cant commitment to a part-time job during their undergraduate years to support themselves or their families cannot be expected to have participated in extracurricular activities to the same degree as those applicants without similar obligations.

Cultural barriers. Expected educational outcomes vary among racial and ethnic groups. The applicant may have been subject to an environment in which high levels of educational achievement were neither expected nor valued.

Geographic location or neighborhood where applicant was raised. The location in which a student was raised and attended schools directly affects the number and quality of his or her educational opportunities.

Prior experience with prejudice. Underperformance on standardized tests based on stereotype threat is a frequent outcome for students whose abilities have been persistently questioned or challenged by the society at large.

Special family obligations and other circumstances. Minority students from poor families are frequently asked to contribute to the finances of their household or obliged to provide supervision and assistance to siblings or disabled relatives.

Appointment and Training of Committee Members

Admissions committees consist of individuals, appointed by their schools, to review applications and make determinations about which students they will admit. An admissions dean, and his or her staff, assist committees with this work. In the not-too-distant past, committees were often composed of basic sciences faculty who were (primarily) academically distinguished white men. Over time, the composition of many medical school admissions committees has changed to reflect changes in the curriculum as well as changing expectations of accreditation bodies, graduate medical education programs, and the public. Although most committees now include basic sciences and clinical faculty, alumni, medical students, and residents, the lack of diversity of most medical school faculties is also a characteristic of their admissions committees.

The education and training of admissions committees regarding the value of diversity and the relevance of a diverse health workforce for improving access to health services and reducing health disparities are suspected to vary widely across institutions. Increased awareness by committees of research findings and relevant literature would be appropriate for this purpose. Examples include findings showing that physicians are more likely to treat higher proportions of patients from their own racial and ethnic groups (Keith et al., 1985; Komaromy et al., 1996); minority physicians have higher percentages of patients covered by Medicaid in their



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