An Unmatched Graduate’s Query: How faith and peer mentoring provided answers.

By Emmy Abraham

Since graduating from a Caribbean medical school in 2015, the wait for residency entrance has been a lesson in enduring perseverance interspersed with rewarding, unique experiences. It has been an eye-opening path with many unyielding doors that would have been difficult to open had it not been for my strong support systems such as my mentor group and my faith.  

I vividly recall multiple attempts to enhance my clinical or research experience including looking for medical internship opportunities locally and, as last resort, in the Middle Eastern countries. Oh, how devastated I was to realize it was a dead-end trying for an internship as a non-resident of the Middle East.  

Even searching for clinical research opportunities was cumbersome. Vigilantly going through various career sites and expectantly applying – only to then wait and receive no response or to be told I am over qualified. I was even told I am disqualified simply because I am awaiting residency entrance. To add another dimension, my full-time income had to manage my family expenses while I actively pursued these clinical enhancement opportunities, dealt with the medical school debt agency, arranged student loan payments, and single-handedly mothered my two young boys. Amidst these regularities, one must never forget the yearly mental work-out regarding ways to attain the best letters of recommendation. At the same time, the yet unknown Match outcome was a focus of deep analysis daily and a difficult mental process given there were no naturally known solutions at the end.  

Year after year, the Match Day has been a teary and a heart-breaking day for myself and my family, a family who has been a strong foundational pillar. All brimming up to the throat with battling, questioning thoughts asking, “What is the reason it did not work out this time?” “What different course of actions could I have taken?” and “How long is this going to take?”. After all, all that is needed is a single Match to a single program! Often, I sat thinking, “Why, oh why, why no Match this year?” 

Though I eventually would surface out of the despair, the terrorizing grip of the feelings of helplessness was traumatizing and a vicious circle; potentially much like the stories of the three unmatched medical graduates who ended in suicide due to being unmatched. However, my faith, centered on a relationship with the Almighty God, brought me up out of pits of despair. I know my God can change impossible situations. So, my helplessness did not progress into a mental health crisis. My faith gave me the privilege of de-stressing through worship music that uplifts the soul much like an eagle soaring high in the sky

Creating worship lyrics and tuning the words was a fond hobby of mine. During one moment of deep anguish about the Match, I wrote a particular, divinely-inspired song. Singing and meditating on the words of that song has repeatedly bolstered resilience, enabled re-orienting of focus, and set me up to progress into a better version of myself. I fondly recall, singing it daily before going to bed at night. Sometimes, I even made my kids sing it with me before their bedtime. My faith got energized when I repeatedly heard those meaningful words. These words fanned my hope and propelled me through the next day of seeking new opportunities. It cleared my mind of the negativity and enabled a flow of creativity as I tried to answer the flood of questions – What can I further do to enhance my credentials to stand out among the applicants? Are there available academic mentors that may assist during the process? Is there a support system that I could lean back on?  

Reflecting back, I would have stayed drowned in the surrounding negativity of the situation had it not been for my faith in God and the resultant coping through the use of worship music. Even now, despite the years of waiting, I live with the strong hope that surely an end to this is very near. Furthermore, while recalling the suicide news previously mentioned, a God-inspired deep concern resonated for others traveling on the same road as me. I realized that a journey together would be much safer and rewarding. A search commenced, with which I ended up among a well-knit peer group under the direction of a faculty mentor who opened opportunities for research, manuscript writing and review of scholarly abstracts.  

I am utterly indebted to our peer group for advancing awareness of available residency resources through our research collaboration. Empowered by the unseen intellectual support from these researched sources and the knowing that you are not alone in this journey have tremendously strengthened my resolve. It created a safe space to bounce ideas, seek answers without criticism, and educate self through scientific activities. It provided a basis to foster mentoring, be it guidance regarding United States Medical Licensing Examination Step 3 resources or sharing past research experiences. The developed camaraderie surely will remain for a lifetime since the strongest bonds are formed during the direst of moments. Surely the need for connections is vital. When we take the focus off of ourselves and deviate to help others, something happens to our mind and body to enable positive wiring, diffuse self-negativity, and uncage ourselves to utilize the full potential in ourselves.  

