Admissions Is Not Enough: The Racial Achievement Gap in Medical Education.

The achievement gap is a disparity in academic and standardized test performance that exists between White and underrepresented minority (URM) students that begins as early as preschool and worsens as students progress through the educational system. Medical education is not immune to this inequality. URM medical students are more likely to experience delayed graduation and course failure, even after accounting for science grade point average and Medical College Admission Test performance. Moreover, URM students are more likely to earn lower scores on licensing examinations, which can have a significant impact on their career trajectory, including specialty choice and residency competitiveness. After the release of preliminary recommendations from the Invitational Conference on USMLE Scoring (InCUS) and public commentary on these recommendations, the National Board of Medical Examiners and Federation of State Medical Boards announced that the United States Medical Licensing Examination (USMLE) Step 1 would transition from a 3-digit numeric score to pass/fail scoring. Given that another of InCUS's recommendations was to "minimize racial demographic differences that exist in USMLE performance," it is paramount to consider the impact of this scoring change on URM medical students specifically. Holistic admissions are a step in the right direction of acknowledging that URM students often travel a further distance to reach medical school. However, when residency programs emphasize USMLE performance (or any standardized test score) despite persistent test score gaps, medical education contributes to the disproportionate harm URM students face and bolsters segregation across medical specialties. This Perspective provides a brief explanation of the achievement gap, its psychological consequences, and its consequences in medical education; discusses the potential effect of the Step 1 scoring change on URM medical students; and provides a review of strategies to redress this disparity.

The end of the Kachemak tradition on the Kenai Peninsula, southcentral Alaska.

The Kachemak tradition was established by ca. 3000 B.P. in Kachemak Bay. Probably somewhat later a variant termed Riverine Kachemak, with a population adapted to salmon and terrestrial resources, appeared on the northern Kenai Peninsula. The Kachemak tradition people seem to have abandoned Kachemak Bay by ca. 1400 B.P. Seven of 12 available Kachemak tradition dates predate 1400 B.P. even at two sigma. Scattered younger dates are thus suspect outliers. The end of Riverine Kachemak tradition has been placed at ca. 1000 B.P., at which time the population was supposedly replaced by in-migrating groups ancestral to the Dena'ina Athapaskans. Close examination of the numerous available radiocarbon dates shows that most Riverine Kachemak dates cluster in the early centuries of the First Millennium A.D. and most Dena'ina dates substantially postdate 1000 A.D. Probably the Riverine Kachemak and Dena'ina peoples never met on the Kenai River. However, the correspondence in date ranges between Kachemak Bay and Riverine Kachemak is striking, suggesting their fates were linked. Both traditions collapsed by 1400-1500 B.P. The causes are probably multiple but do not include cultural replacement.