Challenging the "Other" Narrative: Building Equity and Representation through the ACOI Committee on Ethnically and Racially Underrepresented Populations in Medicine

Medicine is built on a foundation of compassion, service, and human connection. Yet for those of us navigating the path as first-generation students and students from underrepresented backgrounds, that journey often involves traversing spaces where we feel unseen or unsupported. We have both experienced the "invisible barriers" that shape a career in medicine, from the cultural isolation of navigating unspoken professional expectations to the foundational inequities that dictate who receives mentorship and who is left to find their own way.

Our paths to this realization were distinct from one another. One of those paths was shaped by the complexities of navigating medicine as a first-generation student; the other was forged through Native Hawaiian and Pacific Islander research and advocacy, where data disaggregation revealed the pervasive neglect often hidden in daily clinical practice. Despite these different lenses, we are united in our commitment to highlighting how "othering" in medicine is not just a personal feeling, but a structural barrier that requires a technical, data-driven response.

Student Advocacy Through the ACOI Committee on Ethnically and Racially Underrepresented Populations in Medicine

Our shared commitment to dismantling these narratives led us to our roles as student representatives to the ACOI Committee on Ethnically and Racially Underrepresented Populations in Medicine. We recognize that representation and equitable pathways to success are clinical necessities, and this committee provides the framework through which we can translate our lived experiences into formal advocacy.

As student representatives, we prioritize creating professional environments where diverse perspectives drive constructive change. While our individual backgrounds differ, we are united by our shared resolve to address persistent disparities within the medical community. Our work focuses on dismantling the institutional barriers that disproportionately affect underrepresented trainees by refining clinical mentorship and recruitment pipelines as well as addressing documented bias in academic evaluations.

Our objective is to ensure that national policy and professional resources are leveraged to elevate the leadership of minority physicians. By cultivating a workforce that reflects the demographics of our patient populations, we aim to move beyond awareness and toward a medical infrastructure in which health equity is a measurable standard of care.

Bridging the Gap at the Annual Convention

Our immediate efforts are focused on the upcoming Annual Convention, where we are implementing a structured environment for mentorship and advocacy. These sessions are designed to move past traditional networking by creating a protected, non-judgmental space in which trainees can navigate professional challenges.

These student-focused sessions will utilize case-based scenarios that allow attendees to analyze structural barriers in small-group settings. This interactive approach will serve two functions: providing immediate peer-to-peer mentorship, and acting as a qualitative data collection point for identifying shared systemic impediments.

Following the convention, we will synthesize de-identified data from these sessions to generate actionable insights. Our goal is to provide medical schools, residency programs, and healthcare institutions with a summary of the systemic hurdles identified by trainees. By translating these qualitative experiences into a formal summary, we provide the necessary evidence for organizations to implement objective guidelines and targeted resources for their teams.

The Evidence Behind "Othering"

The "invisible barriers" faced by underrepresented trainees are not merely subjective experiences. They are documented systemic risks rooted in the current medical training architecture. Data from the National Medical Association (NMA) and recent literature reveal a significant disparity in residency dismissals, with African American and Hispanic residents dismissed at disproportionately higher rates than their peers (NMA, 2024). This trend is mirrored in clinical performance assessments, where landmark studies from UCLA and UCSF demonstrate that resident race and ethnicity are often associated with lower evaluation scores despite comparable clinical competency (Lowery et al., 2022; Teherani et al., 2018; Klein et al., 2022). At the medical school level, these biases manifest during clerkships as grade discrimination and challenges in professional identity formation, creating a persistent "struggle to belong" that hinders the development of a diverse physician workforce (Venkataraman et al., 2024; Luong et al., 2025).

Beyond formal evaluations, underrepresented students and physicians often navigate a "minority tax" defined as the uncompensated burden of diversity labor and the expectation to serve as cultural liaisons without institutional recognition (Betancourt et al., 2024). This labor, coupled with the social construction of race-based medicine, reinforces a medical infrastructure where "othering" acts as a structural barrier to leadership (Skinner-Dorkenoo et al., 2023). By framing these disparities through the lens of peer-reviewed data, our committee treats these challenges not as individual hurdles to be managed, but as foundational inadequacies of the medical system. This evidence mandates an organizational shift, transforming equity from a conceptual goal into a performance standard at every stage of medical training.

A Shared Vision for Medical Excellence

Our work with the ACOI Committee on Ethnically and Racially Underrepresented Populations in Medicine is about more than identifying obstacles. It is about building a resilient and representative foundation for the osteopathic profession. By transitioning from anecdotal experiences to actionable data, we are providing a roadmap for institutional growth and refining our training environments to be more equitable. In turn, we are strengthening the clinical workforce and improving the standard of care for the diverse communities we serve. As we look toward ACOI 2026 and onward, we invite our peers and mentors to join us in this evolution, ensuring that every physician, regardless of background, has a clear and supported path to leadership.

References

National Medical Association. Resolution to train and stop excluding and firing qualified residents as an additional way of addressing the physician shortage. National Medical Association. Published August 3, 2024. Accessed May 9, 2026. https://nmanet.org/news/resolution-to-train-and-stop-excluding-and-firing-qualified-residents-as-an-additional-way-of-addressing-the-physician-shortage/

Lowery L, Itani O, Wang MB, et al. Disparities in medical school clerkship grades associated with sex, race, and ethnicity. Med Educ Online. 2022;27(1):2095164. doi:10.1080/10872981.2022.2095164
https://pubmed.ncbi.nlm.nih.gov/35791771/

Teherani A, Hauer KE, Fernandez A, King TE Jr, Lucey C. How small differences in assessed clinical performance amplify to large differences in grades and awards: a web-based simulation of setting clerkship grades and Medical Student Performance Evaluation categories. Acad Med. 2018;93(8):1186-1192. doi:10.1097/ACM.0000000000002137
https://pubmed.ncbi.nlm.nih.gov/29329131/

Klein R, Ufere NN, Schaeffer S, et al. Association between resident race and ethnicity and clinical performance assessment scores in graduate medical education. Acad Med. 2022;97(9):1351-1359. doi:10.1097/ACM.0000000000004743

Venkataraman S, Nguyen M, Chaudhry SI, et al. Racial and ethnic discrimination and medical students' identity formation. JAMA Netw Open. 2024;7(10):e2439727. doi:10.1001/jamanetworkopen.2024.39727

Luong V, Cameron P, Brown MEL, et al. The struggle to belong for underrepresented medical students: a narrative review. Perspect Med Educ. 2025;14(1):826-836. doi:10.5334/pme.1873

Betancourt RM, Baluchi D, Dortche K, Campbell KM, Rodríguez JE. Minority tax on medical students: a review of the literature and mitigation recommendations. Fam Med. 2024;56(3):169-175. doi:10.22454/FamMed.2024.268466

Skinner-Dorkenoo AL, Rogbeer KG, Sarmal A, Ware C, Zhu J. Challenging race-based medicine through historical education about the social construction of race. Health Equity. 2023;7(1):764-772. doi:10.1089/heq.2023.0036