DR. MuzquizLeeAnna Muzquiz, MD ’00, associate dean for admissions for the UW School of Medicine and clinical professor and instructor in the Department of Family Medicine, knows that equity in medical school begins by cultivating a healthy ecosystem. As a member of the Confederated Salish and Kootenai Tribes of the Flathead Reservation in Montana, and as a first-generation college student, Dr. Muzquiz has thought a lot about issues of access and barriers to a medical education.

Here we continue our conversation with Dr. Muzquiz to see how the UW School of Medicine is seeking to close the gap of admissions for students underrepresented in medicine throughout the five-state WWAMI region (Washington, Wyoming, Alaska, Montana and Idaho).

What has been most rewarding about your role as associate dean of admissions for UW School of Medicine?
I enjoy meeting applicants at the outset of their medical school journeys and careers. There’s a lot of energy, excitement and passion around the great things that medicine can do for individuals, for communities and for the larger world. I also find it rewarding to be part of the medical education community. The types of people who are drawn to educating physicians bring a lot of passion and excitement with them.

Before I took this role, I was a community doctor for 16 years. I got a lot of satisfaction from seeing patients and helping people on an individual level. Now, I’m energized and rewarded by having perhaps a broader impact on medicine and populations.

What has been the most challenging part of your job?
We would all love to live in a place where we have unlimited resources to do all the things we can think of. I work with amazing people who have so much innovation and creativity, but we’re limited by what we can do, whether by rules and regulations or finances or just the confines of the medical school structure. So that was a steep learning curve, but it has taught me how to think differently and how to work within those confines to the best of our ability.

The other thing I’ve found challenging — and part of the passion that I have for admissions work —is around diversity and creating a physician workforce that reflects communities in need of physicians. We’ve worked really hard to create systems, processes and pathways that honor and value diversity, and we’ve come really far, but we still have a ways to go.

However, things have changed since I’ve come into this position. The kinds of people who are coming to medicine has shifted. The challenge is that the institution of medicine hasn’t been able to adapt as quickly. Applicants are bringing a wealth of diversity, but when we bring these students to the institution, they have challenging experiences because the structures within the institution aren’t designed for them.

People who are different have tended to survive medical school. But we want them to thrive — to be all they can be as opposed to what the institution thinks they should be. We’re still working on it. There are more folks at the table now talking about what we can do to help all learners thrive.

Since 1980, the nation has become a lot more diverse, but medical schools lag in terms of increasing diversity. Why do you think this is?
It matters who is being brought into the realm of thinking about medicine as a possibility. Who are we reaching when we say: ‘This is a possibility. You have potential. There are many paths you could choose. Here’s one, and here’s how you can do it.’?

How we articulate this message and how we get into these communities matters, and up until recently, that really wasn’t happening. Since the 1980s, there have been programs that have put sporadic emphasis on targeting underrepresented communities in order to get people into medicine. I’m a product of those. I’m an American Indian from a rural part of Montana, first generation college student, had no mentor, had no role model, but I happened to stumble into some programming.

Opening the Doors to Medical School

KCTS 9 explores hidden barriers within our healthcare system in a revealing video series called “Hidden Barriers: Learn how bias, prejudice and discrimination pervade our healthcare systems.” For a deeper dive into barriers within the admissions process watch the episode “Opening the Doors to Medical School.”

I was bumbling through an ecosystem that’s been spotty at best — it depends on who’s running the country, how well the economy is doing, and who has the loudest voice. It’s not based on a value that says the people who take care of us at our most vulnerable times should be people who understand who we are. Historically, that value has never crossed people’s minds. [The people who were expected to become doctors] were always the people who could get the best education, who had the most access or who knew people and were connected. It wasn’t the girl from the reservation whose parents didn’t go to college.

So, I anticipate that as difficult as the events have been over the past year, and I’m talking about the pandemic as well as the social justice and racial justice issues that have occurred, I’m hopeful that medicine can really start to unpack these lessons and figure out how we can be more welcoming to students from different backgrounds. I hope it begins to make sense that the people who take care of us at our most vulnerable times understand who we are because they come from the same places we do.

Why do you think that applications to medical schools nationwide have soared during the pandemic, including from those underrepresented in medicine?
It was surprising to us in admissions! We had a record number of applications this season, including from communities underrepresented in medicine. It would be nice to think that it was just the “Fauci Effect” where people suddenly feel compelled to do good in the world. But knowing how admissions work, all the people who applied this past season started the process before the pandemic occurred.

I think there were many people who were working on their applications, but maybe they had plans to do another year of research or to do some volunteer work or take a growth year. But as the pandemic unfolded, they recognized that their plans weren’t going to happen, so they applied to medical school instead.

It also appears to be a more diverse pool of applicants. This could be because some barriers were reduced or eliminated. For example, to take the MCAT [the Medical College Admission Test] is very expensive, but the MCAT provider changed its criteria for fee assistance knowing many were struggling financially during the pandemic.

Some schools like ours eliminated the requirement to have an MCAT score because people felt unsafe going into a testing center. We also eliminated our secondary application fees. These decisions were made using the guiding principles of health and safety, equity and consistency across the entire WWAMI five-state region and they were certainly instigated by the pandemic. These changes continue in the upcoming 2022 cycle and we will re-evaluate again for the 2023 admission cycles and beyond using these same principles.

Within the Hidden Barriers episode “Opening the Doors to Medical School,” they mention that some schools are evaluating life experience more heavily than test scores and that this is increasing diversity. Is this something that UW School of Medicine is doing?
UW School of Medicine was an early adopter of the holistic review approach to admissions. This means that for more than a decade we have used a mission-aligned selection process that considers the whole applicant, balancing applicants’ experiences, attributes and academic metrics as well as what unique and important contributions applicants might bring to the learning environment and the practice of medicine.

We recognize that it takes more than good grades and test scores to succeed in medical school and as a physician, and that starting points and support structures are not equal for all applicants. Our committee is interested in learning applicants’ stories, understanding their journeys and matching those with the mission and needs of the School and our region.

What other things can we do to improve and encourage diversity within our medical school?
There’s not one thing we can do that will improve diversity. My job requires me to report on numbers, data and demographics. I do because I know that’s how many things operate, but it’s more than that. It’s about the stories of our students. And how these stories will change the dynamic of our medical school. And they already have. But change can be hard. It comes with people asking hard questions and challenging the way things have always been done. So, you get a little push back.

I prefer to think of medicine and medical education as an ecosystem, rather than a pipeline. I focus on the admissions piece of the ecosystem so that the next generation can fertilize the soil for those who come after them. A pipeline works, too. I’m a product of a pipeline system. But I could’ve fallen out, or there could’ve been a leak, pipelines break and then who knows where I would’ve been. So, it’s much more than just numbers.

And everyone has a responsibility. Not just me, not just the student affairs people, not just the dean of the medical school — it’s up to all of us. Everyone in medicine has something to offer and has the capacity to cultivate our ecosystem and make it healthy.

Help Close the Gap

A key to closing the gap for admissions is a strong scholarship program; make a gift today to support scholarships at UW Medicine.

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