who are admitted even though they otherwise lack merit go on to save the same number of lives as those who are admitted with merit?

  • Qualified?
  • Posted by LN on September 10, 2008 at 9:05am EDT
  • Affirmative action is not about accepting those who are less qualified, rather about how to choose among the many who are well qualified for the few slots we have available in higher education, med school, etc.
    And to the larger issue of qualification: What makes you or I qualified to even respond to this topic?

  • Results - Evaluation Disconnect
  • Posted by IR Director , IR Director on September 10, 2008 at 9:30am EDT
  • Even if a racially diverse student body does, indeed, cause actual ability to interact effectively with a racially diverse set of patients (This is not proven by this study), it does not support affirmative action (i.e., considering race in admissions) to construct a racially diverse student body. Outreach is another option, though it does require far more effort (i.e., not the easy way out).

  • not a good research paper
  • Posted by William Harbaugh , Professor at University of Oregon Economics on September 10, 2008 at 11:05am EDT
  • This paper does not provide any credible evidence that increasing the racial/ethnic diversity of med school students or sending more students to more diverse schools will increase the number of doctors willing to serve diverse populations.

    The paper does not make *any* effort to determine causality and does not even show a correlation between enrolling in racially diverse schools and serving in diverse communities.

    Quoting from the paper:

    "The design was cross-sectional and as such, it is impossible to infer causality. We did not have measures of students' attitudes, experiences, or practice plans before entering medical school. It is possible that students more interested in diverse and underserved populations chose schools with greater student body diversity and that these preexisting attitudes rather than the medical school experience accounted for the observed outcomes."

    I'm astonished that JAMA would publish a paper that fails to report results from any of the many available statistical methods to examine causality. This should have been a red flag to the reviewers and the editor.

  • Clegg & Harbaugh are Coirect
  • Posted by Chuck on September 10, 2008 at 11:40am EDT
  • Roger Clegg and William Harbaugh made compelling and persuasive criticisms of the flawed study.

    Historically black and Puerto Rican medical schools were excluded from the study.

    But if one did a "flip test," would we find that black students who attend medical schools with lesser racial and ethnic diversity in the student body would be, perforce, more likely to rate themselves as less prepared to care for non-minority populations?

    The endless obsession with race and ethnicity that characteristically mar universities shows no sign of abating in the near future. To see why, watch for more comments to IHE praising this flawed study.

  • ACF
  • Posted by A.R.M on September 10, 2008 at 2:25pm EDT
  • ACF wrote: "from “diverse” groups who are admitted even though they otherwise lack merit"

    Why do opponents of affirmative action automatically assume that minority students in medical schools or other higher ed institutes were admitted "even though they otherwise lack merit"?

    ACF, what makes you think that these students lack merit but were admitted solely on their race?

    Quietly frankly I would listen to those folks who fault the study based on its methodology, assuming they are not looking for reasons to reject the study not because they are anti-affirmative but they find faults with the study. We could legitimately debate that issue and the methodology of the study. But please, stop equating affirmative action with lack of merit. It is simply false and misleading.

    A.R.M.

  • Posted by Roger Clegg , President and General Counsel at Ctr for Equal Opportunity on September 10, 2008 at 3:55pm EDT
  • The question is not whether those admitted are all "well qualified"; the question is whether those being admitted are the best qualified. If schools weigh race in deciding who gets admitted--the kind of "affirmative action" at issue here--then they are weighing other qualifications less. So the best qualified people are not getting admitted. That's just cold logic. And it is born out empirically as well. The grades and graduation rates and law/medical exam passage rates are lower for those groups that are given racial preferences in admissions. How could they not be? If you lower the admission standards for some--which is what you do when you give that group a preference--then those admitted are going to be less qualified and are not going to perform as well.

  • Affirmative action and merit
  • Posted by ACF on September 10, 2008 at 3:55pm EDT
  • A.R.M.,

    Supporters of affirmative action often claim that AA is not inconsistent with merit. Unfortunately, nothing could be further from the truth as AA is presently implemented.

    While originally conceived as a way to ensure equal opportunity to APPLY for a job, it has been implemented to guarantee job application and promotion outcomes, regardless of merit.