Truly, faith and peer support has added to my overall well-being during this journey. Therefore, I would recommend to all fellow residency re-applicants out there to please know there are accessible support systems available within your reach to de-stressing before a crisis arises. It is never too late to seek out a faculty mentor and a strong peer (virtual) support group with whom you can grow and succeed.  

Emmy Abraham, MD, is a medical graduate of International American University – College of Medicine and eagerly looking forward to the 2022 Residency Match outcome. She is passionate about serving under-served communities and has a strong interest in clinical & medical education research. She also enjoys time with her family, listening to contemporary music, learning piano and gardening. 

Acknowledgements:  

I am sincerely thankful to Dr. Juan Narvaez, Dr. Jessica Obi and my mentor Dr. Monica Van de Ridder for reviewing prior versions of this reflective writing. 

Unmatched, now what? The Hazy Path of the Qualified Medical Residency Candidate 

by Jessica Obi, MD

On March 15, 2021, I found out I didn’t match. Needless to say, I felt alone, disappointed, and uncertain of my next step(s). “Dr. Obi!” is what family and friends would call me. The next question I would hear and would still feel uncomfortable answering was, “Which hospital do you work in?” or “What residency program did you match to?” My reply would always leave them asking, “It’s not automatic to match into a program?” followed by “I thought there weren’t enough physicians?” Then my favorite question, “So what are you to do now?” Although these questions are asked from a sincere place and valid, I could not, and still sometimes can’t help but question my worth, intelligence or if I made the right decision to pursue a medical degree. I feel the medical educational system is broken in that it lacks support for candidates like myself – support that includes mentors for such situations and jobs that would allow our degrees to still be useful. Instead, unmatched candidates are left to scramble for positions and other areas of work to repay student loans. The worst part of not matching is not having a sure direction to follow that would guarantee matching during the Supplemental Offer and Acceptance Program (SOAP) or the next  cycle. 

As any unmatched candidate would do, I began searching for mentorship and guidance. I happened to join Twitter to network and follow physicians, and by chance stumbled upon a few accounts dedicated to helping the unmatched. I was able to learn of zoom webinars dedicated to guiding unmatched applicants down this tricky road in terms of personal statements, letters of recommendation, curriculum vitae, and networking.1-2 Of  course, my family, friends, and medical school have been supportive; however, to my utmost surprise, social media, particularly Twitter’s @Inside_TheMatch and @unlikelymds, has provided the most useful support. I have met and networked with awesome physicians and mentors via social media, and I have also found a peer support group  with the same goal of matching. This has undoubtedly powered my strength to persevere. 

The recent match cycle left many unmatched with unanswered questions. There were 42,508 active applicants and roughly 6,254 candidates that went unmatched. Yet, we are forced to forge a unique path to residency. As I reflect on this, I find myself finally at peace to have had this experience. I can use my struggle to gain empathy and experience that will help my patients navigate their struggles e.g., decreasing blood sugar or losing weight. My struggle to achieve residency is analogous to a patient’s struggle to achieve healthy outcomes, and in both cases, it is crucial to have proper guidance and strategy. My attributes of resilience and perseverance developed over this period, will fuel my passion and strength. 

I believe every path, albeit hazy, is unique to the individual whether one is a patient, student, resident, or a physician. Some practices I’ve adopted to cope include remembering my why and my faith, mentorship, networking with other qualified candidates, and following the stories of others   who have previously tread this path and are now residents. Currently, I’m also working on a few  projects that I’m hopeful will be ready for the next match cycle. 

Creating a path to reach this goal is not easy. I find on this journey that I’m developing resilience, endurance and relationships. I’m essentially creating a story, my story, that just may provide enough hope for that competent unmatched candidate – who may be on the verge of quitting – to not give up. 

To all the qualified unmatched reapplicants, you’re not alone. There is a virtual community of faculty, residents, physicians, your peers, that are supportive and are willing to aid as you carve your unique path to matching. 

There is hope. Keep going. 

Dr. Jessica Obi is a 2020 medical graduate of Ross University School of Medicine, from Los Angeles California, and learned in 2022 that she matched in Internal Medicine. She is passionate about health equity and medical education, and outside of Medicine, Dr. Obi enjoys spending time with her family, traveling and fashion and hopes to positively impact the medical field. 

References
1. van de Ridder, J.M.M. [@MvdRidder]. (2021, April 28). INVITATION Zoom network meeting for UNMATCHED STUDENTS, organized by UNMATCHED students. Please register in advance. Please RT.[Tweet]. Twitter. 
 
