Calls to attain a critical mass of underrepresented minority (URM) students, while popular within educational circles, must never be viewed as a stand-alone panacea. Indeed, increased numbers alone may be neither necessary nor sufficient to foster educationally meaningful diversity. As we found in our original research,1 majority faculty had a much different image of what constituted a critical mass of minority students than did minority faculty, including how and where those students were situated within the larger social network. Thus, while the point may be obvious, simply increasing the numbers of URM students without altering the broader social and cultural contexts of educational practices may lead only to continued marginalization and isolation. Groups of students can be just as much outliers (in network terms) as individuals can. Moreover, while the term critical mass has its origins in the field of physical chemistry, social life is infinitely more complex than a chemical reaction—and thus social groups require far greater, and ongoing, attention to the factors that initiate and activate self-sustaining change than do their chemical counterparts.
The authors' point about curriculum, while hopeful, also needs further contextualization. Almost 20 years ago, Hafferty and Franks2 argued that “merely” adding more ethics courses to a medical school's curriculum would do little to halt the ethical erosion of students and physicians widely cited in the medical education literature. Instead, they pointed to a hidden curriculum of ethics instruction that could (and often did) counteract or nullify what was taking place in the classroom.
This is not to suggest that increasing the numbers of URM students and/or courses would be an exercise in futility. Indeed, such actions can serve as markers that a given school is serious about diversity and inclusion. However, enacting any change(s) in isolation or without regard for the surrounding social or organizational context is unlikely to be successful—as noted in the authors' reference to the underperforming (at least in terms of expectations) AAMC Project 3,000 × 2000. Similarly, significant increases in the number of women in medicine have addressed some, but not all, of the gender inequities and sexism historically pervasive in the profession of medicine.
The social isolation of URM students, then, is a systemic problem that requires bottom-up, emergent, and relational solutions. Identifying the variety of activation points/targets (e.g., organizational mission and values, recruitment and hiring practices, leadership development, campus climate, student services, research programs, patient interactions, and community involvement) and the synergies that link them is the principle challenge facing us now. Networks link not only people but also social structures and practices.
Frederic W. Hafferty, PhD
Professor of medical education and associate director, Program in Professionalism and Ethics, Mayo Clinic, Rochester, Minnesota; firstname.lastname@example.org.
Terry D. Stratton, PhD
Associate professor, Department of Behavioral Science, and assistant dean for assessment and quality management, University of Kentucky College of Medicine, Lexington, Kentucky.
Paul Haidet, MD, MPH
Professor, Departments of Medicine, Humanities, and Public Health Sciences, and director, Medical Education Research, Penn State University College of Medicine, Hershey, Pennsylvania.
Carol L. Elam, EdD
Professor, Department of Behavioral Science, associate dean for admissions and institutional advancement, and director, Medical Education Research, University of Kentucky College of Medicine, Lexington, Kentucky.