    I know this because that is my job, and it has been for some time, in multiple capacities (employment, recruiting, constructing programs, admissions, promotions), and at multiple institutions, spanning multiple sectors (public, private, non-profit, government).

    So, I am here to tell you that in all those cases, sex and race are enough to elevate an otherwise unqualified applicant onto a short list. If the review committees themselves do not do this, then the "diversity" department will.

    Anyone else who is even remotely involved in hiring/promotions knows that this is happening everywhere, every day, around the country.

  • Diversity in Medical Education
  • Posted by Dr. McPeaches on September 10, 2008 at 4:20pm EDT
  • Everybody graduated from medical school should be adequately prepared for graduate medical education. Everyone completing graduate medical education should be a safe, competent, humane physician within the bounds of their professional training.

    Period.

    That said, should doctors look something like their patients? Maybe.

    If the doctor doesn't share ethnicity, religion, culture, gender, or socioeconomic group with patients, should they have a clue about how to interact with the patient and their family?

    Should they be able to listen accurately and convey understanding with people with whom the only thing shared is mortality? Should they be able to really talk with people who are in wheelchairs, or drag one foot behind them, who are in pain, who can't read or have lost the ability, who can't see or hear, who are terrified, who have no money, who are disgured, halt, lame or mentally ill?

    Should they be able to explain options and diagnoses, outcomes and treatment plans so that patients and their families can understand? Should they be able to tailor plans to the individual's preferences, circumstances and closely held values?

    Should they be able to take newspaper clippings, sensational articles, misunderstood information from the internet, ill-considered advice from family members and neighbors and integrate it all so the patient knows what gleams and what is dross?

    ABSOLUTELY.

    How do doctors acquire these skills?

    Not by being smart. Not from a book or a lecture or being tops in your class.

    Maybe it's helpful to spend time with people who are like you in aspirations and values but unlike you in almost any other descriptor?

  • To ACF
  • Posted by Dr. K on September 10, 2008 at 6:10pm EDT
  • I see another flaw in this study. If white students self-report that they are better able to deal with diverse people because they are accustomed to doing so in the classroom, they may be mistaken. I have interacted with many whites (colleagues, students, even friends and family) who would consider themselves adept in interacting with other races, but are completely insensitive regarding race and are oblivious of the fact. (I am a black female.) Still, a med school grad who has only ever dealt with whites is hardly likely to be more sensitive or to be comfortable interracting with me.

    But if the question is whether those who have been exposed to diverse groups during their training make better doctors, I would have to say, all other factors being equal, yes. A doctor who sees me as a person rather than an Other is more likely to try harder to save my life. (I believe research on hospital mortality rates and attempted procedures parced by race supports this.)A doctor who knows that different groups share different traditions and values is more likely to listen attentively to me and my family to discover what ours are, rather than assuming I would want what s/he wants.

  • Posted by Roger Clegg , President and General Counsel at Ctr for Equal Opportunity on September 10, 2008 at 6:10pm EDT
  • So, Dr. McPeaches, are you saying that black/Latino patients are better off with (lesser qualified) black/Latino doctors--what Professor William Allen has called "Dr. Jim Crow"--or are you saying that the black/Latino students who are admitted to medical school will be so similar to black/Latino patients in underserved communities that their very presence in med school will magically teach white/Asian students how to relate to those patients?

    Look, I'm sure there are skills that can't be taught in class, but it is hard to believe that the best way to teach those skills is by the sort of osmosis with other medical students that this study presumes, rather than actual experience with such patients, and with supervision and training from doctors who have dealt with them. And that kind of training ought to be made available to medical students--the best qualified medical students--of all colors.

  • Posted by Dr. McPeaches on September 10, 2008 at 7:45pm EDT
  • I assume those black and Latino doctors are competent physicians, despite being black and Latino.

    Let me restate that, I KNOW that those physicians, after coming up through the ringer of pre-med, med school and graduate medical education, are competent UNLESS a great many peole have really dropped the ball along the way.

    Competence is a given. You can have an upper-class, all-white male competent medical workforce, or you can have a diverse competent medical workforce. Last I heard, we weren't having to offer sign up bonuses to get people to enter medical school.