 2. Stulak, J. [@JohnStulakMD]. (2021, April 19). As promised, for those who went unmatched in #MatchDay2021, feel free to sign up for an informal webinar in which we give our insights and your answer questions No matter who or where you are, we are happy to help and be a resource [Image attached]. [Tweet]. Twitter. 

Acknowledgements 
I would like to thank Kyle Swearingen, MD, Emmy Abraham, MD, and Monica van de Ridder, PhD for their support and feedback on the earlier drafts of my reflection. 
 

Just a kid.

by Samantha Rodriguez

19, Baker acted –
heart sinks

no reason, really.
eyes inquire

I dropped out of school –
frustration overwhelms

fresh out of jail, now for trespassing.
thoughts race

I smoke meth, crack and weed since 16,
heart aches

no one ever really asked why.

I still take care of my son –
shock ensues

I just go into another room.
maternal instincts take over

It’s fine though; I control it with my mind.
confusion arises

But I can’t see him anymore.
provider lens resumes

No one asked why.
emotions run high

My dad knows everything;
stomach churns

he’s never tried to stop me.
heart breaks

She’s just a kid,
but no one asked why

Samantha Rodriguez is a fourth year medical student at Florida International University Herbert Wertheim College of Medicine. She is applying for residency in Pediatrics and enjoys yoga and gardening in her spare time. 

The Dahlia & The Mantis: Awakening to the Healing Beauty of Nature

by Mary P. Guerrera

With more time to putter in the yard during the days of the pandemic, I am discovering new ways to work with my hands (and feet) to care for the small grassy grounds surrounding our family cottage.

Using a good old-fashion reel mower, I walk at an easy pace while hand-pushing the rotating blades to their rhythmic swishing.  I am alert to other living beings along the way, and stop instantly if any are noted in my path. 

I’m surprised when a tiny frog jumps onto my toe.  I watch a bunny nibbling a leaf.  I see and hear the springy grasshoppers and winged song birds.  On quite days, the sound of the surf as the tide rolls in seems like the sea is breathing.

With my enhanced attention, I notice mole tunnels and vole trails.  And of course, the wild flowers, shrubs and trees, all with their unique micro-habitats. 

If a neighbor happens by, we chat as I rest.  Now in my second summer of planting dahlias, we share our anticipation of blooms and bouquets.  Taking a simple, root-like tuber and planting it into the dark earth is a process that engenders patience – tending to the area and waiting as months pass, until a green sprout finally emerges.  Even having studied the sciences, I am amazed at how a stunning flower emerges from such a seemingly mysterious process. And now we come to my first dahlia bloom of the season – a beautiful, intricately circular patterning of soft orangey glow.  As I stand near admiring the blossom, I notice another being’s presence too.  A large praying mantis is perched just above, seeming to honor its beauty — what an awe-inspiring pair!

The photo is of my actual dahlia bloom and the visiting praying mantis.  The photo was taken by my neighbor, Maggie Rose Regan

The mantis, a master of the art of being motionless, teaches us the value of stillness – and the attention and closer observation skills such a practice brings.  Indeed, my slowing down and ability to bring more mindfulness into my day-to-day activities has awakened so much more beauty and awe in my life, and reminds me of my interdependent relationship with Nature.

And connecting with our natural, or “other-than-human” world is showing to be beneficial to our health and well-being in many wild and wonderful ways.1,2,3,4.  So inviting a bit more stillness, or ‘human-beingness’ rather than ‘human-doingness’ into our lives, will likely open our senses to the beauty and awe around us, and perhaps cultivate more joy and gratitude along the way – as it has for me.

These experiences inspired me to create a new elective for our first- and second-year UConn medical and dental students during the fall of 2020:  Nature as Medicine.  For our pandemic weary and virtually exhausted students, I thought a shift in environment would be refreshing.  The course was thus designed with the following student learning objectives:

  • Directly experience & learn practices for Rewilding, esp. Forest Bathing;
  • Understand the physical & mental benefits that connecting with Nature has on human health & healing;
  • Enhance observational skills, which are fundamental to the practice of medicine & dentistry;
  • Learn mindful movement practices known to decrease stress/burnout, e.g. Qi Gong, mindful walking/Labyrinth;
  • Deepen their appreciation of the natural world;
  • Share their class experiences with course participants.

