Examination of Racial Bias in Alpha Omega Alpha Inductions: A Single-Center 15-Year Retrospective Study
Authors: Gao Ruoqi 
Published: April 2020

Importance

With USMLE Step 1 becoming pass/fail, subjective clinical evaluations will hold greater weight in residency applications. However, no longitudinal studies exist that examine the role of race in clinical success during medical training.

Objective

Utilizing Alpha Omega Alpha (AOA) as an objective marker of clinical achievement, I investigated the relationship between race and AOA membership at Northwestern University Feinberg School of Medicine over a span of 15 years.

Design, Setting, and Participants

To accomplish this retrospective, single center, multi-year cohort study, names of all Feinberg graduates between 2003 and 2018 were collected via the school’s public website. Images for each student were gathered by social media, assigned an ethnic identity by a blind evaluator, and confirmed by an unblinded evaluator. Finally, each name was verified against the AOA database to determine membership status.

Main Outcomes and Measures

AOA membership among medical students of various racial groups at Feinberg.

Results

From a 2,466 student body, there were 546 (22.1%) Eastern/Southeastern Asian, 123 (5.0%) African-American, 102 (4.1%) Hispanic/Latino, 399 (16.2%) South Asian, 59 (2.4%) Other, and 1205 (48.9%) Caucasian students, with 32 (1.3%) exclusions. Within this collective group, 428 students were inducted to AOA: 62 (14.5%) Eastern/Southeastern Asian, 4 (0.9%) African-American, 10 (2.3%) Hispanic/Latino, 70 (16.4%) South Asian, 10 (2.3%) Other, and 270 (63.1%) Caucasian students, with 2 (0.5%) exclusions. By class/year, the percentage of Caucasians inducted into AOA were higher than the class percent in 15 out of 16 classes, compared to 1 by Eastern/Southeastern Asians and 7 by South Asians. Odds ratio analysis demonstrated Eastern/Southeastern Asian (OR, 0.44; 99.67% CI, 0.28 – 0.69) and African-American (OR, 0.12; 99.67% CI, 0.03 – 0.53) students were at disadvantage relative to Caucasians for AOA membership.

Conclusion

I revealed Eastern/Southeastern Asian and African-American students were statistically less likely to be selected for AOA compared to Caucasian counterparts. Additionally, Eastern/Southeastern Asian students were under-represented almost every year despite being the most represented minority demographic. These results demonstrate subjective bias in AOA membership for both under- and over-represented minorities and suggests the recent Step I paradigm shift may disproportionately affect certain students over others.

KEY POINTS

Question

Which minority groups are disadvantaged compared to Caucasian counterparts for AOA membership?

Findings

In this longitudinal, retrospective cohort study spanning fifteen years at Northwestern Feinberg School of Medicine, I found Caucasian students were 2 and 8 times more likely to obtain AOA membership than Eastern/Southeastern Asian and African-American medical students respectively.

Meaning

Certain bias underlying AOA admission may exist and are possibly stable over time, which is concerning given the recent Step 1 policy changes and thus eventual shift away from objective evaluations in residency applications.