Admissions Is Not Enough: The Racial Achievement Gap in Medical Education

When members of a stigmatized group find themselves in a situation where negative stereotypes provide a possible framework for interpreting their behavior, the risk of being judged in light of those stereotypes can elicit a disruptive state that undermines performance and aspirations in that domain. This situational predicament, termed stereotype threat, continues to be an intensely debated and researched topic in educational, social, and organizational psychology. In this review, we explore the various sources of stereotype threat, the mechanisms underlying stereotype-threat effects (both mediators and moderators), and the consequences of this situational predicament, as well as the means through which society and stigmatized individuals can overcome the insidious effects of stereotype threat. Ultimately, we hope this review alleviates some of the confusion surrounding stereotype threat while also sparking further research and debate.

Previous studies have found racial and ethnic inequities in the receipt of academic awards, such as promotions and National Institutes of Health research funding, among academic medical center faculty. Few data exist about similar racial/ethnic disparities at the level of undergraduate medical education.

While students entering medical schools are becoming more diverse, trainees in residency programs in competitive specialties and academic medicine faculty have not increased in diversity. As part of an educational continuous quality improvement process at the University of California, San Francisco, School of Medicine, the authors examined data for the classes of 2013-2016 to determine whether differences existed between underrepresented in medicine (UIM) and not-UIM students' clinical performance (clerkship director ratings and number of clerkship honors grades awarded) and honor society membership-all of which influence residency selection and academic career choices.This analysis demonstrated differences that consistently favored not-UIM students. Whereas the size and magnitude of differences in clerkship director ratings were small, UIM students received approximately half as many honors grades as not-UIM students and were three times less likely to be selected for honor society membership.The authors use these findings to illustrate the amplification cascade, a phenomenon in which small differences in assessed performance lead to larger differences in grades and selection for awards. The amplification cascade raises concerns about opportunities for UIM students to compete successfully for competitive residency programs and potentially enter academic careers. Using a fishbone diagram, a continuous quality improvement root cause analysis tool, the authors contextualize their institutional results. They describe potential causes of group differences, drawing from the education disparities literature, and propose interventions and future research. They also share countermeasures adopted at their institution and encourage other medical schools to consider similar exploration of their institutional data.