Offered as a daily, two-hour class, each gathering was held out doors during our schools’ one-week elective time frame.   Sessions included experiential activities such as mindful walking, sensory awareness, and gentle movement as we explored the trails of local woodlands and green spaces, masked and physically distanced.  We also practiced quite observation by finding a ‘sit spot’ for sitting in stillness for 15-20 minutes.  Opening one’s senses, noticing any movement, and nonjudgmentally bringing attention back to the present were key parts of this practice.  Our small group of twelve students were invited to share their experiences and reflections during each class via an opening ‘check-in’ and at the close of each session.  In addition, some brief readings and web-based resources were offered to stimulate further curiosity and provide evidence for Nature’s benefits, e.g., the scent/exposure to pine terpenes enhances immune system function in humans.3

The results and general feedback were remarkable, with overall enhanced well-being, improved sleep, and less anxiety reported by most all students.  The students also experienced first-hand the health benefits and value of human access to safe, green spaces – an important lesson as future advocates for their patients and communities.  As such, I am planning to offer the elective again this spring, and look forward to continuing to evolve a Nature-based curriculum.  As health professionals and educators seeking innovative ways of bridging both virtual and in-person learning opportunities, I recommend giving the nature-based learning ecosystem a try! 

Mary P. Guerrera, M.D. is Professor Emeritus of Family Medicine at the University of Connecticut School of Medicine, Farmington, CT where she enjoys teaching medical students and residents.

Residency Training in the COVID-19 Pandemic: Adaptation, Exhaustion, Opportunity

By Ecler Jaqua

As the COVID-19 pandemic advanced, many rapid changes had to be made in medical education. Residency programs had to be adaptive and creative to deal with the ever-changing CDC landscape protocols to educate residents in a restrictive in-person environment.

In a matter of days, our family medicine residency clinic had to change all the in-person visits to telehealth. Video visits were something that was being tested and executed in the faculty clinic, but nothing similar was done on the residency side. At first, it was very challenging to our residents, but especially to our patients who had no idea how to use the app for the video visits. Many appointments had to be changed to telephone visits instead due to technical issues and poor literacy. However, as time went by, most of the residents, faculty and some patients started to get more familiar with the current system. Telehealth is here to stay, and I don’t think it will ever leave us. On the positive side, telehealth has now opened up opportunities for patients who previously were unable to attend their doctor’s visit.

Unfortunately, the pandemic just not affected the way we take care of patients but also negatively affected the training of residents. It led to many modifications for safety reasons within the clinics and hospitals that resulted in decreased volume of procedures, simulation laboratories, face-to-face teaching, hands-on training, and skill-based teaching activities. Elective rotations had to be canceled, reducing interpersonal connections in favor of social distancing and home isolation. The residents’ clinical skills competence in doing a physical exam weakened as they no longer have access to patients under supervision. The conventional bedside teaching where residents and faculty can ask patient questions in real-time and have essential discussions as a team had to be discontinued. Numerous residents were unable to attend conferences, complete research projects, or participate in extra-curricular activities that could help them get a competitive fellowship or their dream job.

Several residency programs at my institution had to restructure their residency training and redeploy many residents to services in need. Due to these rapid changes, the hospital shifts were at times very exhausting for the residents – not only because of the long hours and multiple days working in a row but also the constant fear of spreading the virus to a loved one. On top of all these changes having to wear personal protective equipment (PPE) all the time can be very uncomfortable. Residents many times felt a mix of anxiety, fear, emotional and physical exhaustion during these extraordinary times.

The weekly didactic teaching sessions, a crucial component of residency training, changed radically with the pandemic. All the in-person lectures moved online through platforms such as Zoom. The advantage of having the didactic session online was the ability to have everyone attend from any location and being able to invite speakers from different institutions. Virtual rounding was also implemented in countless residency programs to keep the whole medical team safe. The virtual rounds involve a pre-round done by the residents and medical students, and the attending physician would join remotely to discuss the cases with the whole team. During this time, it is an excellent opportunity for the attending physician to teach, showing research papers and PowerPoint slides about the cases that are being presented. As soon as the virtual round is ended, the attending physician would see the patients by him- or herself and resume the virtual round in the afternoon to discuss their physical exam findings and any other pertinent information from the patients or medical staff. Although there is no replacement for the face-to-face bedside teaching and observation of the resident or medical student performing the physical exam, this model is efficient, delivers substantial educational value, maximizes patient care time, and provides a safe environment to both trainees and patients.

