Are medical schools' admissions committees unconsciously biased against minorities?
That's the question Quinn Capers IV, MD, set out to answer.
He began at The Ohio State University College of Medicine, where he is the associate dean for admissions in addition to serving as an associate professor of cardiovascular medicine.
"Admissions committees are the front door to medical schools, so they have a strong impact on the health of this nation," Dr. Capers says.
"We know that there are still healthcare disparities—women and underrepresented minorities do not necessarily get the quality of care across the U.S. that they should. One important strategy to correct that will be diversifying the medical workforce."
By recognizing and raising awareness of implicit bias on medical school admissions committees, Dr. Capers hoped to remove the subjectivity that minority applicants could encounter in admission and enrollment.
The first significant effort to reduce the effects of bias in Ohio State's medical school admissions committee began in 2011 with a process of "Holistic Review."
"This philosophy balances an applicant's experiences and attributes with academic metrics to pick a group of applicants that will bring diversity and cultural competence to our medical school in addition to all of the other excellent characteristics that we need," Dr. Capers says.
In 2012, Dr. Capers and his colleagues tackled admissions bias with the implicit association test (IAT), an online tool widely used and recognized in clinical and social science research to measure unconscious bias.
All 140 members of the admissions committee took several implicit association tests before the 2012-2013 admissions cycle. Their results revealed that all groups in the committee—men, women, students and faculty—showed significant levels of implicit or unconscious preference for certain racial and gender groups.
How this affects health care
Dr. Capers emphasizes that "unconscious bias does not equal racism nor does it mean that you have discriminated."
"The key word here is ‘unconscious'—not intentional—bias," adds Daniel Clinchot, MD, a study co-author and vice dean for education and chair of the Department of Biomedical Education and Anatomy.
Both researchers note, though, that bias can affect behavior.
"While the study looked at admissions, it could be a patient encounter," Dr. Clinchot says. "It could be the way you talk with a family. It's a matter of how your understanding of those unconscious biases can change the way you interact with individuals—hopefully for the better."
Overcoming bias at Ohio State
Being aware of and understanding these biases can change people's behavior.
After the 2012-2013 admissions cycle, 71 percent of the admissions committee members said the IAT might be helpful in reducing bias, 48 percent were conscious of their individual results when interviewing candidates in the next cycle, and 21 percent said their own results had an impact on their admissions decisions in the next cycle.
"The next class of medical students that were enrolled following the IAT exercise was the most diverse in our College of Medicine's history, at that time," Dr. Capers says.
Maintaining success in diversity
Today, The Ohio State University College of Medicine continues to diversify—in fact, its student population is one of the most diverse among U.S. medical schools.
This hasn't compromised the school's academic metrics; as the percentage of underrepresented minority students increased, so did the average MCAT and GPA scores of each entering class.
Since January 2017, Dr. Capers has led educational workshops to help ensure that awareness of unconscious bias continues to grow in admissions committees not only at Ohio State's health sciences colleges, but also at medical schools throughout the nation.
For other schools looking to replicate Ohio State's success with diversity, Dr. Capers recommends two steps:
- Have admissions committees tested for implicit bias.
- Discuss and be trained in ways to reduce the impact of their unconscious biases.
The workshops Dr. Capers leads for faculty, students and staff end with an anonymous survey that asks participants to detail ways that they plan to reduce the impact of their biases in the future.
Their strategies to counteract implicit bias hinge on four research-proven methods highlighted in the workshop:
- Find a common shared interest. Our experiences influence our perceptions and judgments about people who do not "fit" the groups we might align with, says Dr. Capers. "Probe until you and something you have in common," he says, whether that might be being a Cleveland Cavaliers fan or enjoying a particular hobby.
- Take another person's perspective. "Doing so can help you understand that individual's experience and actions," says Dr. Capers.
- Consider the opposite. Look for possibilities that may not be obvious about a person, rather than make assumptions. For instance, a candidate for medical school may not "look right" on paper as compared with other applicants, says Dr. Capers, but that does not mean the person does not have initiative or passion for the field.
- Counter stereotypes. "Spend time with people whom you admire from groups you may have a bias against. This effort helps connect you with ideas and greater understanding about different communities," says Dr. Capers.