Med students discuss the minority tax, tokenism and other DEI issues they have encountered

During the 2019-2020 academic year, roughly 10% of osteopathic medical students identified as an underrepresented minority, according to the American Association of Colleges of Osteopathic Medicine (AACOM). That includes LatinX students (6% of all DO students), Black students (3%) and Native American students (0.2%).

Being part of an underrepresented group in medical school comes with unique challenges.

In May, the AOA, the Student Osteopathic Medical Association (SOMA), the Student National Medical Association (SNMA) and AACOM convened a focus group of student leaders and leaders in the osteopathic medical profession to discuss potential solutions for the challenges encountered by underrepresented minority osteopathic medical students.

“It was really powerful to be in a room with other student leaders and learn how to commit to advocacy, and also to have the AOA with us to guide us and collaborate with us,” said Aldwin Soumare, OMS IV, SNMA’s osteopathic committee co-chair.

“It’s amazing to see how open the AOA leadership has been, how involved they are and I’m impressed with their confidence in our abilities as leaders and what we can accomplish together.”

The DO spoke with Soumare and several other student leaders who participated in the focus group. They shared the major challenges discussed during the focus group as well as next steps and potential solutions to improve diversity, equity and inclusion (DEI) efforts at osteopathic medical schools.

Challenges

“One of the most urgent needs to advance DEI in osteopathic medical education is for every osteopathic medical school campus and location to have a dedicated DEI officer or DEI office,” says Alana Castro-Gilliard, OMS IV, SOMA vice president. When institutions lack this resource, students from underrepresented backgrounds often find it necessary to take on extra work related to their status as a minority, including mentorship, advocacy and educating their classmates on their group’s needs.

“Students feel that they are having to take extra time from their schedules that other students don’t have to so they can provide this education, so we can all be better physicians, but this should not be a student’s responsibility,” Castro-Gilliard says. “The workload of a medical student is already difficult. These students are taking their board exams, keeping up with their grades, making sure they are getting appropriate experiences to become good physicians, and then on top of all that, holding roles that should be held by a paid staff member.

“Some of us feel like we’re working two full-time jobs.”

This extra work put in by students from underrepresented minorities is called a “minority tax,” and many students from underrepresented backgrounds are contributing more than their fair share, notes Sabri Zooper, OMS IV, SNMA osteopathic committee co-chair.

“To sum it up briefly, the assumption may be, ‘You are in this space now, congratulations, but now that you are in this space, we are going to utilize you, more for the benefit of us than for your benefit,'” she says, elaborating that many schools will uplift minority students by featuring them on their websites and in marketing materials, but at the same time, some schools may not express a genuine interest in hearing or addressing minority students’ concerns.

Some schools’ DEI efforts, such as incorporating more minority students into their outward-facing communications, appear more symbolic, Zooper notes. These practices are known as tokenism.

“Another identified issue is that, in the past, there has not been a continuous connection between leadership within the profession and student advocates,” notes Castro-Gilliard. This makes achieving concrete change difficult, as students are often only serving in leadership periods for a limited time period, and initiatives sometimes lose momentum during leadership changes. Assembling the focus group–which connected student advocates with AOA leadership–is an effort to provide longevity to DEI efforts in osteopathic medical education by identifying student needs and working toward creating solutions.

“That was the AOA’s intention in having this focus group,” she says. “Let’s have some consistency and let’s have the ability to follow through so that this doesn’t end when our student leaders graduate.”

The AOA’s commitment to DEI intentionally includes osteopathic medical students from underrepresented backgrounds, says AOA CEO Kevin Klauer, DO.

“The osteopathic medical profession has always embraced and welcomed all,” he says. “With this focus group, we want to better understand what steps the profession can take to make osteopathic medical education as welcoming as possible to every student. We are raising awareness of students’ concerns so leaders in osteopathic medical education will be positioned to address these important needs.”

Next steps

The focus group plans to meet again in the near future to continue these valued discussions, identity other challenges, and consider solutions.

“We have created a group chat for all of the focus group members, so we can keep in touch and discuss incidents and news in real time,” says AOA Chief Engagement Officer Priya Garg. “The group chat and the regular focus group meetings will help maintain the momentum of these student-centered DEI efforts in the osteopathic medical profession and help us stay on track in our efforts to create change.”

Multiple members of the focus group said that the placement or establishment of a DEI officer or DEI office at every osteopathic medical school would go a long way toward improving DEI efforts in osteopathic medical education.

“Many students would like to see their COMs go above and beyond the standards to achieve mission-appropriate diversity outcomes,” Castro-Gilliard says.

“We are asking for schools to be really invested in this and really take it to the next level, without students having to ask for it every time,” she says.

The COCA recently established a DEI task force, which assembled recommendations to improve DEI in osteopathic medical schools. The COCA’s standards review committee is now reviewing those recommendations, which is the next step toward amending the COCA Standards to potentially incorporate the recommendations. The COCA will post any proposed amendments to its standards for public comment after its standards review committee transmits its work to the COCA and the COCA votes to provide its initial approval. The AOA applauds this initiative.

A promising start

Zooper says she found the focus group to be energizing, and she is excited to see what comes next.

“This focus group was a really good step toward acknowledging DEI issues in medical schools, and also toward trying to figure out what we can do,” she says. “It’s good to finally have a space to talk about what’s going on and what has been going on.”

Nicholas Harriel, OMS IV, SOMA president, agrees.

“I feel like the AOA, AACOM and the other organizations involved are dedicated and really focused on DEI issues,” he says. “The collective goal is to make osteopathic medical education and the profession better for everyone. This meeting, where we discussed the issues and how they might be addressed, is a really solid first step, and I can’t wait to see what actions come out of it.”

As SOMA’s president, Harriel also said the focus group made him think more critically about SOMA’s DEI efforts as well.

“We have done well in the past, but there is always room for improvement,” he says. “I want to make sure that we are initiating programs that are really pushing the envelope in this area.”

Some of SOMA’s current DEI projects include creating an LGBTQ+ task force and advocating for more expansive religious and cultural accommodations in physical exams in medical training, Harriel says. SOMA and SNMA are also hoping to collaborate with COSGP on a DEI toolkit to welcome all students into osteopathic medical education.

Related reading:

What the AOA is doing to promote diversity, equity and inclusion

Why the needs for rural and Native American physicians are interconnected