Diversity in Medical Schools—Need for a New Bold Approach

In this issue of JAMA, Montgomery Rice details the wrenching history of Black men and women and medical education and the many challenges still thwarting the long-standing goal of increasing diversity in US medical schools. 1 From her purview as dean at Morehouse School of Medicine, she offers unique insights and specifically illuminates the failure to increase the enrollment of Black medical students, especially at new medical schools, many of which have explicitly adopted diversity as a foundational pillar of contemporary mission statements.As a consequence, the medical schools serving historically Black colleges and universities (HBCUs) carry an outsize role in training Black medical students, but true diversity continues to lag.A different model is needed to fully address diversity in medicine.In a recent report in JAMA Network Open, Campbell et al 2 evaluated the legacy and consequences of the Flexner Report, which prompted closure of 5 Black medical schools at a time when strict segregation forbade admission of Black students to most other medical schools.Black men and women were nearly completely expunged from medicine.The consequence of those closures substantially reduced any meaningful capacity to educate Black men and women as physicians and led to an estimated deficit of approximately 30 000 Black physicians over the past century through 2019. 2 In the 2019-2020 academic year, 21 863 first-year medical students were enrolled in the US, including 1626 Black medical students (7.4%), of whom 62% were women and only 617 (2.8%) were men-a number that has been stagnant since 1978.3 These metrics are halting; no ideal threshold qualifies as the goal for percent diversity to achieve, and quotas are unacceptable, but the current representation is clearly insufficient and fails to fully serve the population, especially at-risk communities.As noted in the Viewpoint by Montgomery Rice, Medical College Admission Test (MCAT) scores remain the most important gatekeeper for admission to medical school.A base requirement for the requisite aptitude needed in medical school should be unwavering, yet a more holistic assessment of measures of success argues that skills and attributes not captured by MCAT scores may well associate better with success as a physician.Moreover, the precious separation of medical school rankings by fractions of a point drives an emphasis on those metrics that are most readily modifiable, particularly the threshold MCAT score for medical school admission.The current system as configured, despite the important contributions by the 4 mostly Black medical