Yesterday we celebrated Independence Day. This holiday, meant to celebrate the principles upon which this country was founded, rang hollow for me this year. I continue to hold out hope that we can both celebrate all we have accomplished as a country, while recognizing the harms and injustices that have occurred, as beautifully described in this TIME article by Carly Fiorina. But this year, the fourth came upon the heels of the Supreme Court decision to strike down decades of precedent, which previously permitted race to be considered as one of many factors in admission to schools of higher learning. While not surprised by the ruling, I am deeply saddened and frustrated by it because it demonstrates a profound lack of understanding of the persistent inequities in our country, the critical benefits of diversity in the educational setting, and the important role that such diversity plays in addressing the deeply entrenched health inequities that plague us.
In her dissenting opinion, Justice Sotomayor states, “The Equal Protection Clause of the Fourteenth Amendment enshrines a guarantee of racial equality. The Court long ago concluded that this guarantee can be enforced through race-conscious means in a society that is not, and has never been colorblind.” In the aftermath of the George Floyd murder and the many race-based killings that preceded and followed, it became evident that our society is far from colorblind. We have seen undeniable proof of racial inequities in our country including persistent disparities in generational wealth and associated access to early and high quality education, safe neighborhoods, healthy foods, and healthcare. We have learned about the roles of structural racism and explicit and implicit bias in these inequities. In health professions education, we have learned how these inequities are perpetuated through systems that overvalue small differences in performance that do not correlate with excellence in physicianship resulting in an impact that, intentional or not, excludes groups who have had less societal opportunity along the way. Finally, we have seen repetitive proof that diversity in the healthcare workforce improves the quality of the care we provide to all patients and reduces disparities in health. In healthcare and health professions education, this ruling has profound implications for the health and wellbeing of the populations we serve and the hope that diversification of the healthcare workforce brings to improving our current situation.
So, what does this all mean for education here at WUSM? As the statements from the Chancellor and Dean make clear, we are unwavering in our commitment to enhancing diversity in our students, residents, faculty and staff and we are dedicated to the pursuit of a truly inclusive and equitable work and educational environment. To that end, we have been preparing for the possibility of this decision within the Office of Education for some time and have been building resources and practices that support our long-term commitment to these goals. Specifically:
- In our student programs, we have instituted essay and interview questions that help us ascertain experiences of inequity, racism, difficulties experienced, and lack of opportunity. We believe such experiences and people’s reactions to them contribute to the character and empathy of a healthcare provider and support our goals of training trauma-informed care providers. Justice Roberts is clear when he states, “nothing prohibits universities from considering an applicant’s discussion of how race affected the applicant’s life, so long as that discussion is concretely tied to a quality of character or unique ability that the particular applicant can contribute to the university.”
- We will pursue similar strategies in graduate medical education (GME). Recognizing the unique resource constraints of selection committees in GME, we will work across programs to incorporate secondary essays and consider strategies like trained readers to better understand the qualities and experiences of their applicant pool prior to offering interviews.
- We will expand efforts related to recruitment, and in our MD program, we will hire a director of recruitment. We will double down on efforts to recruit and retain a diverse and inclusive community including through engagement with national affinity groups and ongoing support and development of our local affinity groups.
- We will continue to require implicit bias training for admission and selection committee members and interviewers and expand this training as necessary to address emerging issues and constraints.
- We will continue to collaborate with the Office of Diversity, Equity and Inclusion (ODEI), the Academy of Educators, and the Instructional Design Studio to enhance and expand our trainings on bias, understanding structural racism, and supporting safe and equitable learning environments.
- We will continue our health equity and justice curriculum in UME and work with other professions and GME to expand core elements to their programs. Much of this work is already occurring with the rollout of the Understanding Systemic Racism Curriculum by ODEI.
- We will continue our systematic efforts to identify and dismantle bias and structural inequities in assessment across programs including the movement toward competency-based assessment, use of diverse assessment strategies, and trained competency committees. In addition, we will continue and expand training in addressing bias in narrative assessment and letter writing.
- ODEI, in collaboration with our departments, has expanded opportunities in pathway programs (formerly known as pipeline), and have enlisted Jim Skeath and Tracey Hermanstyne to lead these efforts and monitor their progress. The Office of Education is excited to partner with this team to thoughtfully build new and reinforce existing programs.
- We will continually monitor national literature and engage with our national organizations – AAMC, ACGME, AMA – and others to develop and implement new strategies and best practices.
- We will monitor the impact of what we are doing on our learning and work environments and on our ability to have a diverse and inclusive environment that fosters belonging of all people.
The last few years have been exhausting for many of us. This ruling, and other similar decisions that threaten to roll back progress on equity, are daunting. But together we can and will continue the important work we have begun. To support you, in your day-to-day efforts, I encourage you to watch this brief but thoughtful video on how we can all make a difference. Each of you plays a critical role in this work – some at a systemic level, all in how you behave and what you do every day.