Residency programs across the nation adopted video interviews for virtual residency recruitment. One of the advantages of virtual recruitment is the amount of money and time saved during the interview season. Not having these expenses can be a relief to the medical students and the residency program, especially as the financial crisis precipitated by the pandemic led to budget cuts for recruitment in many programs. Virtual recruitment also allows the residency program to interview more applicants as more interviewers may be available. The downside of virtual recruitment is the limited opportunities to socialize with current residents and faculty. It may also cause video fatigue if an applicant doesn’t take a break or stays uninterrupted for more than two hours in an interview.

Although these are challenging times, we were able to reconsider our current resident education and welcome ground-breaking methods while providing a high quality of care. Even though the pandemic affected residency education, several research studies show that the level of knowledge and clinical practices with virtual learning was acceptable. I believe we gained an understanding of how to integrate technology with the current teaching modality without compromising patient care. We also learned how to improve health care systems and redesign curriculums to ensure appropriate training.  

In the near future, as the pandemic subsides, we will see a hybrid of these models. Learning telehealth skills along with classroom and bedside teaching, the flexibility to have lectures in person and virtual so that everyone can attend, and virtual interviews with an option for an in-person interview and visit the residency program site. These adaptations are still a work in progress, but I am hopeful that all the changes and discoveries we had this past year will positively impact medical education.

Ecler Jaqua, MD, DipABLM, DipABOM, FAAFP is a geriatrician and assistant professor of family medicine at Loma Linda University Health. She is the California Academy of Family Physicians Riverside-San Bernardino Chapter president-elect.

I Have Hope – Reflections on Medical Education from the First Wave of the Pandemic

By Suzanne Minor, MD, FAAP

Every month I receive the evaluation comments written by fourth year students about their rotations, sites, and preceptors.  I read through these looking for possible concerns around faculty development and resident development especially with regards to teaching our students.  I want to make sure that if there are any trends, I am on top of them; if there any opportunities, I can quickly work to support faculty as needed.  

This past Fall, I read our first evaluations since our students started back after the pandemic.  I did not know what to expect.  Actually, I expected negative comments to jump out at me.  In the months since our faculty had last worked with students, the coronavirus pandemic had ravaged  South Florida.  Our affiliate hospitals were overwhelmed with COVID-19 admissions and our already busy faculty had born the burden of caring for sick patients with limited PPE. They had to attend to patient families through virtual means, and do so while working long hours. They often had to isolate from loved ones to protect them from possible illness.  And there was not reprieve in site.  One of our affiliates had asked community physicians to do hospital shifts to spell over-worked hospitalists.  I didn’t know what students would experience as they returned to the clinical setting. 

As I read, I noticed I had been holding my breath and my shoulders were tight with tension. But I didn’t need to be worried, after all.  I felt my throat catch and a surge of sad happiness, probably a release of pent up emotions related to this crazy pandemic.  The comments by students were amazingly positive.  Over and over students spoke about the excellent, high-quality teaching provided.  Students on hybrid rotations commented about the incredible learning experiences they received through virtual rounding and cases plus in-person scrubbing for surgeries. Particular patient care experiences were sometimes cited.  I know those hybrid rotations were crafted quickly and with great effort in order to provide optimal learning experiences despite the pandemic.  Some faculty took more students than usual yet still provided outstanding teaching and supervision.  They were taking on added duties even in this situation and I imagined that they would probably write quite a few letters of recommendation in the coming months, adding further to their time demands. 

There are just a few comments about faculty performance being negatively impacted by COVID-19.  Still, those comments are rare.  Our dean of clinical education took great care in working with sites to ensure that students would not work with patients suspected of having or diagnosed with COVID-19 and to ensure the safety of patients, students, staff, and faculty.  The COVID-19 admissions slowly declined; students are only able to be in the clinical setting because the numbers were coming down. Yet, in spite of this pandemic, our faculty is giving their all to students and patients.  Not only are faculty teaching during a pandemic, they are teaching well even in this different environment, providing meaningful experiences to learners while also accounting for safety. 

