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A Proposal for Avoiding Bias in Medical School Admissions Decisions

Hubbeling, Dieneke MRCPsych

doi: 10.1097/ACM.0000000000001635
Letters to the Editor

Consultant psychiatrist, South West London and St. George’s Mental Health NHS Trust, London, United Kingdom;

Disclosures: None reported.

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To the Editor:

Dr. Capers and colleagues reported how members of the admissions committee of Ohio State University College of Medicine were showing signs of implicit racial bias.1 After individual members became aware of their own score on the black–white implicit association test, a more diverse group of students was admitted. The authors rightly argued that more research into implicit bias is necessary and that interventions need to be developed to counteract its influence in academic medicine. However, I believe that there is another option available to avoid bias in admissions decisions.

Being aware of biases does not always reduce their influence.2 The increased number of students from minority groups that Dr. Capers and colleagues observed could have other causes—for example, “overcorrecting” for biases by using different admissions standards. The authors note that some survey responses reflected “the possibility that having been made aware of their implicit white preference, admissions committee members may have modified their behavior in the subsequent admissions cycle.”

When auditioning for an orchestra, musicians play behind a screen and members of the appointing committee can judge musical capabilities without knowing the identity of the candidate. This procedure does exclude racial bias. However, there is no equivalent method for admission to medical school, and all current selection methods probably have some kind of bias which cannot be excluded without majorly changing the process by which we select candidates.

A lottery is currently the only available procedure that is definitely not biased.3 To avoid biases at all costs, once candidates have reached a certain minimum academic standard, they should be chosen by lottery for admission. Otherwise, one has to accept that admissions decisions clouded by biases—or by overcompensating for biases by using different standards—are realistic possibilities.

Dieneke Hubbeling, MRCPsych

Consultant psychiatrist, South West London and St. George’s Mental Health NHS Trust, London, United Kingdom;

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1. Capers Q, Clinchot D, McDougle L, Greenwald AG. Implicit racial bias in medical school admissions. Acad Med. 2017;92:365–369.
2. Cain DM, Loewenstein G, Moore DA. The dirt on coming clean: Perverse effects of disclosing conflicts of interest. J Legal Stud. 2005;34:1–25.
3. Hubbeling D. Lottery for medical school admission. Med Teach. 2017;39:222–223.
© 2017 by the Association of American Medical Colleges