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PAUL SCHNEIDEREIT: White-coat world — Dal med school weighs best formula to deliver more diversity

“This year, we had six grads of African descent, the highest number ever. We have six that will graduate this coming year. We’ve also had increases in Indigenous students,” says Dalhousie medical school's dean, Dr. David Anderson.
Dr. David Anderson, dean of the faculty medicine at Dalhousie University: “Admissions are a contentious issue." (BRUCE BOTTOMLEY)

Admission to Dalhousie University’s medical school isn’t easy.

The school gets roughly 1,000 applications each year. Up to 400 prospective students are interviewed. Just over 100 are offered spots.

The med school’s admission process, as you’d expect, is rigorous. But for members of under-represented socio-economic or minority groups, it’s been even tougher.

How Dal medical school chooses its students came under public scrutiny two years ago when two of its then med students were charged in separate high-profile criminal cases in August 2015.

In one case, William Sandeson was eventually convicted of first-degree murder in the death of fellow Dalhousie student Taylor Samson. In the other, Stephen Tynes, who originally faced charges that included uttering death threats against members of the medical school, ended up pleading guilty to weapons charges and had a peace bond imposed.

But according to the man who asked for an independent external review of the school’s admission process late in 2015, Dal med school dean Dr. David Anderson, those criminal cases weren’t the reason.

The connection’s easy to assume, of course. And Anderson acknowledged, in a recent interview, that the circumstances likely moved up the timing.

But, he emphasized, such evaluations are “routine” and admissions — which had gone through a number of changes over the last decade — had not been reviewed for quite a few years.

Weeks before either criminal incident, he had flagged — in one of his first blog posts after becoming the med school’s 13th dean on July 1 — a compelling reason for a review of admissions. In 2017, the school’s undergraduate MD program was due for an accreditation review (by the Committee on the Accreditation of Canadian Medical Schools).

Meanwhile, the man who chaired that review, College of Physicians and Surgeons of Nova Scotia registrar and CEO Dr. Gus Grant, said — when  I spoke to him recently — the dean did not indicate the review was connected to the criminal cases.

That’s the backdrop. It’s clearly necessary context. But it shouldn’t overshadow the importance of the recommendations — which focus strongly on the need to widen diversity among Dal med students — or the med school’s response.

The review was actually delivered to Anderson a year ago, in August 2016. The document was made public earlier this summer.

As a preface to remarks on his committee’s work, Grant underlined such a report, with its recommendations, makes it “tempting to only see the weak points of a process.”  But he wanted to be clear: Dal’s med school produces top-notch doctors. Admissions, he said, did “very, very well” in selecting people who could succeed in both the study and practice of medicine.

“It’s not perfect, no system is perfect. The important point to make is the dean wanted to make sure the process was robust and appropriate and to see if there were ways to make it even better.”

Dr. Gus GrantDr. Gus Grant: "It's fair to say there's a broad public perception that medicine is only available to people from privileged backgrounds."

The emphasis on diversity, Grant said, was grounded on sources like the federal Truth and Reconciliation Report and Dal’s commitment to social accountability.

So what did the review committee find and what did it recommend?

Until last fall, the makeup of Dal’s medical school admissions committee included 16 members of the medical faculty (three working in New Brunswick), two medical students, a faculty member not from the faculty of medicine and a member of the public not in the medical profession.

The report recommended representatives of the African-Canadian and Aboriginal communities be added as mandatory members of the admissions committee. It also recommended the committee include three — not one — members of the public.

“A committee that’s looking to populate a class with appropriate diversity, the committee itself should have appropriate diversity,” said Grant. “A committee that’s going to select people who are going to serve the public should have more public representation.”

The report also recommended the admissions committee reflect gender equality.

Anderson said all those recommendations were accepted — and appropriate members added — last fall, as the committee began reviewing candidates for the 2017-18 academic year.

The admissions committee also accepted recommendations on developing its own conflict-of-interest guidance document and developing appropriate cultural competency training.

Those turned out to be the relatively easy parts.

Far trickier has been finding agreement on the best way to tackle what the report identified as a lack of diversity related to socio-economic background.

“In the view of the committee, and in my view, there were potential sources of bias in the way applications were scored,” said Grant. “And, in my view, the scoring of the applications favoured, and favours, candidates from more privileged backgrounds. It wasn’t done intentionally. But there was a hidden bias that potentially favoured these candidates.

“And, moreover, I think it’s fair to say there’s a broad public perception that medicine is only available to people from privileged backgrounds.”

For example, the admissions process now evaluates candidates partly based on their precise GPA (grade point average) and MCAT (medical college admission test) scores. But, as Grant reasonably argued, those scores can’t tell you if that person had to work part time or, coming from a more privileged background, benefited from private tutors.

There are also cultural biases in the MCAT that disadvantage Aboriginals, he said.

“I think the ingredients in being a successful physician, an excellent physician, the most important ingredients are character, compassion, empathy, trust, consistency,” said Grant. “Make no mistake, you have to have a certain level of cognitive ability, but it’s likely overstated. And, in the view of our committee, academic excellence has been likely overrated in the selection of candidates.”

So, the review report recommended using threshold GPA and MCAT scores only as a screen to eliminate candidates below those levels. Scores above those marks would convey no extra advantage.

Would the changes make it any easier to get into medical school?

“No. The reality is it’s always going to be competitive. But one of the thrusts of this report is, 'Let’s measure the things we seek to value'. It’s attractive to put a big emphasis on GPA and MCAT, for example, because it’s so measurable,” he said. “The mistake often made is people value the measurable rather than measure the valuable. That’s not my line, I think it’s Einstein’s,” Grant added.

The dean said all the recommendations are under review and being discussed. But the recommendation on GPA and MCAT — and others related to assessment and scoring — didn’t fly with the admissions committee, apparently. Dal officials say the committee has decided to retain its current methods in those areas.

But that doesn’t mean the medical school isn’t committed to addressing such issues, said Anderson.

“Admissions are a contentious issue. There are 100 different opinions for every issue around admissions,” he said.

 “I think those are where it may not be done exactly the way … (the) recommendations that Dr. Grant’s committee put (it) to us, but the principles — that we are paying attention to diversity, non-academic features, social accountability — all those things are incredibly important to us.”

He said the school has done a lot of work to increase diversity, pointing, as example, to programs put in place over the last eight years to improve representation from minority communities.

“This year, we had six grads of African descent, the highest number ever. We have six that will graduate this coming year. We’ve also had increases in Indigenous students.”

The med school also runs summer camps for junior high school and high school students, in Halifax and Cape Breton, to help them learn what’s involved in going to medical school. “The direction around looking at students who are disadvantaged in whatever way to being able to get into medical school is definitely something we’re paying attention to,” Anderson said.

 “We’re having discussions right now as to how do we do that same sort of thing for rural students and for students who may come from socio-economic challenged backgrounds who, again, might not consider medicine on their radar as far as being able to get into med school.”

So the concerns raised by Grant’s group are shared by the medical school, the dean said. But there are clearly differences in opinion in how to address them.

There’s no question getting a medical degree is perceived as expensive — and thus unattainable — for many from disadvantaged backgrounds.

How Dalhousie’s medical school finds ways to tackle the lack of socio-economic diversity among its students will bear watching.

Paul Schneidereit is a columnist for Local Xpress.



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