Tea at Trianon: The End of Merit in Med Schools

John Wilson Croker on Marie-Antoinette

"We have followed the history of Marie Antoinette with the greatest diligence and scrupulosity. We have lived in those times. We have talked with some of her friends and some of her enemies; we have read, certainly not all, but hundreds of the libels written against her; and we have, in short, examined her life with– if we may be allowed to say so of ourselves– something of the accuracy of contemporaries, the diligence of inquirers, and the impartiality of historians, all combined; and we feel it our duty to declare, in as a solemn a manner as literature admits of, our well-matured opinion that every reproach against the morals of the queen was a gross calumny– that she was, as we have said, one of the purest of human beings."

~from History of the Guillotine by John Wilson Croker, 1844

Edmund Burke on Marie-Antoinette

"It is now sixteen or seventeen years since I saw the queen of France, then dauphiness, at Versailles; and surely there never lighted on this orb, which she hardly seemed to touch, a more delightful vision. I saw her just above the horizon, decorating and cheering the elevated sphere she had just begun to move in, glittering like a morning star full of life and splendor and joy. Oh, what a revolution....Little did I dream that I should have lived to see such disasters fall upon her, in a nation of gallant men, in a nation of men of honor and of cavaliers! I thought ten thousand swords must have leaped from their scabbards, to avenge even a look which threatened her with insult. But the age of chivalry is gone; that of sophisters, economists, and calculators has succeeded...."

~Edmund Burke, October 1790

Wednesday, April 10, 2024

The End of Merit in Med Schools

From Roger B. Cohen:

The medical profession’s leaders, almost without exception or dissent, now vigorously enforce this new orthodoxy of anti-racism. Most notably, they have designed and implemented a new version of medical education explicitly grounded in ideology rather than scientific excellence. In pursuit of this project, the president of the AAMC (which accredits U.S. medical schools) and the chair of the AAMC’s Council of [Medical School] Deans stated publicly in July 2022: “We believe this topic [Diversity, Equity, and Inclusion] deserves just as much attention from learners and educators at every stage of their careers as the latest scientific breakthroughs.”

The AAMC’s DEI Competencies, issued in October 2021, details the new required social justice skills that medical students must acquire. In addition, the AAMC has discouraged the use of the rigorous Medical College Admissions Test (MCAT) as a filter to help select medical students. Dozens of the 158 allopathic (MD granting) U.S. medical schools have made the MCAT optional. Several medical schools, including the prestigious University of Pennsylvania, have programs to admit students from designated “underrepresented” identity groups without requiring the submission of MCAT scores at all. The MCAT itself has been revised to include social justice questions that are easy to ace because the answers are always the same: structural racism is the cause of any group disparities that disfavor underrepresented groups. But even this re-engineered test shows persistent group disparities in test scores, which means that Asian applicants must score almost 4 times higher than black applicants to have an equal chance of admission.

Large discrepancies in qualifications, which endure despite strenuous efforts to dumb down the MCAT, have spawned the euphemistic practice of “holistic review” of medical school applicants, “a process that considers each applicant individually by balancing their academic metrics with experiences and attributes.” The search for a so-called “new excellence” in how medical applicants are chosen places diversity, equity, and inclusion at its core; reduces reliance on demonstrated scientific knowledge and proficiency; and emphasizes applicants’ “attitudes, values, and experiences.” Under holistic review, “it’s the journey, not the destination” that counts.

This reckless demolition of longstanding standards now extends to medical licensing exams. In an effort to reduce purported “racial bias” against self-identified black, Asian, and Hispanic examinees who score lower than self-identified whites, the Step 1 federal licensing exam, taken at the end of the second year of medical school, is now pass/fail and no longer numerically graded. This change works to the disadvantage of graduates of foreign and lower-ranked U.S. medical schools who rely on their performance on that exam to demonstrate excellence and their future potential as physicians.

Medical academia’s efforts to deemphasize testing and reduce the importance of exam-based proficiency comes at a time when other institutions are moving in the opposite direction. Prestigious colleges such as Yale, MIT, Brown, and Dartmouth have recently reinstated the requirement that applicants submit scores on the SATs. Why? Because SAT scores are the best predictor of academic performance and mastery. And in a world of rampant grade inflation and resumé padding, the tests are vital to identifying academically promising candidates who might otherwise be overlooked. The same factors apply to medical school admissions. The MCAT is the most reliable and least manipulable gauge of the types of skills that enable students to do well in medical school and beyond. It is foolish and reckless to abandon the test because all groups do not perform equally. (Read more.)