• Catherine Reinis Lucey and Aaron Saguil.
• C.R. Lucey is executive vice dean, vice dean for education, and professor of medicine, University of California, San Francisco, School of Medicine, San Francisco, California. A. Saguil was associate dean for recruitment and admissions, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Bethesda, Maryland, at the time this work was completed. He is associate dean, regional education, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, San Antonio, Texas, now. He is also vice chair, Medical College Admission Test Validity Committee, Association of American Medical Colleges, Washington, DC.
• Acad Med. 2020 Mar 1; 95 (3): 351-356.

AbstractThose in medical education have a responsibility to prepare a physician workforce that can serve increasingly diverse communities, encourage healthy changes in patients, and advocate for the social changes needed to advance the health of all. The authors of this Perspective discuss many of the likely causes of the observed differences in mean Medical College Admission Test (MCAT) scores between students from groups well represented in medicine and those from groups underrepresented in medicine. The lower mean MCAT scores of underrepresented groups can present challenges to diversifying the physician workforce if medical schools only admit those applicants with the highest MCAT scores. The authors review the psychometric literature, which showed no evidence of bias in the exam, and note that the differences in mean MCAT scores between racial and ethnic groups are similar to those in other measures of academic achievement and performance on high-stakes tests.The authors then describe the ways in which structural racism in the United States has contributed to differences in achievement for underrepresented students compared with well-represented students. These differences are not due to differences in aptitude but to differences in opportunities. The authors describe the widespread consequences of structural racism on economic success, educational opportunity, and bias in the educational environment. They close with 3 recommendations for medical schools that may mitigate the consequences of structural racism while maintaining academic standards and admitting students likely to succeed. Adopting these recommendations may help the medical profession build the diverse physician workforce needed to serve communities today.

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