Wednesday, May 21st, 2014

Bias in the Medical School Admissions Process

Tehreem Rehman

The long and cumbersome process of applying to medical schools has finally come to a close this month for applicants starting medical school in the fall. Stressful years of hard work seem to boil down to one or two interviews at each school. Unfortunately, this process can be particularly toiling emotionally and psychologically.

Recent accounts from my peers about encountering prejudice in the application process triggered reflections on my own experiences of encountering racism and sexism as a Muslim woman of color applying to medical schools in this country. I was in the fortunate position of being offered fifteen interviews across the nation. As a Women’s & Gender Studies major at Columbia University, I was excited to talk about my health justice activism, my desire to work with underserved populations in inner-cities, and my hope to expand reproductive rights for women of color in the US. The night before my very first interview, I ironed my new suit, reviewed information about the school, and went over potential bioethical cases that could be thrown at me.

The morning of my interview, I joined other similarly anxious interviewees, making small talk about the weather, our undergraduate majors, and the hassle of making the long trip. After a long tour of the historic library, I rushed through my lunch and briskly walked over to where my first interview would be held.

I was greeted by an older white gentleman who beckoned me in with a smile.

Mistake #1: I lugged in my pink zebra-striped messenger bag, which my advisor later gently told me looked unprofessional.

After a brief exchange about my hometown and where I went to school, my interviewer suddenly professed that he had a burning question on his mind. “I know this is politically incorrect and all but is it okay if I ask you what your thoughts are on Shari’a?”

Mistake #2: I didn’t say no.

For the next twenty minutes or so, we talked about Shari’a and its apparent compatibility or incompatibility with the American legal system. From the beginning I openly conceded that I had a very limited understanding of what Shari’a even was. But that did not seem to matter to him. His questions were telling me that I was an American Muslim after all, and must of course be ready at a moment’s notice to defend Shari’a and why it’s not a threat to American principles of liberty and democracy. When my interviewer finally glanced at his watch and I realized that our time together was coming to an end, he quickly asked a question about why I was interested in the field of women’s health. I was cut off with a “well, I hope to see you this fall.”

And that is how my interest in medicine and relevant competency to become a physician-in training was assessed. That was my first medical school interview.

Mistake #3: Upon returning to the waiting room, a fellow interviewee informed me that I had a conspicuous piece of lettuce stuck between my front teeth

Although not all of my medical school interviews were negative experiences, I can go on about similar encounters at many of the other interviews. There was the time I was directly asked in the beginning whether I would feel “uncomfortable” attending a medical school that was affiliated with an institution heavily focused on scholarship on another religion. Or the time I was asked why I was not wearing a scarf if I was an American Muslim. Did he think I would exhibit similar “deceit” in medical school?

Along with anti-Muslim sentiments, I also faced animosity towards my views as a feminist.

At one point, I was essentially told I should not bother with protesting rape culture in my activism. “Men are just tempted more easily than women,” my interviewer proclaimed, who, as in all of the aforementioned scenarios, was an older white gentleman. There was a clear lack of any diversity in the body of individuals with the authority to evaluate applicants at many of these medical schools.

This individual went on to unabashedly assert that, “Rape culture has not changed. The only difference for your generation is that no one is monitoring the women who roam around late at night in co-ed dorms drinking. If my daughter was ever raped, I would kill the guy who did it. If my son ever raped anyone, I would kill him.” This highly tense conversation went on for twenty more minutes, in which he made more offensive statements such as, “Social welfare is useless. It just encourages black women to have more babies out of wedlock.”

I had initially perceived this as a stress interview by assuming that he was simply pushing me to defend my views on social justice issues, such as why there is sustained poverty in historically marginalized populations. However, when we started to talk about gender-based violence, he crossed the line and made comments that were not only derogatory but also triggering for a co-survivor of abuse. As someone who views herself as an activist, it was disempowering to be silenced on matters that I felt passionate about in a situation where a clear power differential was present.

Interviews take place behind closed doors. If I did not reach out to my pre-health advisor, I would not have been able to bring this matter to the attention of the dean of this medical institution. Although the dean profusely and sincerely apologized for my adverse interview experience in our subsequent meeting, I sensed that this physician would not be barred from conducting future interviews. The dean confessed that my interviewer was a “very good friend” of his and I suspected that the interviewer’s institutional pedigree may have even superseded the dean’s.

My misgivings were apparently not wholly unfounded. During my second make-up interview, I ran into a girl who had also interviewed with the same physician. She was a fellow woman of color who similarly had a highly unpleasant experience. I learned that her undergraduate school actually kept a record of students’ evaluations of their interviewers at different medical schools. This particular physician had received complaints about improper conduct for years now.

And yet, there he was sitting across from me that day, interrogating me on everything except on the field of medicine. Ironically, however, he was also one of the few interviewers who managed to not bring up a question related to my faith.

Instead of striving to learn more about my passion for medicine, I felt many of my interviewers were striving to “box” me into a preconceived category – the confused Muslim feminist, the threatening Muslim feminist, or my favorite, the liberated Muslim feminist who supposedly overcame “cultural oppression” at home. It was always a struggle to not let myself be defined in such a demeaning manner. My defiance was polite and kind.

