Aderonke Bamgbose Pederson, MD, is now an assistant professor of psychiatry at Harvard Medical School in Boston, but her success came despite serious barriers.
After immigrating to Chicago from Nigeria when she was 16, Pederson lost both her parents to lung cancer while she was still in high school. She faced housing and food insecurity but maintained a rigorous academic profile. While advisors told her she was a competitive applicant, Pederson says her lack of financial resources limited her options for college. If not for a University of Chicago pathway program that allowed outstanding students attending Chicago’s public schools to take college courses at the university, Pederson doubts she would be where she is today.
“I’m qualified and have all of the odds stacked against me,” Pederson says. “What happens when [students are] qualified but [are] hidden under a lack of resources?”
Pederson went on to attend Northwestern University Feinberg School of Medicine in Chicago and stayed to complete her psychiatry residency at Northwestern University McGaw Medical Center before eventually taking a position as a psychiatrist and assistant professor at Massachusetts General Hospital and Harvard Medical School, where she leads research into disparities in mental health care. At each step of her education, Pederson can identify a mentor or diversity, equity, and inclusion (DEI) program that helped her progress to that next step.
“These little encounters are the opposite version of a thousand cuts that can destroy something,” Pederson says. “A thousand blessings, little encounters, happenstance interactions with people who look like you and understand your struggle — those people are what then make the environment workable.”
It’s why Pederson is concerned by efforts to ban or defund DEI efforts in higher education.
As of July 2024, 12 states had passed laws restricting DEI efforts in some way, according to a legislation tracker run by The Chronicle of Higher Education. These laws come at the same time that institutions of higher education are learning to navigate the June 2023 U.S. Supreme Court’s decision that deemed race-conscious admissions unconstitutional.
More recently, Rep. Greg Murphy, MD (R-N.C.), introduced a bill that, if passed, would prohibit medical schools from receiving federal funding if they adopt policies and requirements relating to DEI. In response to that legislation, Rep. Joyce Beatty (D-Ohio) introduced House Resolution 1180, which affirms the importance of DEI efforts in medical education.
Advocates of DEI work say that opponents mischaracterize the goals of such work and dismiss the real impact these efforts have on health care. Studies show that racially diverse health care teams can result in improved self-reported patient experiences, receptivity to medical recommendations, and reduced health care spending.
AAMCNews spoke with DEI leaders in academic medicine to dispel some common myths about DEI.
Myth: Diversity, equity, and inclusion efforts in medical schools are about pushing a political agenda and are a detriment to the practice of medicine.
While each medical school crafts its own definitions of diversity, equity, and inclusion, DEI leaders understand the goal of the concept to be valuing differences and promoting the well-being and success of all people, regardless of race, socioeconomic status, or background.
“Inclusion means everybody,” says Ana Nuñez, MD, FACP, vice dean of Diversity, Equity, and Inclusion and a professor of medicine at the University of Minnesota School of Medicine, as well as chair of the AAMC’s Group on Diversity and Inclusion.
A body of research conducted over decades has demonstrated that, in the United States, a person’s health and experience with the health care system can vary significantly depending on a variety of social factors, including socioeconomic status, level of education, race or ethnicity, gender, and where they live, among other considerations.
Data from the U.S. National Center for Health Statistics show that, in 2019, people in rural areas had a 20% higher age-adjusted death rate than did those in urban areas; the American Cancer Society reports that Black women get breast cancer less often than non-Hispanic White women but die at a 40% higher rate; and the Centers for Disease Control and Prevention has published statistics that show that, in 2020, American Indian and Alaska Native (AIAN) people died of diabetes at more than twice the rate of Asian people, to name a few examples.
As the United States’ population is growing more culturally and racially diverse, DEI leaders say that preparing future physicians to care for the distinct needs of all their patients is vital to the future of health care.
“At its core, medical schools’ efforts to incorporate diversity, equity, and inclusion (DEI) into medical education and their curricula are about helping future doctors better understand the specific issues that each patient is facing to provide better medical care,” the AAMC stated in a fact sheet entitled “Medical Schools Advocate to Improve Everyone’s Health.” “... These efforts seek to address the long-standing and well-documented inequities in our health care system and their impacts on the health of patients and communities throughout the country.”
