New Haven, Conn.-- Black and Asian medical school students are less likely to be selected for membership in a prestigious medical honor society, Alpha Omega Alpha (AA), than white medical school students, according to a Yale-led study. The disparity suggests bias in the AA membership selection process, which could negatively affect opportunities for minority medical school students, note the researchers.
The study was published March 6 in JAMA Internal Medicine.
Studies have demonstrated racial and ethnic inequities in medicine, including disparities in the receipt of awards, research funding, and promotions. Yet few studies have examined the link between race and ethnicity and opportunities for medical school students.
Medical students are eligible for AA membership if they rank in the top quartile of their class and are selected by a committee at their institution. Society membership is important because members are more likely to get into the residency program of their choice, and more likely to attain the rank of full professor, dean, or department chair than nonmembers, the researchers said. Yale is one of the few medical schools in the United States that does not offer AA membership.
To investigate, the Yale research team analyzed data from the Electronic Residency Application Service, the official service that medical students in the United States use to apply to residency programs. Their analysis included 4,655 U.S. medical students from 123 medical schools during the 2014-2015 academic year who applied to one of 12 residency programs at Yale-New Haven Hospital.
The researchers found that the odds of AA membership for white students were nearly six times greater than black students, and nearly two times greater than Asian students.
"In our fully adjusted model -- which takes into account measures of professionalism, leadership, research, and standardized test scores -- underrepresented minorities are still less likely to be AA members," said first author Down Boatright, M.D., a Robert Wood Johnson Foundation Clinical Scholars Program scholar.
The study did not, however, find a significant difference in AA membership between white and Hispanic students, which the researchers attributed to a too-small sample size of Hispanics.
The findings suggest potential bias in the AA membership selection process, which could limit opportunities for black and Asian medical students. For example, non-members may be automatically screened out by competitive residency programs that use membership as a filter, Boatright noted.
"We look at the pipeline of physicians entering into medicine, and there's talk about how we need to increase the number of underrepresented minorities that are becoming physicians," said Boatright. "This study shows there is some systematic bias at the level of medical schools that has not been addressed."
"Understanding the reasons for and addressing bias in all aspects of medical education, including the selection process for AA membership, is critical if we are to address the crucial issue of eliminating bias in medical education and enhancing diversity in the physician workforce," said Patrick O'Connor, M.D., the Dan and Amanda Adams Professor and chief of general internal medicine and a study author. "This study sheds light on potential bias related to an important metric by which students at many U.S. medical schools may be evaluated."
Other study authors include David Ross, M.D., Edward Moore, and senior author Marcella Nunez-Smith, M.D.
This work was supported by funds from Dr. Rosemarie Fisher, associate dean of graduate medical education at the Yale School of Medicine and designated institutional official for Yale New Haven Hospital. Ross and Moore are co-founders of Scutmonkey Consulting, LLC.
Citation: JAMA Internal Medicine