2

Keynote:
Who and How We Educate Matters

As the keynote speaker, Valerie Montgomery Rice, M.D. (Morehouse School of Medicine [MSM]) focused her talk on “who, and how, we educate matters.” As president of MSM and a long-time leader in the field, she noted that “the conversation about leveraging equity and inclusion is not new to any of us.” She recalled a 2015 Council of Deans meeting through the Association of American Medical Colleges (AAMC), when a “leaky pipeline” was depicted to explain the disproportionately low numbers of Black males in medicine. Despite the attention to the issue and the establishment of new medical schools since 2007, significant progress has not taken place. Medical school enrollment nationwide is only about 8 percent African American. She reminded the group of the societal benefits of a diverse medical student body and workforce.

ROLE OF HISTORICALLY BLACK COLLEGES AND UNIVERSITIES

Dr. Montgomery Rice pointed out that HBCU medical schools “punch above their weight.” Specifically, the four HBCU schools (Charles R. Drew University of Medicine and Science, Howard University College of Medicine, Meharry Medical College, and Morehouse School of Medicine) enroll a total of 1,298 Black students compared with 1,097 across the top 10 Predominantly White Institutions combined. From 2009 to 2019, Meharry, Howard, and MSM outpaced all other schools in enrolling African American students. Seventy-eight percent of Black applicants include MSM among the institutions to which they apply, whether they ultimately attend or not, she added.

As important as this contribution is, Dr. Montgomery Rice stressed that MSM and other HBCUs have the capacity to enroll only so many students. “It is not just up to us to change the overall 8 percent matriculant rate,” she stated. In an analysis looking back to 2011, her team found that if all U.S. medical schools matriculated Black applicants at the rate that MSM does, there would be 1,200 more Blacks in medical schools today. They also noted that, overall, the medical school acceptance rate of white applicants is 40 to 42 percent compared with a rate of 36 to 38 percent for Black applicants. She suggested overindexing especially in the case of Black males because of lower matriculation rates.

Dr. Montgomery Rice emphasized that a school’s mission statement and actions must be aligned. “We at MSM have mission-focused recruitment. We look for students who have a commitment to the community,

a commitment to primary care, and a commitment to Georgia and going back to practice in the community.” She explained MSM’s holistic review of applicants. “We take admissions data analytics seriously. We know which feeder schools and which majors will be most successful. We do this very intentionally.” Strategies for success once students matriculate include attention to mentoring and the milieu (the environment where they learn); structured curriculum and critical thinking skills; and monitoring, exam practice, and feedback. The environment is structured to include a low faculty-to-student ratio, learning communities, group and problem-based learning, a family environment, and caring faculty.

USE OF DATA

Dr. Montgomery Rice is a strong proponent of the role of data to drive student success, using data from students’ undergraduate and graduate education through to professional practice. For example, by looking at a student’s undergraduate coursework, a “preemptive strike” to provide additional support for success can take place. Other key touchpoints include Medical College Admission Test (MCAT) scores and testing through the journey to residency. These data are compiled in an enterprise data warehouse to create algorithms and dashboards for students, faculty, advisors, and administrators to review, track, and act upon. The system, called Progress IQ, is used for medical and all graduate degree programs.

“This has allowed us to be consistent in shifting the curve,” Dr. Montgomery Rice stated. Notably, MSM students’ MCAT performance, on average, is lower than the national average, but their scores are comparable to national Step 1 scores after 2 years.¹ These scores allow for high student matching to their training preferences, especially primary care and core specialties.

Dr. Montgomery Rice noted that while MSM provides an equitable learning environment during students’ first 2 years of medical school, students then enter the larger environment for their training. A study of the causes, effects, and consequences of lower assessment performance for UiM (underrepresented in medicine) students found student, cultural, and structural factors in the clinical learning environment (Teherani et al.,

___________________

¹ The Medical College Admission Test is a standardized exam for prospective medical students. “Step 1” is the set of United States Medical Licensing Examinations that students typically take after their second year of medical school.

2018). Lower assessments affect career options among other consequences, she reminded the group.