Myth: Diversity efforts are resulting in unqualified students being accepted to medical school.
Critics of DEI efforts claim that moves by some medical schools to de-emphasize standardized testing scores have resulted in less competitive, and thus less qualified, people becoming physicians — to the detriment of their future patients.
But Nuñez argues that eschewing DEI efforts does the opposite: It leaves talented people out of the practice of medicine.
“Talent is ubiquitous, but opportunity is not,” Nuñez says.
AAMC data show that the average MCAT® scores and GPAs of students admitted to medical school have remained steady over the past five years, even as schools have reported increasing diversity of admitted students. Graduation rates within six years also remained steady (96%) between 1998 and 2018. Plus, according to a 2023 survey about new-resident readiness, program directors reported that more than 97% of first-year residents met or exceeded expectations.
Many medical school admissions committees rely on an approach known as holistic review, which takes into account a variety of factors about each student and compares them with the mission, priorities, and needs of the university and the workforce. This may include an applicant’s MCAT scores and GPA, but it could also weigh other qualities, such as extensive experience working with a medically underserved community or the demonstration of having overcome significant adversity. The purpose of medical school and residency is to prepare future physicians to care for all people, Pederson says, and this goes beyond academic achievement.
“We can fall back on the truth that it was never about admitting people who were unqualified; it was about shedding light on people who might be overlooked,” Pederson adds.
Sheryl L. Heron, MD, MPH, FACEP, was almost one of those overlooked students. Heron, who immigrated to the United States from Jamaica as a child, was not accepted to medical school her first time applying. After her second application round, she was accepted to Howard University College of Medicine, a historically Black college in Washington, D.C. Now she is chief diversity and inclusion officer, associate dean of Community Engagement, Equity, and Inclusion, and a professor of emergency medicine at Emory University School of Medicine, as well as chair-elect of the AAMC’s Group on Diversity and Inclusion.
“I've never had a patient ask me, ‘Hey, where did you go to medical school? What were your board scores?’ Ever, in my entire career,” Heron says. “But I have had patients say, ‘Thank you for the care that you’ve given me, and thank you for your kindness and your ability to provide excellent care.’”
Myth: DEI is just code for discriminating in favor of Black and Hispanic/Latino people.
Critics of DEI efforts often focus on the role DEI has in admitting, hiring, and promoting people who are Black and Hispanic. They say this amounts to discrimination against White and Asian people, and that positions should be filled on merit alone, without regard for race.
In fact, Black, Hispanic/Latino, and AIAN students remain underrepresented in U.S. medical schools. AAMC enrollment data for 2023 show that 53% are White; 29%, Asian; 10%, Black; 12%, Hispanic/Latino; and 1%, AIAN.
But Nuñez says focusing solely on race grossly oversimplifies the spirit of DEI.
Diversity is not just about race but rather includes many factors that affect life experience and perspective: socioeconomic status, rural upbringing, religion, ideology, gender, sexuality, age, and disability, to name a few. Nuñez says that having a variety of perspectives — even and especially the ones she doesn’t share — challenges medical schools and health care systems to be better.
In a survey of medical school graduates conducted by the AAMC, 95% of respondents indicated that they were adequately prepared to care for people of different backgrounds, and 90% indicated their own knowledge and opinions had been influenced or changed by hearing the perspectives of those who were different from them.
“Diverse is not a code word for Black and Brown people or women,” Heron says. “Diversity is about the excitement that individual thoughts and thinking bring to a narrative that includes a lens through which [people] see things.”
Critics have pointed to the AAMC’s data showing that Black and Hispanic/Latino people, on average, are accepted to medical school with slightly lower MCAT scores and GPAs than their White and Asian counterparts.
But, as Nuñez points out, this reduces the applicant to just one of many qualifications for medical school. While federal law now prohibits the consideration of race as a reason for offering or denying admission, it does allow admissions committees to consider ways in which racial discrimination or other barriers may have influenced that applicant’s life and what qualities they possess from having overcome such barriers.
