Gaslighting the Racially and Ethnically Minoritized Medical Student: How US Medical School Assessment Practices...

Area of Science:

• Medical Education
• Health Equity
• Critical Whiteness Theory

Background:

• Physicians from racially and ethnically minoritized (REM) populations are under-represented in medicine, impacting public health and social justice.
• Existing medical education recruitment efforts for REM students have not translated into equitable outcomes, with disparities attributed to social determinants, bias, and burden.
• Critical Whiteness Theory (CWT) offers a framework to analyze how assessment systems in medical schools contribute to these disparities.

Purpose of the Study:

• To examine how medical school assessment systems, rooted in historical practices and standardized testing, perpetuate inequities for REM students.
• To critique the current assessment paradigms through the lens of CWT, highlighting their role in promoting a white supremacist culture.
• To propose a justice-oriented assessment model for improved recruitment, retention, and outcomes of REM students.

Main Methods:

• Analysis of the historical development of assessment in medical education, including the influence of the Flexner Report and standardized testing.
• Application of Critical Whiteness Theory to deconstruct assessment practices and their alignment with a white supremacist culture.
• Review of literature and case examples to illustrate the misalignment between admissions, remediation, and assessment, and its impact on REM students.

Main Results:

• Medical school assessment systems, historically focused on aptitude and rote knowledge, favor a white supremacist culture and disadvantage REM students.
• Current assessment practices, including reliance on standardized tests and arbitrary grading, contribute to "gaslighting" REM students, attributing their poor outcomes to personal failing rather than systemic issues.
• Misalignment between admissions and remediation strategies perpetuates inequities, with programs ill-equipped to support REM student success.

Conclusions:

• A justice-oriented approach to assessment is necessary to remedy inequities in medical education.
• Reforming assessment practices can improve the alignment of recruitment and retention efforts for REM students.
• Implementing a justice-oriented model will lead to better patient outcomes, increased physician diversity, and a more comprehensive definition of the "good doctor".