The underrepresentation of minorities in medical schools, in academic awards and recognitions, and in medicine continues to be a challenge for the medical profession, medical organizations, and for Alpha Omega Alpha Honor Medical Society (AΩA). As an organization that has as its motto “Be Worthy to Serve the Suffering,” AΩA has worked, and will continue to work, to ensure the development of diverse leaders, fostering within them the objectivity and equity to be inclusive servant leaders who understand and embrace diversity in all its forms. We welcome and appreciate the perspective of Icahn School of Medicine at Mount Sinai (ISMMS), its faculty, students, AΩA members, and chapter councilor, whose Perspective1 in this issue raises the profile of this discussion in search of tangible progress. We, with the support, resources, and energy of AΩA and its membership, are committed to join in solutions. To put it succinctly, our outlook is: How can we help?
Since 1902, AΩA has been an interdisciplinary membership organization with a distinguished history of service to medicine, our profession, society, and our patients. AΩA members firmly believe that in the profession of medicine we will improve care for all by recognizing high educational achievement, honoring gifted teaching, encouraging the development of leaders in academia and the community, supporting the ideals of humanism, and promoting selfless service to others. Membership in AΩA emphasizes the worthiness of the physician through medical practice, scientific discovery, and service.
More than 100 years ago, in 1906, AΩA led the nation in ensuring equality in its membership by inducting its first female member, and amending its Constitution to read:
Women are admitted on the same terms as men. In fact, race, color, creed, sex, and social standing form no barrier to membership, the only qualifications necessary being scholarship and character.2
A Commitment to Diversity, Inclusion, and Equity
AΩA maintains its commitment to diversity, inclusion, and equity to all of its members—past, present, and future—and to the profession of medicine in a number of ways.
We acknowledge and recognize that as a national medical honor society we can, and always should, do more to increase the number and support of underrepresented groups in medical schools, AΩA membership, and the medical profession. These efforts include students, residents, faculty, and those in community practice. The AΩA national office, along with its medical school chapters will continue to advocate for and support increasing diversity, inclusion, and equity efforts in medical schools, in medical specialties and subspecialties, and throughout the medical profession.
We also inform and educate AΩA chapters, members, and students about the importance of inclusion, diversity, and equity by working with AΩA chapters to continually improve the eligibility and election processes for AΩA membership.
In addition, we respect the covenant set forth for more than 100 years ago in the AΩA Constitution, which states, “No candidate shall be denied election because of age; race; color; ethnicity; religion; national origin; sex; pregnancy status; gender identity or expression; sexual orientation; physical or mental disability; marital, civil union, or domestic partnership status; veteran status; socioeconomic status; or any other characteristic protected by the Equal Opportunity and Affirmative Action laws.”3
Further, we work with medical schools on the mitigation of biases—both conscious and unconscious—in medical education; in medical student, resident, and faculty assessments; and in the AΩA nomination, selection, and election processes to foster elections that are unbiased, fair, and nondiscriminatory. As Teherani et al4 observe, any biases inherent in the subjective clinical rotations of the third and fourth years of medical school may reflect on student evaluations and award selections. Medical school should be a safe, unbiased, inclusive, and diverse educational environment where excellent physicians, healers, and medical professionals can learn to care for patients so that they can become tomorrow’s leaders in medicine and be worthy to serve the suffering. This is why AΩA will continue to work with its chapters, councilors, and selection and election committee members to understand possible biases throughout medical school and pursue the goal of eliminating bias from the admissions process through graduation, into residency, and throughout a physician’s career.
We also support medical school efforts to increase diversity in medical school admissions by recognizing and promoting pipeline programs that encourage underrepresented minority students to apply and gain acceptance to medical school. We will continue to support the use of a holistic admissions process, as set forth by the Association of American Medical Colleges holistic review initiative,5 as an effective strategy to select matriculants who can enrich the educational environment and bring increased cultural competence and awareness to medical education and the care of the patient.
Additionally, we assist in advancing medical school initiatives to achieve a more inclusive and equitable learning environment and workforce; advance performance assessment tools; and promote faculty development programs to alleviate racism, bias, and discrimination in medical education and health care.
We also support the development of diverse leaders, fostering their objectivity to be servant leaders who understand and embrace being role models.
Membership in AΩA
All medical students (on entry to medical school), residents, fellows, and physicians throughout their career are eligible for nomination and election to AΩA membership. Members are elected as medical students, residents, fellows, faculty, and alumni by local medical school chapter members (students, residents, fellows, faculty, and alumni) who assess each nominee’s accomplishments, competence, character, caring, and life experiences that have collectively made them excellent students, residents, fellows, faculty members, or practicing physicians, and admired members of the medical profession.
The criteria for nomination include scholastic achievement, demonstrated professionalism, leadership capabilities, adherence to ethical standards, fairness in dealing with colleagues, achievement in teaching and learning, scholarship, and a record of service to school and community. Membership in AΩA recognizes excellence at each level of education and experience in becoming and being a physician, including trustworthiness; character; leadership; scholarly achievement; clinical competency and excellence; compassion; honesty; caring; professionalism; and service to patients, team, colleagues, and community.