Nuñez says DEI efforts create opportunities for people who may not have the resources or connections that often give others a step-up in medicine, whether that’s applying to medical school, gaining experience during medical school, or matching into a competitive specialty. This includes people who are the first in their family to graduate from college, military veterans, people with disabilities, immigrants and children of immigrants, people from rural areas, and people of all races, ethnicities, ages, genders, and sexual orientations.
Myth: Medical schools are required to teach DEI concepts and recruit faculty, staff, and students from historically marginalized communities to maintain accreditation.
MD-granting medical schools in the United States are accredited by the Liaison Committee on Medical Education (LCME), an independent body that is recognized by the U.S. Department of Education and sponsored by the AAMC and the American Medical Association (AMA). The LCME does not prescribe any specific curricular content, and the AAMC and the AMA have no role or authority in the granting of accreditation.
The LCME sets standards for accreditation, but each individual medical school is responsible for developing a medical-education program and curriculum that ensures medical students have the professional competencies appropriate for entry into any residency program upon graduation.
As part of those standards, the LCME requires each school to have policies and practices in place to achieve the school’s own defined, mission-appropriate diversity outcomes.
Myth: Funding of DEI programs would be better spent on scientific advancement or other aspects of medical education.
Two states, Texas and Florida, have implemented legislation defunding DEI efforts in higher education. In Texas, any state-funded institution risks losing funding if it offers programs related to DEI, and in Florida, state and federal dollars can’t be used for DEI initiatives.
Part of the confusion around DEI, says Nuñez, stems from the fact that it is a nuanced topic that is often oversimplified in political rhetoric.
Often, students and faculty do DEI-related work on top of their other responsibilities, and for little or no additional pay.
And funding that is allocated specifically for DEI initiatives can go toward a wide variety of efforts, including pathway programs that recruit students from disadvantaged backgrounds or from rural areas; providing first-generation medical students with tutoring, mentorship, and financial-literacy training; grants for research into health care disparities; training or curriculum audits; hiring or promoting experts in health equity; and affinity groups that focus on making all medical students and faculty find a welcoming community.
Funding these programs is meant to recruit and retain future doctors who will be equipped to perform at their highest potential and provide scientific and culturally informed care to all their patients. Separating DEI from the science of medicine ignores the evidence that social factors influence how people receive health care and the outcomes they face, Heron explains.
“Current data on health inequities prove [DEI] must be embedded in education and teaching,” she says. “DEI is grounded in science.”
For example, the American Academy of Dermatology released an updated recommended curriculum in 2022 that included more pictures of how skin conditions might appear on different skin tones — something that audits found was lacking in previous curricula.
With the United States facing the prospect of a physician shortage of as many as 86,000 doctors by 2036, and these shortages being most severe in medically underserved areas, where physicians who identify as underrepresented in medicine or had a rural upbringing are more likely to practice, DEI advocates argue that medical schools can’t afford to defund DEI programs that work to close these gaps.
Nuñez says that devaluing the role of DEI work and the offices that lead it will only contribute to further disparities.
“We’re the anti-silo people,” Nuñez says, explaining that DEI office staff work across departments and try to ensure that equity is incorporated across the board. In a country where the neighborhood in which you live could mean a 20-year difference in life expectancy, “getting rid of DEI is going to hurt people and hurt health.”
Myth: Medical school faculty and staff aren’t allowed to do any DEI work because of the current political landscape.
Heron has seen how the current anti-DEI climate has impacted the people doing DEI work. Some have seen their roles eliminated or changed. Some say they are afraid to do anything that could be seen as DEI work, in case it could run afoul of the law.
Heron urges them to educate themselves on what their state’s law says and reach out to their institution’s legal team to make sure they’re not misinterpreting it.
“This world is changing. We’re becoming more and more multicultural, and we need to be able to care for each other and work with each other with the utmost love,” Heron says. “I encourage people: Don’t give up; don’t be deflated. Think about those who have gone before us [in the fight for equity]. We have this moment in time to do what we can, and we must believe that this matters.”
