Diversifying the health care workforce is commonly identified as a key strategy to facilitate access to quality health care for all.1–3 Medical schools strive to recruit, retain, and develop a diverse student body that enriches the learning environment and is
Diversifying the health care workforce is commonly identified as a key strategy to facilitate access to quality health care for all.1–3 Medical schools strive to recruit, retain, and develop a diverse student body that enriches the learning environment and is prepared to meet the public’s health needs.4 There is substantial evidence from higher education5–11 and academic medicine12–16 that a diverse educational environment adds value to the community.
Several studies have examined the influence of diversity on medical education from the student perspective. Diverse learning environments are correlated with students’ increased comfort with diversity and are also correlated with an enhanced sense of value both in its contribution to their educational experience and in the delivery of and access to care.12–16 Within the classroom, students perceive that increased racial and ethnic diversity acts as a catalyst for in-depth discussions from alternative perspectives, elicits a broader range of examples, and improves understanding of medical conditions and treatments.16 In a study that evaluated the influence of diverse faculty and patients, students’ attitudes toward affirmative action were predicted by the number of diverse faculty, the percentage of minority patients, and the frequency of informal interactions with diverse peers and voluntary cultural activities.13
This evidence of the influence of diverse learning environments on students’ perceptions of different populations highlights the critical importance of including diversity in the training of future physicians. To take advantage of what diversity contributes to the development and implementation of policies that advance institutional missions, academic health centers (AHCs) should have a clear definition of diversity.4
In the United States, the definition of diversity in higher education has reflected the evolving sociopolitical and demographic landscape. Historically, definitions of diversity primarily have focused on race and ethnicity. In 1997, through Office of Management and Budget (OMB) Directive 15, the federal government made substantial changes to the racial and ethnic data that they collected.17 With the goal of acknowledging the growing multiracial, multiethnic U.S. population, this new classification system separated Hispanic origin from race, allowing respondents to self-identify with as many categories as were applicable. The 2000 Census reflected these changes, painting a different picture of the U.S. population, especially among racial and ethnic minorities. Furthermore, the OMB directive specified that all federal agencies had to comply with the new standard by 2003.
Recognizing these changes, in March 2003, the Association of American Medical Colleges (AAMC) Executive Committee (equivalent to a board of directors) adopted a new and expanded definition of underrepresented minority (URM).18 The previous definition of URM included four specific racial and ethnic groups—African Americans, Mexican Americans, Native Americans, and mainland Puerto Ricans—whereas the new definition included any racial and ethnic populations underrepresented in the medical profession relative to their numbers in the general population. The Executive Committee also emphasized the importance of considering local demographics when defining underrepresentation. This recommendation allowed for greater flexibility targeting ethnic populations that may have been previously excluded from some diversity initiatives, such as Hmong, Cambodians, and Laotians living in California and in the upper Midwest. In addition, the new recommendations included other Latino ethnic groups, beyond Mexican Americans and mainland Puerto Ricans, that were underrepresented in the United States.
Defining URM and diversity in medical schools became even more important in 2008 when the Liaison Committee on Medical Education revised and strengthened key accreditation standards to focus on diversity and inclusion.19 The first standard, MS-8, requires each medical school to develop programs or partnerships aimed at broadening diversity in medical school admissions. The second standard, IS-16, looks more generally at institutional factors and the alignment of policies and practices within the mission and vision to achieve appropriate diversity among the students, faculty, staff, and other members of the academic community. Thus, clarifying both the definitions of URM and diversity and the evaluation process for diversity programs became integral to the accreditation process.
The AAMC has largely depended on individual institutions to adopt their 2003 definition of URM, and institutions in turn have interpreted the updated definition in a number of different ways. In this study, we surveyed diversity leaders at U.S. AHCs to assess how their institutions defined URM. We hypothesized that the release of the updated AAMC guidelines would lead to greater variation in URM definitions between institutions. Because growth in the Latino population accounted for more than half the total U.S. population growth in the last decade,20 we also surveyed diversity leaders about their perceptions of Latino representation in the medical profession.
Using the AAMC’s Dir