医学院面试素材一

从今天开始，我将与大家不定期分享医学院面试的素材，帮助大家做好面试准备。文章主要是为申请人本人准备，所以不做翻译工作了，望见谅。

本篇文章系转载，主要讨论的是DEI，我本人也是学校的DEI部门的成员，对此深有体会。一方面DEI能够让所有人的利益都得到重视，尊重，让大家更愿意表达自己；另外一方面，DEI做的不好的地方，有很多潜在的危险，如文中提到的；你自己可以想到一些吗？比如中医西医？比如。。。。

Even as the U.S. grows more diverse, the medical professionis slow to follow

 

I’ve never cared for a Hmong child, but I often think aboutwhat it would be like.

 

The summer before we started medical school, I and otherstudents were advised to read Anne Fadiman’s “The Spirit Catches You and YouFall Down.”

 

The book chronicles the illness of Lia Lee, a Hmong girlwith severe epilepsy, and her family’s saga navigating the American medicalsystem. The Hmong come from Southeast Asia.

 

The story has become a symbol of the sometimes devastatingconsequences of a cultural divide — a cautionary tale of miscommunication,misperception and mistrust, culminating in a catastrophic two-hour seizure andpermanent brain damage. Lia died in 2012, after living the last 26 years of herlife in a persistent vegetative state.

 

This is, of course, an extreme case — and there are fewerthan 300,000 people of Hmong descent living in the United States. But many ofthe cultural, structural and language barriers that plagued Lia’s experienceremain pervasive in medicine and may be more important than ever, amid growingracial and ethnic diversity in the United States.

 

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But even as we care for an increasingly diverse patientpopulation, we haven’t done enough to diversify the medical profession. Between1978 and 2008, 88 percent of graduates of U.S. medical schools were white orAsian. Blacks, American Indians and Hispanics together made up the remaining 12percent. And while in some cases we’ve made progress, in others, we’re actuallymoving backward.

 

A new working paper provides compelling evidence for how amore diverse medical workforce could improve health outcomes. Researchersrecruited more than 1,300 black men in Oakland, Calif., and randomly assignedthem to either a black male doctor or a nonblack male doctor in the sameclinic. Before meeting their doctors, patients selected which preventivescreening tests they would like, if any. These included both noninvasive tests,such as blood pressure measurements, and invasive tests, such as diabetes andcholesterol screening, which require blood samples.

 

Initially, all patients chose roughly the same number ofscreening tests. But after a conversation with their doctor, black men with ablack doctor were substantially more likely to opt for every test than thosewith a nonblack doctor. The effect was particularly pronounced for invasivetests, which require more trust between doctor and patient: Patients with blackdoctors were 47 percent more likely to get diabetes screening and 72 percentmore likely to get cholesterol tests.

 

“I was really surprised by the size of the effect,” saidMarcella Alsan, lead author of the study and an associate professor of medicineat the Stanford School of Medicine. “We wanted to go beyond just documentingdisparities and see if there was a way to intervene. This seemed to have abigger impact than we expected.”

 

Black men paired with black doctors were also much morelikely to discuss their other health problems, and black doctors wrote morenotes about their patients — including about personal problems they werestruggling with — than did nonblack doctors.

 

“I never approach patients based on race alone, but there’sno doubt it’s an important factor at times,” said Oluwaferanmi Okanlami,director of medical student success in the Office of Health Equity andInclusion at Michigan Medicine. “Medical encounters are inherentlyuncomfortable, and people often yearn for a sense of familiarity. I’m much morelikely to hear ‘I’m so happy to have a black doctor!’ when I’m caring for ablack patient than a patient from another background.”

 

On average, black men in America die nearly half a decadeearlier than white men, and have among the shortest life expectancies of anymajor demographic group. Having more black doctors might reduce deaths causedchronic disease, but many black men don’t have the opportunity to see doctorswho look like them. Nor do members of other racial and ethnic groups.

 

During a period of large demographic shifts across theUnited States, changes in the physician workforce haven’t kept up. Since 1978,there has been just a four- percentage-point increase in the proportion ofHispanic medical school graduates and less than a two-point increase in blackgraduates. The number of black men in medical school has actually declinedsince the 1990s, and black women now outnumber black men 2 to 1 in medicalschool.

 

In 2012, blacks and Hispanics made up more than 30 percentof the U.S. population, but only 14 percent of medical school graduates andless than 10 percent of practicing physicians.

“There’s a severe under­representation of certain minoritygroups in medicine,” Alsan said. “And an increasingly strong argument to fixthat.”

 

While individual interactions between doctors and patientsare important, a more diverse physician workforce could also have broadereffects. It could help us move toward a system in which the lived experience ofminority groups is better understood and validated, and the barriers they face morereadily identified and addressed.

 

Black, Hispanic and immigrant physicians are, for example,much more likely to practice in underserved areas and to care for uninsuredpatients and those on Medicaid. They’re also more likely to choose specialtieswith doctor shortages, such as primary care and pediatrics.

 

But many effects are more subtle: biases confronted,research questions asked, new perspectives recognized.

 

“This is about creating a system with more structuralcompetency,” said Lisa Cooper, the Bloomberg Distinguished Professor in HealthEquity at Johns Hopkins Medicine. “It’s about giving doctors the skills,knowledge and attitudes to understand the many societal and historical factorsthat affect health, instead of thinking of health as something that’s just theresult of individual choices and behaviors.”

 

One study found that half of medical students and residentshold erroneous beliefs about biological differences between blacks and whites,such as believing that blacks have thicker skin, that their blood clots fasteror that they have less-sensitive nerve endings. Perhaps unsurprisingly, blackAmericans are systematically undertreated for pain. Other research finds thatdoctors are less patient-centered and more verbally dominant with minoritiesand that they show less empathy in end-of-life conversations with thesepatients.

 

More diversity could help. Students who attend medicalschools with more-diverse student bodies feel more prepared to care forpatients from different backgrounds. And more-diverse research groups may bemore likely to explore the interests of marginalized populations and to publishmore impactful studies.

 

More broadly, research suggests that greater exposure topeople of other backgrounds can reduce bias and that black patients who aretreated at hospitals with more-diverse patient populations fare better —possibly because doctors are more familiar with their social and culturalcircumstances.

 

“The argument for more diversity is really one aboutchanging the overall climate,” Cooper said. “Diversity brings new energy andcreativity. It allows physicians to learn from one another and to focus onproblems that may not have been recognized before.”

 

Despite advances in treatments and technologies, medicineremains a fundamentally human field. The care we give and the care we receiveis powerfully influenced by the interactions between doctor and patient.Progress toward a more equitable system will require focusing not only on who’son the exam table but also on who’s beside it.

Khullar is a physician at NewYork-Presbyterian Hospital, anassistant professor in Weill Cornell’s medicine and health-care policy andresearch departments, and director of policy dissemination at the PhysiciansFoundation Center for Physician Practice and Leadership. Follow him on Twitterat @DhruvKhullar.