What Makes a Med School ‘Woke’?
9 min read
“People will die if doctors misdiagnose patients.” This is true as far as it goes. But the recent news that prompted Elon Musk to share this observation on X was not precisely about medical errors. It was about what he might call the “woke mind virus.” A story by Aaron Sibarium in TheWashington Free Beacon had revealed complaints that UCLA’s medical school was admitting applicants partly based on race—a practice that has long been outlawed in California public schools. And this process wasn’t just discriminatory, the story argued; it was potentially disastrous for the public.
The Free Beacon noted that the med school’s U.S. News & World Report ranking had dropped from 6 to 18 since 2020, and the story shared leaked data showing students’ poor performance on their shelf exams. (These evaluations are used as preparation for the national licensing exams that every M.D. recipient must pass before they can practice medicine in the United States.) According to Sibarium, almost one-quarter of the class of 2025 had failed at least three shelf exams, while more than half of students in their internal-medicine, family-medicine, emergency-medicine, or pediatrics rotations had failed tests in those subjects at one point during the 2022–23 academic year—and those struggles led many trainees to postpone taking their national licensing exams. “I don’t know how some of these students are going to be junior doctors,” one unnamed UCLA professor told him. “Faculty are seeing a shocking decline in knowledge of medical students.”
Steven Dubinett, the dean of UCLA med school, denied the story’s allegations. He told me that the admissions committee does not give advantages to any applicants based on race, and he called it “malign and totally not true” to say that his students have been struggling. Dubinett believes that anti-DEI sentiment both within and outside the school is to blame for stirring up this controversy: People “think diversity, equity, and inclusion is in some way against them. And nothing could be further from the truth,” he said. But the stakes are high for prospective doctors and patients alike. The Free Beacon’s claims call attention to a heated fight among medical educators over how much admissions criteria and test scores actually matter, and whether they have any bearing on what it means to be a good physician.
Sibarium asserts that both UCLA’s fall in the rankings and its decline in test performance can be blamed, in part, on race-based admissions. The latter metric “coincided with a steep drop in the number of Asian matriculants,” the story said, and was associated with a change in the med school’s admissions standards. Dubinett told me that the decline in shelf-exam performance was “modest.” He also pointed to data shared with the UCLA community by the school after the publication of the Free Beacon story, which show that every test-taker had passed surgery, neurology, and emergency medicine during a recent set of exams from 2023–24. The data also show that, for most other specialties, the passing rates were close to the expected benchmark of 95 percent. Moreover, 99 percent of UCLA’s med students had passed the second of three tests required to obtain a medical license on their first try as of 2022–23, and scores have remained above the national average over the past three years.
Meanwhile, the Free Beacon offers little more than speculation about how UCLA’s shifting racial demographics might be linked to academic problems at the school. Nationwide, Black and Hispanic medical students do matriculate with slightly lower grades and scores on the standardized Medical College Admission Test than white and Asian matriculants, according to statistics compiled by the Association of American Medical Colleges. Yet data from UCLA and the AAMC show that the average MCAT scores of UCLA’s accepted medical students have not declined in recent years. As for grades, the average GPA among UCLA’s accepted applicants is 3.8—up from 3.7 in 2019. Dubinett told me that the school sets a minimum threshold for MCAT scores and GPAs that is designed to produce a high graduation rate. “There’s a cutoff based on national data—it’s not made up in our back room,” he said. “We’ve got nearly 14,000 students applying for 173 spots. Are you going to tell me that we’re getting people who are unqualified?”
So what did happen in 2022 to suddenly make so many students perform poorly on their shelf exams? The Free Beacon acknowledges that the med school began a major update to its curriculum in 2020. Following a national trend, UCLA significantly cut back the initial amount of time spent on classroom teaching so that clinical rotations could begin a year earlier. Med schools have been trying to expose their students to real-world experiences sooner, on the principle that book-learned facts are less worthwhile without on-the-job training. Yet shelf exams still require memorizing a hefty dose of facts, which can only be more difficult given less time to study. Dubinett chalks up the initial drop in scores to having students take the tests earlier in their education. Five other medical schools, he notes, also reported a decline in shelf-exam performance under a compressed curriculum.
Whether med schools’ broader shift away from traditional coursework has been producing better doctors overall is a separate question. A new curriculum that led to lower standardized-test scores in the short term might be associated, in the long run, with either better or worse clinical care. But no one really knows which is the case. There is still no reliable way to track educational quality. The influential—but controversial—U.S. News med-school rankings, for instance, don’t directly evaluate how good a program is at preparing future doctors. The benefits (or costs) of switching up criteria for admission into med school are just as mysterious. One study counted as many as 87 different personal qualities that are considered useful in the practice of medicine. Which qualities matter most is anyone’s guess.