Yet, now I find myself wondering if I exhibited passivity and weakness that betrayed my feminist soul. Should have I been more loud, abrasive, blunt, or forthright? Is it this sort of reluctance that enables such implicit, and consequently all the more injurious, racism and sexism to persist? Or am I justified in wholeheartedly believing that the onus is not on me, but, rather, on those that insist on flaunting their ignorance and privilege? Medical schools need to take a serious look into their admission processes, particularly with respect to interviews, if they want to ensure that they are not inadvertently countering the establishment of the very diversity they are yearning for in the future physician workforce; such systemic introspection is especially pertinent as this nation’s medical establishment has an unfortunate history of perpetuating institutionalized racism and sexism.

Know Your Interview Rights and Responsibilities
A Note from the AAMC

This is an excerpt from the AAMC’s guidebook,
The Official Guide to Medical School Admissions
How to Prepare for and Apply to Medical School

Although interviewers are instructed by admissions officers and guided by federal statutes on what are unfair or discriminatory pre-admission inquiries, there may be an occasion when an interviewer asks an inappropriate question.

You have the right not to answer what you sense is an inappropriate question. If such a question is asked, try to relax and provide a thoughtful and articulate response (two essential characteristics of a good physician). You may also respectfully decline to answer the question and explain that you were advised not to answer questions that you sensed were inappropriate.

You have the responsibility to report being asked an inappropriate question to help prevent further occurrences. Medical schools have the responsibility to establish procedures that enable applicants to report such incidents in a confidential manner. Medical schools should inform applicants of these procedures prior to interviews and assure them that reporting an incident will not bias the applicant’s evaluation.

If a medical school did not inform you of its procedure and an incident occurs, use these guidelines. If possible, report in confidence the interviewer’s name and the interview question(s) that was asked to an admissions officer during the interview day. Otherwise, email this information to an admissions officer within 24 hours of the interview noting the date and time of the incident. Furthermore, you have the right to ask if another interview is deemed necessary to ensure an unbiased evaluation of your application to that medical school.

Some interviewers use the interview to assess how well you function under stress and may purposely ask challenging questions to observe how you respond under pressure. How you communicate will be a critical part of the encounter; however, this does not give an interviewer the right to ask you inappropriate questions in their attempt to challenge you during the interview.

Examples of inappropriate questions:

  • What is your race, ethnicity, religion, sexual orientation, political affiliation, marital status, opinion on abortion and/or euthanasia, income, value of your home, credit score, etc.?
  • Are you planning on having children during medical school?
  • Do you have any disabilities?
  • Will you require special accommodations?
  • Have you ever been arrested?
  • Have you ever done drugs?
  • How old are you?

Sample response to an inappropriate questions:
Q. What are your plans for expanding your family during medical school?
A. Can you please clarify your question? I want to make sure that I’m providing information that is most relevant to my candidacy.
Q. Have you ever done drugs?
A. I am uncomfortable discussing my medical history and possible use of prescription medications during this interview.

About Tehreem Rehman

Tehreem Tehreem Rehman is a first year student at Yale School of Medicine.  She recently graduated from Columbia College as a John Jay Scholar with a B.A. in Women’s & Gender Studies. As a Co-Founder of Columbia’s Public Service Initiative, Tehreem was selected to be a People for the American Way Foundation’s Young People For (YP4) Fellow for the 2012-2013 academic year in order to expand the program. Tehreem has previously served as the National Chair of the American Medical Student Association’s Race, Ethnicity, and Culture in Health committee and as a National Editorial Advisor for the New Physician Magazine. She is currently a Humanity in Action Fellow through which she intends to create a multi-school platform to address institutionalized racism and sexism in the medical school admissions process. Tehreem is interested in clinical interventions for violence, addressing gender power dynamics in the clinical setting, and the impact that health inequities have on women of color and low-income backgrounds.

12 thoughts on “Bias in the Medical School Admissions Process

  1. It is highly discouraging to hear that students are thrust into these type situations when seeking slots at medical schools. My takeaway from this is to ensure that prospective students do not stay silent and report this type of experience while going through the admissions process and also when in medical school.

    1. I agree. And that is just part of it. The onus shouldn’t be on people who may already come from stigmatized or otherwise already vulnerable backgrounds. There needs to be open dialogue at the admin level.

    2. I agree. But I also don’t think the onus should only be on students susceptible to experiencing such bias, as they are probably coming from already stigmatized or otherwise vulnerable populations. Is the alternative I’m positing significantly more difficult than what you suggest though? Probably

  2. I am deeply sorry this was your experience. I am horrified, but will not say I am “surprised,” as there is no reason for xenophobia like this, which permeates so many corners of our society, not to seep into medical institutions/selection processes. I am so grateful that you are sharing your experience through this forum. From what you have shared, I can see that any institution would be lucky to have a student such as you and I am sure you have found a school that supports you and all aspects of your identity.
    A fellow feminist med student

  3. I had a bad interview experience as well. It was really disheartening to be asked such ignorant questions by physicians who (in theory) should know better.

  4. In my first interview I was asked “what is it like to grow up black in the south?” By a 70 year old Caucasian orthopedist. I did not see that coming in prep.

  5. I am so sorry you went through that! Truthfully, I didn’t have bad experiences during my interviews–everyone was professional and stuck to relevant questions. I’m a pretty status quo white girl, though. I’m horrified at some of the things that were asked of you and itching to know the names of the medical schools. I sincerely hope that enough anonymous complaints are received that the offending individuals are removed from their positions. Goodness gracious.

  6. Sorry to hear what you had went through. The admission process is already daunting and hectic experience. Years of handwork and preparation should obviously not be undermined by closely minded figures who unfortunate have the upper hand.

  7. This is very interesting and an experience I would never dreamed important to determining the v potential. of an applicants success in the practice of medicine..

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