Letters to the Editor
We agree with Dr. Boateng and Dr. Thomas that social isolation is an important barrier to success among underrepresented minority students (URMs), and we feel for their frustration at the complexity and slow progress on this important issue. Cultural distance for URM students is likely greater than for non-URM students and can affect socialization and interpersonal skills that are valued during medical school such as networking, self-promotion, and reflection. Curricula that foster cultural competency, explore issues of diversity, and promote professionalism are essential to prepare students to care for patients of all backgrounds and circumstances. However, students' problems with interprofessional behavior, social norms, and support mechanisms cannot be fully modified through curricular changes. Nor can medical school curricula overcome, or be responsible to teach methods to overcome, cultural and social barriers due to socioeconomic status, cultural distance, and social norms.
These complex barriers make themselves known through negative social and psychological experiences that students have encountered throughout their lives. Strategies to deal with these barriers are much more specific to the individuals involved and cannot be addressed through melding and generalizing students' experiences in a structured manner. But there are ways that medical schools can help. For example, schools can offer support through increasing the number of URM students, having student activities about diversity, and providing social and cultural outlets. Also, having a place where students feel comfortable discussing their experiences of cultural and social barriers is critically important. And helping students address frustrations with poor clinical evaluations and learn concrete approaches to improve the evaluations is also essential. Other approaches include having well-staffed offices for diversity, having student societies, and encouraging students to use their external support systems, including family and religion.
We encourage medical schools to simultaneously focus on curriculum and “downstream” social factors important for URM students' success. Medical schools are optimally positioned to partner on a long-term basis with local pipeline institutions and form new models for the future. We should not be discouraged and should continue to improve student1 and faculty diversity2 and seek innovative strategies to ensure academic success for URM students.
Kara Odom Walker, MD, MPH, MSHS
Assistant clinical professor, Department of Family and Community Medicine, University of California, San Francisco, School of Medicine, San Francisco, California; firstname.lastname@example.org.
Gerardo Moreno, MD, MSHS
Assistant clinical professor, Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
1 Saha S, Guiton G, Wimmers PF, Wilkerson L. Student body racial and ethnic composition and diversity-related outcomes in U.S. medical schools. JAMA. 2008;300:1135–1145.