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Weiss and colleagues’ timely study¹ examining the perspective of premedical advisers from historically Black colleges and universities (HBCUs) on medical school admission among Black students is critically important to inform medical school admissions practices after the recent US Supreme Court decision on race-neutral admissions.² Interviewing 26 premedical advisers from HBCUs, the authors found 3 emerging themes: (1) variation in relationships with medical schools, with some premedical advisers characterizing relationships with predominantly White allopathic medical schools as exploitative and relationships with osteopathic, Caribbean, and HBCU medical schools as supportive; (2) significant disparity in premedical resource allocation (eg, shadowing opportunities for HBCU undergraduates); and (3) the importance of incorporating family, peers, and alumni in helping Black premedical students navigate the physician pathway.¹

As the US faces a significant deficit in producing a physician workforce that meets the needs of the diverse population,³ HBCUs have and continue to be important contributors to helping ensure a diverse physician workforce. Established in the 1800s, HBCUs have extended college access to Black students for centuries. Although HBCUs make up only 3% of US colleges and universities, they produce 20% of all Black college graduates and 25% of Black science, technology, engineering, and mathematics (STEM) graduates.⁴ Some HBCUs, like Xavier University of Louisiana in New Orleans, produce more Black students who apply to medical school than most, often larger, and more well-resourced predominantly White institutions (PWIs) across the US. Historically, HBCUs have successfully done so by approaching premedical education and advising holistically, creating collaborative STEM coursework, engaging family early, and providing premedical advising and skills-building starting with the first year of college.³ Data show that HBCUs provide a fostering, identity-affirming, culturally inclusive educational environment for Black students.⁵ Compared with Black graduates from non-HBCU colleges, Black graduates from HBCUs are more likely to report social, emotional, and financial well-being.⁵ Despite this, there has been a marked decline in medical school graduates from HBCUs in recent years. Between 2004 and 2018, the number of Black MD HBCU graduates dropped from 278 to 143, with a corresponding decrease in the proportion of Black graduates coming from HBCUs from 26.2% to 9.8%.⁶

Weiss and colleagues’ study¹ sheds light on the holistic, student-centered approach that HBCU premedical advisers described that they used in supporting students. Given that even after entering medical school, Black students are more likely than their peers to leave medical training,^7,8 it is critical for medical schools to not only holistically admit students from diverse backgrounds but also provide the holistic student support needed to ensure that all students thrive.⁹ Premedical school advisers described applying holistic advising approaches, such as a prehealth induction ceremony to incorporate family members in the premedical education process. Medical schools, especially PWI allopathic medical schools, should partner with HBCU premedical advisers and incorporate more holistic and targeted premedical student approaches that contribute to educational equity, lead to a continuity of support from the premedical phase through undergraduate medical education and beyond, and promote a thriving environment for all trainees.

Partnerships are not enough. Compared with peer institutions, HBCUs have historically been severely underfunded. The long-lasting impact with the marginalization of HBCUs in premedical education was well characterized by HBCU premedical advisers who were interviewed by Weiss and colleagues.¹ While studies have found that HBCUs with strong medical school affiliations and externally sponsored enrichment programs are more successful in gaining admission to medical schools for their students than those without such affiliations and programs,¹⁰ HBCU premedical advisers in the current study shared that they were challenged to find the critical clinical opportunities that students needed to be successful medical school applicants. They cited competition with more resourced and connected local and regional PWIs as a particular obstacle. In the setting of this scarcity, relationships with predominantly White medical schools could serve as a bridge for HBCU premedical students. However, advisers characterized that while predominantly White medical schools offered outreach to HBCU students, they did not holistically consider HBCU students for admissions. Therefore, HBCU premedical students may be doubly disadvantaged in their journey to medicine even before entering medical school.

What is clear from these findings is that it is imperative that medical schools reevaluate and, if needed, restructure the effectiveness of their efforts to expand access to medical education. The resource scarcity that the premedical advisers described, coupled with pervasive underfunding of HBCUs, suggests that HBCUs are undervalued by society. HBCUs are arguably the greatest source of Black premedical trainees in the US, a pivotal resource that the growing, diverse US population cannot afford to lose. It is vital to amplify voices from HBCUs in the ongoing conversation on promoting equity in attaining premedical competencies and holistic admissions strategies. The invaluable perspective of premedical advisers at HBCUs highlighted by Weiss and colleagues’ study¹ illuminates the imbalance in clinical opportunities with predominantly White colleges and universities and the critical role that enhancing respectful, collaborative relationships with predominantly White medical schools could have. It is imperative that premedical education opportunities are structured to ensure that HBCU students have equal access to premedical opportunities. Investment in building long-lasting, trusting partnerships between medical schools, particularly predominantly White allopathic schools, and HBCUs may go far in meeting the shared goal of building a diverse physician workforce that can meet the needs of the US population.

Published: October 23, 2024. doi:10.1001/jamanetworkopen.2024.40966

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2024 Nguyen M et al. ÌÇÐÄvlog Open.

Corresponding Author: Mytien Nguyen, MS, Department of Immunobiology, Yale School of Medicine, 333 Cedar St, New Haven, CT 06510 (mytien.nguyen@yale.edu).

Conflict of Interest Disclosures: None reported.