    Magical osmosis? Take a magical trip with me to the 1950's as a group of white doctors in white coats stand around the bedside of a poor black woman in an inner city hospital. What approach to this patient do you see modeled for these young doctors?

    Of the forces that alter how we treat each other -- edict from above, fear of litigation, politeness, professionalism, true empathetic identification -- what might most account for the change we would see viewing this same scene in 2008? There are many... but having black, Hispanic, Phillipino men and women in the physician group, including people (white or not) from economic backgrounds who have family members that have been treated in county or charity settings, etc., would certainly alter the atmosphere, would it not? That seems to me far more real, and far less magical, than having a cultural, socioeconomic, ethnic, gender elite teach the latest research on how to handle "these people."

  • Posted by Dr. McPeaches on September 10, 2008 at 7:45pm EDT
  • "And that kind of training ought to be made available to medical students—the best qualified medical students—of all colors."

    "Best qualified"? BQ is in the eye of the beholder. Highest MCATs? Most elite college? Longest list of volunteer job? Best ghost-written admission essays? Most charming at the interview? Both parents are doctors, grandaddy was a doctor, uncle Joe is a US Senator? Best schools from day one? Thousands of dollars spent on SAT courses, MCAT courses, etc? Name on the science building same as the applicant's?

    There are more applicants who are qualified for the positions than there are positions.

    Is what this country most needs now another gender, ethnic, cultural, economic elite physician? Maybe. But I think it likely that these majority group physicians come out a little better if they rub shoulders as colleagues with some folks who aren't just like them.

  • Clegg and the Center for Equal Opportunity
  • Posted by EdPolicy on September 11, 2008 at 5:05am EDT
  • I'd like to point out that Roger Clegg's Center for Equal Opportunity is an anti-affirmative action think tank. The name of the center is worded in such a way to intentionally misguide people (similar to the tactics used by Ward Connerly). By claiming that they are focused on eliminating discrimination on the basis of race (read: eliminate affirmative action) they claim to be protecting individual's rights. Far from it, Mr. Clegg. It is also no coincidence that your comments appear here again and again when articles are written about diversity or affirmative actions. Hopefully readers of this article and the comments will recognize you for who you are and what you are truly "fighting" for.

  • Reply to EdPolicy
  • Posted by Roger Clegg , President and General Counsel at Ctr for Equal Opportunity on September 11, 2008 at 8:25am EDT
  • The Center for Equal Opportunity is opposed to preferences and discrimination on the basis of race and ethnicity. Those forms of affirmative action that involve such discrimination are indeed opposed by us; we also oppose other forms of discrimination, however (e.g., racial profiling in drug cases). The origin of our name is historical: Early on in the civil rights movement there was a split between those who wanted the civil rights laws to guarantee equal OPPORTUNITY (our position), versus those who thought they should guarantee equal RESULTS (through quotas, racial preferences, and the like). We make no secret of our mission--see our website, www.ceousa.org--and we will continue to speak out against politically correct as well as polically incorrect discrimination and preference.

  • EdPolicy Folly
  • Posted by Chuck on September 11, 2008 at 10:45am EDT
  • When reader "EdPolicy" attacked Roger Clegg's sensible and clear statements, he/she unwittingly gave proof of exactly what Mr. Clegg and the Center for Equal Opportunity steadfastly support - no discrimination and no preferences based on race, gender or ethnicity when awarding public contracts, employment or university admissions.

    On 2008, "EdPolicy" simply cannot accept that such a set of policies is good for the country and in accord with the law. Instead, he/she will continue to pretend that "affirmative action" is about fairness and equity, which it most certainly is NOT any longer.

    Affirmative action is all about racial preferences and gender double standards. Anyone who's served on a university admissions committee or a university faculty hiring committee can readily attest to that fact.

  • Posted by Dr. McPeaches on September 11, 2008 at 2:45pm EDT
  • Equal opportunity? We have achieved it? Was I asleep? Wow! If we really have equal opportunity and fairness we can be just like the French and ignore race...works really well over there...

    I think the final word on this topic has already been spoken. See "The Meritocrats" at http://magazine.uchicago.edu/0602/issue/lite.shtml