Who Are Flexnerian-Deprived Black Americans? A Quantitative Analysis of Historical Representation Within American...

The Flexner Report of 1910 denied educational opportunity to over 35,000 Black Americans whose ancestors date to the United States (US) by 1910, Flexnerian-Deprived Black Americans (FDBAs). Within the sociohistorical justice (SHJ) framework, FDBAs ethnically represent Black Americans with ancestry throughout foundational American history since enslavement, Ethnic Black Americans (EBAs). This study uses the SHJ framework to answer: How are sociohistorical and ethnic subgroups of Black Americans, namely FDBAs and EBAs, represented within American medical education compared to the general population?

Because FDBA/EBAs currently have no sociohistorical/ethnic designation, we approximate their representation using existing, race-based medical student demographic enrollment data from 2021-2022 to 2024-2025. A Representation Score (R-score) mathematically quantifies each sociohistorical/ethnic subgroup's makeup in medicine relative to the general population (< 1 is underrepresented; > 1 is overrepresented).

Analysis suggests that the only sociohistorical/ethnic subsets of Black Americans underrepresented in medicine are FBDAs/EBAs. FDBAs/EBAs represented barely half their share of students intraracially (R = 0.51) and less than a third of their share interracially (R = 0.30). Non-FDBA (Black Americans identifying as African, Afro-Caribbean, and Other) representation approached three times overrepresentation among students intraracially (R = 2.7) and two times their share interracially (R = 1.6) for 2024-2025, with African women being over four times overrepresented intraracially (R = 4.4).

Race-based data aggregations misrepresent Flexnerian accountability. Recent "equity" efforts may have unintentionally driven FDBA/EBA representation to the lowest levels since 1970, while simultaneously amplifying non-FDBAs to the point of overrepresentation. Historical accountability requires data disaggregation beyond race-based categories-because historical deprivation is carried through lineage, not race.