As I continue to review the report, I am aware of the halo/horn effect and wonder if students were so grateful to be back in the clinical setting that they are providing more positive comments about faculty that they might have  had there not been a pandemic-mandated pause in their clinical training.  I also wonder if faculty were just so grateful to have students back that they were nostalgically reminded of the joys and wonders of teaching and passing on our wisdom and passion for patient care to those coming after us – those who will probably be our doctors one day.  Whatever the reason, joyous teaching interactions leapt from the report with jubilant aplomb. 

The end of the report contains students comment about the teaching they received from residents.  The comments about resident teaching were just as positive and strong.  I admit that I shed a few tears when I read comments about our former graduates who are now residents in multiple clinical programs and sites teaching our students in such a challenging situation.

These comments weren’t just positive.  They detailed specific high-quality teaching moments.  I’m so grateful to bear witness to the interpersonal connections at play with each other: patients, students, staff, residents, faculty.  

These observations carried through to the personal statements of our fourth-year students applying to residency.  So many students were inspired by the physicians that cared for them or their loved ones in their formative years.  We are all interconnected.  It may sound very “airy fairy” or New Age, but I notice this connection again and again: physicians inspiring patients to become physicians-in-training, physicians and residents teaching students who will one day become physician educators themselves, patients receiving care but actually who are educators.  We are all connected and in this report I see this so clearly.

I’ve been thinking a lot lately about the interconnectivity of each person within society and on this planet.  It is so clear to me during this pandemic that we as a people are only as strong as the weakest link.  If just a few people are not wearing masks or are gathering together, the novel coronavirus will continue to spread.  But if we follow basic guidelines, we are strong together and our unity-in-action speaks to our interconnectedness.

Medical education and patient care are intricately woven together like a tapestry with every thread contributing its own texture and color to the pattern and strength to the structure. I am so honored and grateful to witness and be a part of the beauty on the report before me, because I know that the words written are just a glimpse of the overall experience students had at their sites with their preceptors, residents, and patients. 

Suzanne Minor, MD, FAAP, is the Assistant Dean for Faculty Development and an Associate Professor at the Florida International University Herbert Wertheim College of Medicine She is a member of the Editorial Board of Reflective MedEd. Follow her on Twitter @minor_se

My Advice

by Andréa Wakim

Early morning rounding,
Stressful days working,
Rigorous nights studying,

Often faced with the questions,
How is studying going?
Any tips for excelling?

My advice to you is this:

Fall in love.

Fall in love with your free time.
Fall in love with your hobbies.
Fall in love with brief silence.
Fall in love with your happiness.

When there is something you love,
You will make the time for it.

When there is something you love,
You will look forward to it.

When there is something you love,
You will be motivated.

When facing any challenge,
Remember what you love.
Return to what you love.

Do this,
And I promise you,
You will succeed,

Because you are rooted
In love.

An Open Letter to Dr. Wang from Two Asian American Scholars Who Support Affirmative Action

Dear Dr. Wang,

Your article was recently  retracted by the editors of the Journal of the American Heart Association and was denounced by the AAMC and the American Heart Association. As researchers and leaders in selective admissions and medical education, and as Asian Americans, we are deeply disturbed and offended by your article’s lack of conceptual rigor and its perpetuation of racist tropes, namely that a race-conscious admissions process produces unqualified Black physicians and physicians of color.

A flawed paper

The crux of your argument seems to be that by using a set of holistic admissions criteria, medical schools admit unqualified applicants and therefore, produce an unqualified physician workforce. However, you seem to confuse winning a competition on a single scale with being qualified. Being competitive is not the same as being qualified.  24,127 runners qualified for the Boston Marathon.  Not all qualifying runners will finish at the top, or even within minutes of the most competitive athletes, but most will finish and all were qualified through a rigorous process to pursue the marathon course.  The tripartite mission of medicine – education, research and patient care – is served best with attention to equity, not competition.

Dr. Wang, you falsely defined “qualified” applicants using only MCAT scores, which are incomplete metrics of an applicant’s qualifications for medical school.  Aggregate national acceptance data from 2017-2020 shows that 18.1% of applicants to medical school with MCAT scores between 514-517 were not accepted.  For those scoring above 517 (95th percentile) 12.2 percent were rejected by every school.  Practitioners in undergraduate medical education (UME) admissions understand that assessing academic preparation and personal qualifications for medicine is complex, nuanced, and cannot be reduced to the MCAT, which has  limited capacity to predict academic success (and does not predict clinical outcomes).  We would no more assess cardiovascular health using only body weight than admit applicants to a profession based only on MCAT scores. There are many other factors that must be considered in context.  Among these factors is the experience of racism.

