Med schools can't manufacture equality

Class of 2010 reacts to supposed unrepresentattiveness

ARAN DANGERFIELD AND SCOTT HURTON

As the incumbent class of 2010, we would like to elaborate on several of the issues brought up in the article “Med students don’t represent patients” (the Manitoban, Sept. 6) regarding the representation of diversity in medical school.

We would first like to address the comments delivered by Dean Sandham in his welcoming remarks at the Class of 2010 inauguration ceremony. This address emphasized the humanitarian experience of medical practice and warned students against the development of attitudes of entitlement and indifference. The statement, “You’re not entitled. You’re privileged,” taken in context, was meant to relay the message that we as future physicians must be mindful of and humbled by the fact that patients allow us into their lives. Further, we must be aware of the inherent responsibilities we have to our patients and communities to deliver care with the highest level of esteem, compassion and respect.

In 2001, the population of Manitoba was estimated to be 1.12 million, with 72 per cent living in urban and 28 per cent living in rural settings. The proportion of rural students in the class of 2010 is 22 per cent, representing roughly 79 per cent of the pre-described population need. It is important to note that these statistics do not take into account the number of students who plan to move from urban areas to rural settings upon completion of their degrees. Several programs associated with the faculty of medicine, such as the student-run Manitoba Medical Student Rural Initiative Group (MMSRIG), the Rural Manitoba Health Internship Program, the Medical Student Summer Work Experience and Training (SWEAT) program, and Rural Week, further foster and encourage interest, and allow students to gain insight into rural practice.

Medicine is a humanistic discipline. The structure of the course encourages the development and abilities of students, many of whom are from a broad and diverse range of backgrounds, to provide humane and competent care independent of their sociological experience. In the selection process, one of the things medical schools look for are individuals who are able to contribute their unique life experience and outlook to the medical profession and establishment. Indeed, a number of students in our class have children, have travelled the world, and many

have graduated with degrees that have little to do with medicine or science. It is unreasonable to suggest that because a physician does not have a specific condition, disability or disease, or come from a specific ethnic group or socioeconomic background, they are incapable of relating to a patient and providing empathic, competent care.

The medical school application process is indeed rigid and competitive. There are two categories for admission, regular and special consideration, intended to enhance the opportunity for a diverse contingent of applicants. Candidates applying in the regular consideration category are evaluated on the basis of undergraduate adjusted grade point average (AGPA), Medical College Admissions Test (MCAT) scores and a Personal Assessment Score (PAS) based on the applicant’s entrance essay, referee reports and an interview. The special application category, meanwhile, uses similar criteria, but with more emphasis on the PAS, and is open to Manitoba residents who are of aboriginal descent, former health care and social welfare workers, or those in the military. Using the criteria above, the medical school then selects its class for that year, from the pool of applicants. However, it’s important to note that the admissions committee can only select those who apply. If no one with a visible disability, or few aboriginal students, apply in the first place, how then are the schools expected to select them?

In the end, we must accept that it is not reasonable to construct a generation of physicians based solely on local demographics. The role of the faculty of medicine in selecting applicants is not that of social engineer, but rather to choose the best and most highly capable applicants. If after such selections are made we find that our choices do not reflect today’s society, then perhaps the question should be posed to our schools, our community groups, and our government: why are candidates from different backgrounds unequally qualified and what can we do to change this? As a society, we should rightfully demand that all members of our society be provided equal opportunity to enrol in our competitive programs, but it is unreasonable to demand that our schools manufacture artificial equalities.

Aran Dangerfield and Scott Hurton are co-presidents of the faculty of medicine class of 2010 at the University of Manitoba.