Painting By Tony Green
Information from Industry
I swear… that by the set rules, lectures, and every other method of teaching, I will pass on a knowledge of the art to my own sons, and the sons of my teachers, and to students bound by this contract and having sworn this oath to the law of medicine, but to no one else.
— Oath of Hippocrates, ca. 400 BCE
We call them “doctors,” a word taken directly from the Latin meaning, literally, “teachers.” Although the Ancient Greeks called them iatroί or “healers,” — even as far back as Hippocrates in the 400s BCE — an essential part of the physician’s life was teaching the healing arts to the next generation.
Medical education was freely available in those times. Anyone with sufficient talent and dedication, and with the right attitude, might attract the mentoring of a great physician. Hippocrates would have been as willing to take on an Ethiopian student as an Athenian.
It is only in our own, more “advanced” country that we had to wait until 1940 for the American Medical Association to stop listing “physicians” and “colored physicians” with separate designations in their catalogue. In 1949, Harvard Medical School appointed its first black professor. Osteopathic physicians were more progressive; we granted our first degree in osteopathic medicine to a black (and a woman at that!), Meta Christy in 1921.
Yet, 88 years after Dr. Christy’s graduation, our medical schools still have but a fraction of the number of minorities needed. Under-represented minorities include blacks, Native Americans, Mexican Americans, and mainland Puerto Ricans. There are also far too few young black, Hispanic, and Native American women and men applying to medical schools.
According to the Kaiser Family Foundation, there were 16,167 medical school graduates in the United States in 2008,1109 of whom were black and 1183 of whom were Hispanic — that’s 6.9% and 7.3%, respectively, when these groups represent over 12% and over 15% of the general population. In other words, our medical schools are still utterly failing to reflect the communities of patients we serve.
Why? It’s not for lack of trying. Almost every medical school has an office of minority or multicultural affairs. However, this kind of minority recruitment is a waste of money, time, and talent, as evidenced by the poor statistics cited above. Despite the fact that many medical schools have had such offices since the early 1970s, we still are nowhere near our goal of truly equal opportunity for all talented and motivated students.
What, then, is the problem? According to the Council on Graduate Medical Education (COGME) a federal body commissioned by Congress, the problem begins much earlier than medical school.
“Increasing the number of under-represented minority students who successfully advance through the elementary, secondary, and post-secondary academic pipeline is the first step to enlarge the potential number of these students eligible to enter medical school…,” COGME wrote in its 2003 report to Congress.
“Research indicates that the greatest barrier to URM admission to medical school is the low applicant pool of URM college graduates resulting from high attrition rates in high school and low enrollments in college.“
The problem is not in our medical schools, or in our medical school admissions offices. In fact, under-represented minority college graduates apply to medical school at an even higher rate than do white college graduates (about 28 per 1000 vs 24 per 1000). The problem is in the educational attention they receive long before they even register for their medical college admission tests or have their first meetings with their pre-med advisors.
Despite claiming for a half century to offer an equal education to all children, it seems to not nearly be the case. A 2008 study by the Education Trust found that 1 in 3 math classes in under-represented minority neighborhoods are taught by teachers without qualification to instruct in the subject; because of state underreporting of the problem, the situation may actually be much worse. Recruiting science teachers for inner-city middle schools is notoriously difficult. (Although in some cities, like my own, the gap between black and Hispanic students’ scores and white students’ scores on elementary reading and math achievement tests has begun to narrow a bit, the progress is still far too little and far too slow, and has not really translated in a turnaround in high school achievement scores or drop-out rates as students seem to become more aware of, and embittered by, perceived limitations on their choices as they become adolescents.)
Many medical schools have a relationship with a local high school, but if we wait until the 11th and 12th grade, we are conceding the battle and the war. By then we have already lost half a generation: Colin Powell’s America’s Promise Alliance undertook a magnificent study of the dropout problem and concluded that inner-city drop-out rates are running in the 50% range, and even higher (Detroit’s schools graduate just 25% of their entering 9th grade classes, while Cleveland and Baltimore graduate about one third of their students). Meanwhile, suburban schools systems are graduating 70% and 80% of their young people. Starting in high school is far too late.
These students have been steered away from the medical professions not as they graduated from college, or from high school, but somewhere around the fourth grade. It could be argued that they are at a disadvantage even before that if they have been deprived of the most fundamental basic mathematical skills, the training in scientific thought, and the development of academic discipline necessary for further achievement. The battle is being lost in the elementary school classrooms, not in the medical school admissions offices.
Perhaps the battle for their imaginations is lost even earlier in kindergarten and pre-K. They grow up in neighborhoods where many of them don’t know anyone who has finished college, much less medical school. Few have even finished high school. Children play what they experience: the son of a carpenter bangs nails with his toy hammer; the daughter of a grocer plays “store”; the niece of a chief, firefighter; and so on. If a child has never met a doctor except for an annual 10-minute check-up, and that doctor comes from a different culture, speaks with a different accent, frankly looks like a “them” rather than an “us,” how likely is she to visualize herself someday treating patients of her own?
My institution, located in the heart of Harlem, could easily have chosen to insulate itself from its own community, bemoan the state of preparation of first-year medical students, and relied on an aggressive minority recruitment office to hunt down the best among the small number of under-represented minority college graduates. Instead of fighting over applicants in a small pool, though, we have chosen to increase the size of the pool — not today, but in the years and decades to come.
Touro College sponsors “Project Aspire,” a program in which we place our medical students and staff into community schools, PS 197, and the Bronx High School of Medical Science, on a regular basis. The mini-Hippocrates and Hippocratia, walking around his or her kindergarten in the tiny white lab coats, wearing working stethoscopes provided by the project, are playing, to be sure, but it is in play that children begin not to dream empty dreams, but to imagine possible future realities. The encouragement they receive from real medical students and healthcare professionals who look “just like them,” will, over time, change attitudes in our neighborhood. The program has already begun to have an impact on the lives of the young people we serve, but it should be little more than a demonstration project: what our school is doing in our neighborhood is something that needs to become a national program.
A new partnership, a nationwide program that will put children in minority neighborhoods in direct contact on an ongoing basis with osteopathic and allopathic physicians and other health professionals, one that will use the resources and people-power of our medical schools to enhance the science and mathematics education offered to these children from their very beginnings in school is what is needed if we are to reach the stage where each cohort of medical school graduates really looks like a microcosm of the United States.
Authors and Disclosures
Jerry Cammarata, PhD
Dean, Student Affairs, Touro College of Osteopathic Medicine, New York, NY
Disclosure: Jerry Cammarata, PhD, has disclosed no relevant financial relationships.