“Scholastic achievement” refers to the qualities of becoming and being an excellent physician, such as knowledge, clinical care, patient care skills, competence, character, trust, trustworthiness, professionalism, communication and relationship skills, decision making, teamwork, lifelong learning, and leadership. Depending on the mission and goals of each medical school, “achievement in learning” could also include consideration of unequal barriers candidates faced at any level of education and in their personal lives, and how those were overcome. Measures of excellence vary across the continuum of education, training, and practice. The choices of these measures are made by faculty and peers, professional organizations, state medical boards, patients, and colleagues. AΩA recognizes these assessments and evaluations in defining excellence as a physician and that they do, and should, evolve to reflect the values of the profession and evolution of assessment measures.
Each AΩA chapter and its members develop and use their medical school’s series of assessments and rubric based on AΩA national criteria to evaluate nominated students’ progress toward becoming an excellent physician. They develop and modify the metrics and rubric that determines their election criteria as best fits their medical school and their medical school’s mission, as well as their learning objectives and assessments. All members of each medical school’s chapter are eligible to vote for new members. Each chapter then selects up to 16% of its graduating class, up to 25 residents/fellows, 3–5 faculty, and 3–5 alumni as new members of AΩA annually.
AΩA aspires to elect members who are developing into, or have become, excellent physicians. Today, there are 132 AΩA chapters in medical schools in the United States, Puerto Rico, and Lebanon. Nearly 200,000 distinguished physicians, researchers, and scholars of all races, creeds, colors, religions, genders, and medical or surgical specialties have been elected to membership in AΩA.
AΩA has been, and continues to be, committed to ensuring access to medical education and membership in AΩA for historically underrepresented racial/ethnic groups including African American, Latino/Hispanic, Native American/Alaskan, and any other group traditionally considered underrepresented in medicine or the population of the United States.6 Each medical school also has its own unique regional and/or local perspective on underrepresentation based on its mission. In addition, the Liaison Committee on Medical Education requires each school “ . . . to achieve mission-appropriate diversity outcomes among its students, faculty, senior administrative staff, and other relevant members of its academic community.”7 Likewise, it is imperative that each AΩA chapter consider and integrate diversity, inclusion, and equity—in general and in the context of their school’s mission—when undertaking the AΩA election process.
To further advance diversity, inclusion, and equity in medical schools and their related AΩA chapters, AΩA recently established the AΩA Award for Excellence in Inclusion, Diversity, and Equity in Medical Education and Patient Care, and in October 2019 announced the first 4 award recipients: Meharry Medical College, State University of New York Upstate Medical University, The Johns Hopkins University School of Medicine, and University of North Dakota School of Medicine and Health Sciences.
AΩA’s Commitment to the Profession
AΩA is resolute and purposeful in its commitment to improving diversity, inclusion, and equity. We affirm that inclusion of talented individuals from different backgrounds benefits patient care, population health, education, and scientific discovery. AΩA values an inclusive, diverse, fair, and equitable work and learning environment for all and supports the medical profession in its work to achieve a welcoming, inclusive environment in teaching, learning, caring for patients, and collaboration.
This is why AΩA is committed to working with the students, faculty, and alumni of ISMMS and other schools that are working diligently to ensure that student voices are heard and recognized as they express their perceptions and beliefs that flaws in the structure of medical education and assessment have led to certain students being entitled over others. AΩA has been engaged with students, faculty, leadership, and community members who have shared with us their open exploration of these complex issues and potential solutions. They are to be commended for recognizing potential inequities in medical education that often reflect societal inequities and for their willingness to work with AΩA, and others, in making a sincere effort toward progress.
AΩA is pleased that ISMMS decided to maintain an active chapter and will continue to elect residents, fellows, faculty, and alumni. ISMMS elected 25 of their residents as new members in 2019. This is one more step in AΩA’s and ISMMS’s long-standing partnership that recognizes exemplary students, residents, fellows, faculty, and staff.
However, it is unfortunate that some students and faculty at ISMMS believe the evaluation of students in medical school to be so flawed in their school that there is little-to-no chance of reinstating medical student AΩA elections there. Indeed, if the school has committed to work toward unbiased assessment of students, this would help improve equitable selection to AΩA, and ongoing evaluation of the outcomes of election of their medical students to AΩA would provide a tangible measure of progress.
Medicine and medical education have changed dramatically since AΩA was established in 1902. Diversity in medicine and medical education has not kept pace with the progressive diversification of the U.S. population. AΩA continues to work with its members, medical schools, academic health centers, private practices, research laboratories, medical associations, and the general public to ensure that the practice of medicine is representative of our communities, society, and the general population.
The diversity of medical schools—students, residents, fellows, and faculty—is changing and will continue to change. AΩA is committed to continuing to work with its members, medical school deans, and AΩA chapters to ensure that AΩA elections—for students, residents, fellows, faculty, and alumni—are unbiased and based on the values of AΩA and the profession of medicine in service to our patients.
Progress toward inclusivity, diversity, and equity is more than simply checking off a box or responding to criticism—it is about being and developing excellent physicians. AΩA looks forward to continuing its work with ISMMS, and all of its 132 chapters in medical schools across the United States, in Puerto Rico, and in Lebanon, to develop the next generation of medical professionals who are servant leaders caring for all patients. We must continue to guide medicine to be unbiased, open, accepting, inclusive, and culturally aware to “Be Worthy to Serve the Suffering.”