“This is where partnerships matter to seek innovation,” she said. One such partnership is with the Josiah Macy Jr. Foundation to look at eliminating discrimination in health professions’ learning environments. She related a recommendation from a 2020 conference on the subject: “Equity in assessment means that all learners have fair and impartial opportunities to learn, be coached and receive feedback, be assessed and graded, be advanced and graduated, and be selected for subsequent training and job opportunities” (Lucey et al., 2020). She urged all health centers to examine their data to see if intrinsic biases exist and engage in training and other changes as revealed through the data. “That is how we get to equity in assessment.”

COVID-19 revealed inequities, Dr. Montgomery Rice continued. MSM partnered with many groups, beginning with the U.S. Department of Health and Human Services and the National COVID-19 Resiliency Network. Linkages were made with vulnerable communities to do monitoring and evaluation and ensure the dissemination of appropriate information in real time. It will be important to document the experience to educate and train the workforce for the next crisis, she added. The Health Equity Tracker was developed in partnership with Google and others and can be used beyond COVID-19 to determine where to allocate resources to eliminate disparities. Dr. Montgomery Rice highlighted partnerships with other organizations that include Thermo Fisher Scientific Inc. and the Bill and Melinda Gates Foundation to improve access to testing; the American Cancer Society to strengthen and develop UiM faculty; and the Chan Zuckerberg Initiative to accelerate precision health at the four HBCU medical schools.

“Our greatest partnership came from an understanding of what we could do with the assets we have,” Dr. Montgomery Rice continued. She called attention to the More in Common Alliance, a partnership between MSM and CommonSpirit Health, with its 144 hospitals and thousands of points of care as a way to diversify the healthcare workforce.² Through the alliance, MSM will help stand up five medical education campuses over the next 10 years, with a focus on rural and other underserved communities. Looking beyond MSM in other efforts to expand representation in medicine, she noted that Xavier University and Morgan State University have announced plans to create medical schools.

___________________

² For more information, see https://moreincommonalliance.org/.

Why does a more diverse medical workforce matter, Dr. Montgomery Rice posed. She noted that AAMC has found that if underserved populations were to experience the same healthcare use patterns as populations with better healthcare access, the current demand for physicians would rise by an additional 74,100 to 145,400 physicians. This also points to the need for more minority physicians to achieve equity in utilization.

“We must lead by example,” Dr. Montgomery Rice reminded workshop participants. She expressed pride in the choices that HBCU learners make about where and how to practice medicine. For example, 79 percent of MSM’s graduates work in underserved or economically disadvantaged areas, and many in primary care. However, she stressed that HCBUs cannot do this work alone. “I am excited about the Roundtable raising awareness about how everyone can do this better, not just MSIs [Minority-Serving Institutions]. We all have a stake in success.”

Workshop co-chair Dr. André Churchwell (Vanderbilt University) agreed that the concept of embedding social justice into education would benefit all schools. He also asked Dr. Montgomery Rice to explain the Common Alliance. She responded that many participating hospitals are in rural and underserved communities, and the goal is for the workforce to reflect the communities around them. Patient-provider concordance matters, she stressed. A teaching academy will open up regional opportunities. Faculty members will be clinicians at the hospitals.

Workshop co-chair Dr. Shirley Malcom (American Association for the Advancement of Science) noted that many institutions rely on MCAT scores as a leading indicator, but the work at MSM shows how to shift the curve holistically and that the MCAT does not matter as much as is perceived. Dr. Montgomery Rice stressed the role of data to solve problems. “These students who did not have the [MCAT] numbers but see graduate and success rates—what are they doing? We step back and understand the environment of empowerment.” MSM starts with the assumption that everyone can learn and succeed, she continued. “Give them the right resources, maybe at a different pace, but the outcome will be excellent.” Tools are available for student success, and faculty commit the time and energy to make themselves available. She noted a drop-off in Step 1 scores among students who spent most of their schooling in a hybrid environment because of the pandemic, which she expects to rebound. “At Morehouse School of Medicine, we are back in person. The milieu requires high-touch.”

REFERENCES