We now have even more evidence that a lowering of standards in service of diversity is doing real harm to the medical profession.
We now have even more evidence that a lowering of standards in service of diversity is doing real harm to the medical profession.
D iversity is good, but it should never come at the expense of quality. That’s especially true in fields like my own medical profession. For years, the medical establishment has relentlessly pushed to recruit more minorities into medical school. While a great many are highly qualified, a great many aren’t, yet the powers that be are lowering standards to let them in. A growing body of evidence demonstrates the danger of diversity gone wild. Yet when anyone points it out, they are brutally maligned as racist.
I know from experience. One year ago, I commented on a study that found that minority resident trainees in three major teaching hospitals performed less well than their white and Asian counterparts. The authors of that study posited that racism and bias were the only explanation. In response, I pointed out the possibility that the assessments may have been correct and that many of the minority residents did indeed perform less well. The blowback was as swift as it was severe.
I was denounced by the institution I served for 52 years, the Perelman School of Medicine at the University of Pennsylvania. My name was scrubbed from its website because of the backlash by potential applicants to its Health System’s residency programs. The Penn administration was fearful that the quest for diversity would be diminished by having me associated with the school. I was subsequently fired from the leading point-of-care medical system, UpToDate. To this day, I am routinely denounced in medical circles for daring to have common sense.
Turns out, I was right. There is now a new study on the performance of emergency medicine residents throughout the United States that goes a long way to confirming my point. In typical fashion, the study’s authors don’t acknowledge their own findings, yet their data strongly support that diversity is going too far, threatening the quality that patients deserve and depend upon.
The study assessed trainees, across 128 different training programs, on their medical knowledge and their clinical performance. In the first year, the residents generally performed similarly. Yet starting in the second year and continuing throughout the three or four years of training, the Underrepresented in Medicine (URM) trainees, particularly women, were assessed as demonstrating less medical knowledge and less effective patient care.
Naturally, the researchers conclude that so-called “intersectionality” is to blame. Apparently, discriminatory attitudes must underlie the disparate outcomes. Yet the way the trainee assessments were performed clearly contradicts this interpretation.
The faculty who conducted these assessments work closely with the trainees and come to know them well. Initially, when new trainees arrive at a program, they are given the benefit of the doubt if they demonstrate some deficiencies and are assumed to need time to adapt to the new training program and to start to demonstrate their competence. The fact that all the residents were judged to perform equally at the initiation of their training is not surprising and is quite typical, indicating that the faculty is not suffering from bias.
The authors would have us believe that bias develops over trainees’ time in the program. Yet it’s far more likely that, with time and experience, the faculty recognize which trainees are performing well — and which aren’t. Perhaps the trainees experience flagging interest in their choice of specialties. Perhaps their deficiencies in medical knowledge are uncovered over time. Perhaps they demonstrate difficulty in performing procedures.
Or perhaps it becomes clear that previous poor performance as medical students has continued into residency — an unfortunate yet increasingly common reality as standards have been lowered in the name of diversity. Medical schools have long used factors other than academic achievement in admissions decisions. Poor academic performance in medical school is a predictor of poor performance in post-graduate clinical training. While “affirmative action” has now been banned, medical schools are still looking for ways to prioritize race and gender over academics.
These realities are surely playing out in residency programs. No doubt, many of the trainees performed in an exceptional fashion. Yet there’s equally no doubt that some of the trainees performed quite poorly, especially URM trainees. These problems should be confronted and acted upon, for the sake of patient care and health. Instead, medical experts are attributing poor performance to bias or racism, letting the problem of poor performance fester.
This is cowardice, plain and simple. It’s more politically fashionable to send faculty to implicit-bias training than it is to hold poor-performing residents accountable. Upholding standards now inevitably leads to accusations of racism. Yet it’s the right thing to do for the sake of patients. They don’t need diversity gone wild, with the attendant lowering of standards and unwillingness to confront reality. They need medical education and training to raise up the best possible physicians who provide the best possible care, regardless of their race, gender, or any other consideration.