Medical schools must do more to help poor and marginalized students graduate

If the medical profession wants greater diversity among doctors it must find ways to help medical students who are poor and/or members of marginalized groups stay in school and graduate.

That conclusion emerges from a new study, published online in JAMA Internal Medicine, analyzing medical school attrition rates according to socioeconomic factors in students’ lives and backgrounds.

The authors looked at attrition, which they define as withdrawal or dismissal from medical school for any reason, among about 33,000 allopathic medical students during the academic years 2014-2015 and 2015-2016. They compared attrition rates among students across three groups: those who belonged to a race and/or ethnicity underrepresented in medicine (URiM), were low income, or grew up in an underresourced neighborhood (defined as one that is medically underserved). They also compare rates between these groups and students identifying as non-Hispanic white.

The results show higher attrition rates among students from all three groups compared to their counterparts and to the overall attrition rate. The rate for URiM students was 5.6%, compared with 2.3% for non-Hispanic whites. For low-income students versus those without low income the rates were 4.2% and 2.3%, respectively. And students who grew up in underresourced areas had an attrition rate of 4.6%, versus 2.4% for those who did not. The overall rate during the two academic years was 2.8%.

The study also reveals that attrition rates increase along with a student’s number of coexisting marginalized identities. The rate among students who were neither URiM, low income or from underresourced neighborhoods was 1.9%. In contrast, those who identified with all three identities had an attrition rate of 7.3%.

In addition, the authors note an association between race/ethnicity and attrition. Regardless of socioeconomic status, students belonging to URiM groups had attrition rates comparable to those of non-Hispanic white students who were low income and grew up in underresourced neighborhoods.

The authors say that while the reasons for higher attrition rates between students URiM students and non-Hispanic whites are “multifactorial,” these students “experience interpersonal and structural barriers that impact their experience during medical school.” Among these are a lack of mentors and role models, microaggressions and discrimination in the form of bigotry from patients and faculty, biased evaluations, and inequities in academic rewards.

“These experiences of social isolation, racism, and discrimination have been associated with burnout, depression, and attritionand highlight the need for medical schools to adopt a more proactive antiracism strategy,” the authors say. Such a strategy would include financial and administrative support for diversity, equity and inclusion offices, and requiring the Liaison Committee on Medical Education to monitor and attrition or early signs of it, such as leaves of absence.

They also recommend shifting retention efforts “away from deficit-based to strength-based models that emphasize recognition of individual students’ talents.” Such models, they say, have helped college students recognize their value and been associated with “higher engagement, retention, and sense of professional identity formation.”

The study, “Association of Sociodemographic Characteristics With US Medical School Attrition” was published online July 11 in JAMA Internal Medicine.