In Response to Bliss et al: Academic Medicine Must Look Inward to Address Leaky Pipelines

We read with great interest the paper by Bliss et al on the University of Utah Health Sciences Learning, Engagement, Achievement, and Progress (HS-LEAP) program’s provision of longitudinal support and mentorship for underrepresented in medicine (URM) students.1 The authors reported less than half of accepted students completed the program and suggested the attrition may be partially due to student specific deficits. In addition to student deficiency concerns, the leaky pipeline of diversity-focused programs also represents the need for academic institutions in general to take an inward look to determine how systems and processes should change to improve URM student retention and promote their advancement. The problem isn’t always with the URM student. Students included as underrepresented in medicine were American Indian/Alaska Native, Black, Latinx, Pacific Islander, Southeast or Refugee Asians, and those from lower socioeconomic and rural backgrounds.

The Association of American Medical Colleges does not provide recommendations for the implementation of pipeline programs, and as such, there are no requirements to address the societal bias and racism that contribute to low numbers of underrepresented minorities in medicine.2 It is important for pipeline programs to address racism, isolation, low institutional expectations and privilege systems as they impact the success of URM learners.3 Working from a skills-based only model, or a learner deficiency only model, is to deny the fact that race and racism make up part of a URM learner’s identity and life experiences, and impact how the learner learns.

Academic leaders must dismantle institutional systems and policies that advantage some learners and disadvantage others. For example, concerns about bias have been raised in medical school admissions and the Alpha Omega Alpha honors society.4 Academic leaders must promote equity for URM learners and ensure an academic environment that is inclusive and enriching. They must provide funding for URM-specific programing, and advocate for campus-wide policies that support this group.5

We commend Dr Bliss and colleagues for their meaningful work in this longitudinal pipeline program and the successes they share despite challenges reported with attrition. The continued success of pipeline programs depends not only on learner ability, but also the academic environment in which the learner is placed. This letter is a call to action for all academic institutions with pipeline programs to look at their academic environments to dismantle systems of racism and privilege that impact the academic success of URM learners. The time is now.