Your paper ignored structural racism, and claimed that centuries of colonization and racism, and their implications for contemporary society, vanished with the Civil Rights Act of 1964.  This is tantamount to claiming lead poisoning ended when the Consumer Product Safety Commission banned lead paint in 1977.  Medicine takes place within societal realities that cannot be ignored.

Racism affects different populations differently, and solutions must acknowledge these differences. As Asian Americans we face anti-Asian racism and xenophobia especially in the COVID era, but the inequalities we face are different from other forms of racism, especially anti-Black racism. Regardless of economic status, Black people must survive murderous state racism and deep structural inequalities, as they pursue educational goals. Similarly, and in different ways, Latinx, Indigenous peoples, and the diversity of Asian Americans including Southeast Asian and Filipinx Americans confront different forms of intersectional racism. Systems of oppression (e.g., racism + patriarchy + poverty) intersect to affect us in different ways. We are not all playing the same “game.” Unfortunately a uterine lottery pick predetermines resources produced by deep systems of inequalities that are heavily reproduced in access to education resources, supports, and outcomes.  It would be odd if a fair admissions process could somehow simply ignore that fact.

Intersectional racism-conscious admissions

Talent is universal, opportunity is not.  Many schools already employ advanced, holistic evaluation and selection methods for choosing the next generation of physicians.  Affirmative action, or race-conscious admissions in education, is a critical policy and practice to advance diversity, which has been deemed necessary for robust educational benefits.

Higher education can seek to achieve diversity necessary to facilitate educational benefits, through narrowly tailored practices. Race cannot be the reason that anyone is admitted or denied, nor can race be considered to reach quotas or “parity.” The narrowly tailored consideration of race as “one of many factors” through holistic review should center and acknowledge how intersectional structural racism shapes students’ educational contexts. Everyone, including white and Asian Americans, benefits from diversity resulting from affirmative action and race-conscious admissions that account for individual students’ whole stories and contexts of education. Medical admissions should value a wide array of applicant experience to foster an appreciation of the wide array of patient experiences.

We are calling for robust praxis in intersectional, racism-conscious admissions, which affirmative action law allows. Using an admissions approach that is conscious of intersectional racism, we center everyone’s unique human dignity in evaluating their qualifications, moving beyond checking off a particular racial box to understand the totality of the applicant’s experience and talents. It does not guarantee admission for anyone. It offers a fairer, more equitable evaluation process. Only highly qualified applicants are admitted.

Equity is fundamental to medicine living up to its ideals to “do no harm” and serve all people. Black Lives Matter.

Sincerely,

Dr. Nakae and Dr. Poon

Sunny Nakae, MSW, PhD, is a clinical associate professor of social medicine, population, and public health and Associate Dean for Student Affairs at the University of California-Riverside School of Medicine. She has previously held administrative positions at the University of Utah School of Medicine, Feinberg School of Medicine at Northwestern University, and Loyola University Chicago Stritch School of Medicine. She is the author of Premed Prep: Advice from a Medical School Admissions Dean (Rutgers University Press, 2020)

 

OiYan Poon, Ph.D. is an associate professor affiliate in the Department of Educational Policy Studies at the University of Illinois at Chicago. Her research focuses on how race-conscious holistic admissions works, and the racial politics of Asian Americans and affirmative action.

Seeing for Myself in the Morgue

By Emily Hagen

As Dr. W, the pathologist, ushered my peers and me in, he made sure that we were properly wearing our masks, gloves, cloth gowns, and expressions of respect. He encouraged us to speak up if we felt too nervous to walk further inside. The morgue smelled of formaldehyde and goose bumps formed on my skin as my body sensed the frigidness of the room. I was more excited than scared to watch Dr. W perform an autopsy on Ms. S, our ninety-four-year-old “patient.” As a pre-medical student at the time, little did I know how much this experience would significantly shape my understanding of the practice of medicine. And it would imprint on me an appreciation for the autopsy.Read More »