In this issue of JAMA Network Open, Nguyen et al 1 analyzed more than a decade of data from the Association of American Medical Colleges' Graduation Questionnaire and found that students in more racially diverse medical schools reported greater overall satisfaction with the quality of their medical education.Education quality was rated higher both by students from racial and ethnic groups underrepresented in medicine (URiM; ie, American Indian or Alaska Native, Black, Hispanic, and Native Hawaiian or Pacific Islander) and by White students.These findings challenge a central claim of contemporary opposition to programs promoting diversity, equity, and inclusion (DEI)-that the goals of DEI conflict with the goal of excellence in higher education.To properly contextualize this study, it is important to situate it within the history of medical school admissions, the evolution of DEI policies, and the contested meaning of merit in medical education.In the middle of the 20th century, US medical schools were among the most racially exclusionary institutions in higher education.In 1948, more than one-third of US medical schools explicitly disallowed Black students. 2In 1950, of the 25 103 students attending US medical schools, 647 (2.6%) were Black. 3Most of these students (513 79%) attended Howard or Meharry, the 2 medical schools established to train Black physicians.Across all other medical schools, 1 of every 200 students (0.5%) was Black, 3 compared with 1 of every 10 Americans. 4It was considered important to train at least some Black physicians to meet the needs of Black patients, whom many White physicians would not treat.Beginning in the late 1960s, the proportion of medical students from URiM groups began to rise and increased throughout the next 5 decades, though never reaching population parity, to a peak of approximately 26% in 2021. 5This rise was attributable in large part to court rulings recognizing the injustice of racially segregated institutions; policies, including affirmative action, designed to remedy racial exclusion from educational and employment opportunities; and concerted efforts by medical schools to diversify their entering classes in the interest of reaping the educational benefits of diversity and training a physician workforce to meet population needs.From their inception, these policies and programs, now often grouped under the umbrella of DEI, have encountered backlash, largely from those who felt unfairly displaced when individuals who were previously excluded were now included.This opposition produced decades of legal challenges, ultimately leading to the 2023 Supreme Court decision ending affirmative action in higher education, followed by a series of presidential executive orders in 2025 vilifying and eliminating DEI policies and programs.In the wake of these actions, URiM enrollment in US medical schools declined to its lowest level in years. 5ntral to arguments opposing DEI is the concept of merit.DEI critics contend that admissions should be based solely on merit and that any other considerations will result in less qualified people being admitted to selective institutions and, in the case of medicine, less qualified physicians caring for the population.Merit is commonly defined as individual ability, achievement, or deservingness.Few would argue that these attributes should not be primary considerations in medical school admissions.The problem with many anti-DEI arguments is not their emphasis on merit, but the narrow and incomplete conception of merit on which they rely.Implicit in these arguments is the notion that merit should be judged exclusively by grades, standardized test scores, and perhaps extracurricular portfolios, independent of other considerations.This conception of merit has at least 3 fundamental flaws.First, grades and test scores, while unarguably important, cannot be fairly interpreted without attention to context.
Somnath Saha (Tue,) studied this question.