"We're Kind of in This Weird Space": How Asian Americans physicians navigate perspectives towards race-conscious...

(In)equity in admissions is a global conversation. Approaches to addressing these inequities include affirmative action, holistic admissions and race-conscious admissions. Different countries vary in their usage of these approaches: while some have nationwide policies to implement affirmative action through quota systems, others utilise more holistic approaches, which are determined by individual institutions. This study explored the perspectives of Asian American physicians regarding race-conscious admissions in medical education, using Poon and colleagues' multidimensional model of race class frames to understand how individuals navigate tensions between private and public interests.

Using an interpretive qualitative approach, we employed an inductive-deductive qualitative research methodology using purposeful, snowball sampling to identify participants. One-hour interviews were conducted with 25 Asian American physicians across the Northeastern, Southern, Midwestern and Western regions of the United States. Interview transcriptions were analysed using inductive and deductive thematic analysis.

The majority of participants supported race-conscious admissions, but both groups (supporters and non-supporters) had fundamentally different interpretations of educational equity. We constructed five themes. (1) Understandings of Race-conscious Admissions examines whether participants held accurate understandings of race-conscious admissions policies; (2) Intersectional Realities versus Individual Merit explores how supportive participants viewed race and socioeconomic status as inextricably intertwined whereas unsupportive participants treated them as separate variables; (3) Public versus Private Interests demonstrates how supportive participants wanted to expand educational opportunities whereas unsupportive participants emphasised individual interests; (4) Evolution of Consciousness documents transformative experiences that facilitated movement from individualistic merit-based frameworks toward systemic understanding; and (5) Coalition versus Competition illustrates divergent visions for Asian American physicians. Critically, widespread misunderstanding of race-conscious admissions practices was identified, particularly among unsupportive participants.

This study challenges monolithic representations of Asian American perspectives on race-conscious admissions, demonstrating significant heterogeneity that aligns with Poon's multidimensional framework. These results have significant implications for medical education policy, suggesting that efforts to build support for equitable admissions practices must address both factual misunderstandings and deeper philosophical differences about individual versus structural explanations for educational disparities. Future research should explore intervention effectiveness and examine how physicians' admissions policy attitudes relate to their clinical practice patterns with diverse patient populations.