At UCLA, not only has dry—yet still important—scientific material has been compressed in favor of hands-on experience. The school has also committed to instilling its student body with a social consciousness. In prior coverage for the Free Beacon, Sibarium has described the mandatory Structural Racism and Health Equity course for first-years, which, according to a 2023–24 syllabus obtained by the Free Beacon, intends to help students “develop a structurally competent, anti-racist lens for viewing and treating health and illness,” and encourages them to become “physician-advocates within and outside of the clinical setting.” The Free Beacon called attention to pro-Palestinian, anti-capitalist, and fat-activist messaging included in the course this academic year. That story quotes a former dean of Harvard Medical School, Jeffrey Flier, who described the course as “truly shocking” and said that it is based on a “socialist/Marxist ideology that is totally inappropriate.” (Dubinett told me that the entire first-year curriculum is being evaluated.) Other academics have expressed concern about how a similar approach to teaching students, adopted on a larger scale, might be changing medicine. Schools’ focus on racism and inequality “is coming at the expense of rigorous training in medical science. The prospect of this ‘new,’ politicized medical education should worry all Americans,” Stanley Goldfarb, a former associate dean at the University of Pennsylvania medical school, wrote in a 2019 op-ed in TheWall Street Journal. In a follow-up from 2022, he warned of a “woke takeover of healthcare.”
What, exactly, makes a med school “woke”? Any physician can see that unevenly distributed wealth and opportunity play a role in people’s health, and that many illnesses disproportionately fall along racial lines. Doctors who learn about these topics while in school may be more cognizant of them in the clinic. Indeed, after Goldfarb’s first essay was published in the Journal, some physicians started sharing stories that could be taken to support this argument: Posting under the hashtag #GoldfarbChallenge, they described how trying to help patients navigate dire living situations is as much a part of the job as recalling the nuances of biochemistry.
Acknowledging inequality is not an entirely new phenomenon in medicine. Schools were already teaching classes on cultural competence and health disparities when I was a student at the University of Rochester a decade ago. What is different is the open endorsement of political activism—almost always from a left-wing perspective. I certainly attended my share of lectures on how to care for patients from different backgrounds, but I don’t recall witnessing any lecturers leading classroom chants of “Free, Free Palestine,” as allegedly occurred during UCLA’s first-year course this spring. Since I graduated, the AAMC has published a voluntary set of “Diversity, Equity, and Inclusion Competencies” that encourage trainees to “influence decision-makers and other vested groups” by advocating for “public policy that promotes social justice and addresses social determinants of health.” The guidance lists “colonization, White supremacy, acculturation, assimilation” as “systems of oppression” whose impact must be remedied. This new pedagogical approach comes at a time when U.S. physician groups have taken vocal stances on controversial issues such as gun violence, transgender rights, and mask mandates.
I suspect this left turn in medicine was born of a feeling of impotence, rather than a Marxist conspiracy. Doctors have always been better at altering people’s physiology than fixing the social and economic circumstances of their patients. Perhaps medical schools now figure that health outcomes will improve if physicians become more involved in progressive politics. But whatever the intention, this approach will alienate a lot of patients. In recent months, some doctors have been disciplined for voicing pro-Palestine or pro-Israel stances—presumably on behalf of potential patients who might be offended by their politics. Maybe the same caution should apply to med-school lectures given at UCLA.
The push for improved student-body diversity has also grown in prominence. For most of the 20th century, schools encouraged applicants to fit the typical pre-med profile of a diligent lab rat. Over the past few decades, that attitude has changed. Now admissions offices are more comfortable with the idea that students who haven’t focused on the hard sciences or don’t have perfect academic records can still become successful—or might be even better—physicians.
I credit this shift for my own admission to medical school. I was a socially minded liberal-arts student who decided to study linguistics after a calamitous run-in with organic chemistry. By the time I applied, some schools had decided that MCAT scores were not the ultimate determinant of who will make a good doctor. My university was so interested in attracting the sorts of kids who might enrich the campus through what it now calls “the diversity of their educational and experiential backgrounds” that it allowed me to skip the exam altogether. I did end up having academic struggles, and passed anatomy by the skin of my teeth (having failed to correctly answer how many teeth humans have, among other questions). Now I’m a medical-school professor myself. It takes all kinds.
To this day, would-be doctors are expected to master an incredible amount of minutiae, but it is only through clinical practice that they figure out which facts matter most. Nothing is as clarifying as seeing patients live or die because of what you know—or, just as often, how well you communicate it. The Free Beacon article relayed an anecdote by a faculty member describing how a student “could not identify a major artery” in the operating room when asked. Being told to pick out an artery on the spot and failing at that task is, frankly, a rite of passage for medical students. But I’ve seen more people hurt by doctors who didn’t know how to speak Spanish or build rapport than by doctors who forgot the name of a blood vessel. If we keep arguing over what health-care professionals must know, it’s because the answers are as varied as our patients.
