Thread by @soumya_goblue

So I read this trainwreck of an article from beginning to end. I have thoughts. This article is clearly racist, "blaming" underrepresented in medicine minorities (Black and Latinx Americans) for not being "good enough" to be cardiologists, and also whiny ahajournals.org/doi/10.1161/JA…

At start, while Dr. Wang provides useful historical context, he already introduces his (wrong) opinion on why URM numbers are low: "AAMC short‐term goal was missed because of a paucity of qualified candidates, particularly blacks" qualified URMs are not mentored in colleges...

He blames "holistic admissions processes" for creating a track only for whites/Asians based on objective tests and grades, and "subjective" criteria for Blacks/Hispanics causing "Severe academic difficulties for underrepresented minorities were noted as early as the mid‐1970s"

I think about the fact that if Brock Turner, the Stanford rapist, had never been caught - he probably would have had the objective tests and grades to become a doctor. Hmm, maybe we should do "holistic admissions" that include...not being a rapist or sociopath for...everyone?

Re: Grutter v. Bollinger, well known to me as a @UMich alumna, who was on campus when case was decided, but after I had been accepted/enrolled. My entering class, 2002, was quite diverse, both ethnically and socioeconomically...when that case was decided, that drastically changed

Since that case, the undergrad campus has morphed into largely very wealthy white and Asian students. That in turn, has led to large changes both in learning (less breadth of knowledge from not interacting with diverse classmates) as well as changes in the city: cost of living...

has drastically increased in #AnnArbor. Many local businesses (including the Shaman Drum bookshop amongst others) were pushed out of our central campus area as rents became higher; Poorer students were pushed out to outer cities, causing "ghettoization" of those areas.

It's been decades since that SCOTUS decision, and we're still trying to reverse effect it had on student body and city (with people like @lsong) advocating for more affordable housing. Simply put, race neutral admissions don't work, because the whole system is inherently racist.

"Yet he minimized high attrition rates for academic reasons and high unmatched rates for graduate medical education programs that had been reported for underrepresented minorities" - URMs are not matching because programs are not using right criteria to recruit diverse applicants

He uses tiny study out of one institution, U of Maryland, where 7 Black Students and 1 Hispanic student failed Step 1, to say, what exactly? "This occurred despite “unlimited hours for tutoring...including Kaplan preparatory courses, for blacks and Hispanics." URMs are dumber?

(Btw, my Black co-med students did better on Step 1 than I did, as an Asian person 🤯). And a research and mentoring program for URM Junior Faculty? So they can get their foot in the door that the vast majority of white and Asian applicants already have through doctor family? 😱

@OhioStateMed Cardiology "we simply made it a priority to rank [underrepresented in medicine] applicants more aggressively than in previous years, thus achieving success in matching them regardless of recruiting" - @DrQuinnCapers4 photos from interventional suite are inspiring

Oh, yay here's the whining about how Asians have it so bad, written literally by an Asian cardiologist at UPitt: 🙄"Asians have not only been subject to historical discrimination in education but are also held to higher academic standards for medical school admissions...

obscures the fact that Asians would be the group most negatively affected by racial and ethnic balancing.55, 61 Demographic balancing necessitates affirmative action for underrepresented groups and negative action for “overrepresented” groups."
I'm Asian, but I'm not a whiner and

"recent African immigrants and Afro Caribbeans should be excluded from the African American group"...literally having black skin makes a person a target of police brutality and discrimination in the United States, not the history of slavery alone.

I do see the point of Hmong, and other relatively poor Asian populations not being grouped with wealthy South Asians or East Asians (Chinese, Japanese, South Koreans), but this can be done without throwing Black and Hispanic applicants under the bus...

Many discussions have occurred elsewhere that MCAT is a racist test - Dr. Wang is again impyling Black and Hispanic students are...less intelligent? "Differences for MCAT scores by racial and ethnic groups have been long been observed, even when accounting for parental income"

Here we go demonizing primary care now: URMs only becoming PCPs because they didn't have "chops" for competitive fields (like cardiology) "working in an underserved area may be attributable to inability to secure a job in other areas because of low professional qualifications."

"A recent systematic review demonstrated that better communication was present on several metrics, but not quality, when patient and physician racial and ethnic concordance was present." but ONE STUDY showed Hispanic men did not like certain aspects of having Hispanic doctors!

"race and ethnicity was no longer associated with differences in outcomes after accounting for social determinants of health....more clearly associated with both biological and social constructs" - far more Blacks and Hispanics are affected by poor SDOH -this is splitting hairs

FINALLY SOMETHING I AGREE WITH: "Therefore, efforts applied to cardiovascular disease training programs at the trainee and faculty levels are unlikely to be successful. Any successful intervention must increase the qualified medical school applicant pool."

That didn't last long: "Racial and ethnic preferences...for blacks and Hispanics result in relatively weak academic starting positions...This has been postulated to lead to poor performance through compounding “academic mismatch,” stress‐related interference, and disengagement."

Yet again, Dr. Wang insinuating Black and Hispanic students are less intelligent, which is patently FALSE -it is due to lack of mentoring, home-related stress (has he even mentioned financial stress once? How do you keep up the same grades when working 3 jobs in college? etc.)

He again goes into differential failures in Step 1, not taking into account there are VASTLY more whites and Asians than Blacks and Hispanics taking #USMLE Step 1, and the percentages he provides are not comparable. (also old, numbers from 1990s, when there were even less URMs)

And as to matching, there is evidence that a lot of residencies use very subjective criteria for matching, including research/publications URMs may have less access to due to less mentorship (@jbcarmody has a great thread about this)

https://twitter.com/jbcarmody/status/1289395047008309248

As well as things like physical attractiveness, using Eurocentric features. Are there programs that won't match the African American medical student with dredlocks even if they have a 240 USMLE Step 1? pubmed.ncbi.nlm.nih.gov/31149924/

"standardized tests are present at all stages of credentialing in medical profession. Accepting lower MCAT scores...will naturally lead to recommendations to decrease other downstream objective expectations for those groups" so? #MCAT and #USMLE do not correlate with good doctors

Oy, finally to the conclusion. Is he...comparing a professional tennis player to the medical education pipeline? "Affirmative action tends to undermine the spirit of individual initiative. Such is human nature; why struggle to succeed when you can have something for nothing?”

I'm done. Finally. I'm just going to say, articles like this are why #Cardiology gets a bad reputation for being non-diverse, conservative, and not progressive or innovative (at least in socioeconomic/policy realms). It's not true, but this is not a good look, @American_Heart

@threadreaderapp unroll, please