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Here are action items we would like to see from Feinberg School of Medicine:

1. A review of Feinberg’s AOA membership profiles with specific attention to differences by race and ethnicity with findings shared to the student body for full transparency
2. Discontinuing medical student nominations and inductions for AOA membership immediately
3. Creating a diverse task force that includes medical students from all classes to determine the future of AOA at Northwestern, for example, terminating the entire Northwestern AOA chapter, ending student inductions permanently, or resuming student inductions once there is an equitable selection process
4. Including the aforementioned task force on any “updates on the holistic review process” that will be shared in Fall 2020 (as stated on the Feinberg website)

The Northwestern AOA chapter was founded in 1903 and includes undergraduate, graduate, and honorary members. At Feinberg, the top 25% of the class is nominated to the AOA committee, where the top 16% of the class is selected for induction. AOA selection can be a valuable accolade for students pursuing competitive residencies, and membership has been associated with increased likelihood of matching into the residency specialty of their choice [1,2]. Further, multiple studies have found an association between AOA membership and the likelihood of pursuing academic medicine and rising to the rank of full professor, dean, or departmental chair [3]. However, many medical schools have chosen to end AOA or placed a moratorium on student nominations to critically evaluate the selection process. Medical schools have found the process discriminates against Black, Indigenous, People of Color (BIPOC), thereby perpetuating racial inequality in medical education and affecting future opportunities for BIPOC medical students. Schools without AOA include: 

Harvard Medical School
Stanford University School of Medicine
Yale School of Medicine
UC San Diego School of Medicine
Mayo Clinic Alix School of Medicine
Icahn School of Medicine at Mount Sinai
California Northstate University College of Medicine
California University of Science and Medicine
UC Riverside School of Medicine
Frank H. Netter MD School of Medicine at Quinnipiac University
Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine
Carle Illinois College of Medicine
Central Michigan University College of Medicine
CUNY School of Medicine
San Juan Bautista School of Medicine
John Hopkins School of Medicine uniquely selects AOA after the residency match.

A JAMA Internal Medicine study analyzed data from ERAS of 4,655 US medical students and 123 allopathic US medical students who applied to 12 residency programs at one academic health center from 2014 to 2015 [4]. After controlling for Step 1 scores, research productivity, community service, leadership activity, and Gold Humanism membership, they found that the odds of AOA membership for white students were nearly 6 times greater than those for Black students and nearly 2 times greater than for Asian students.  

Feinberg nominates students for AOA consideration solely based on clinical performance in clerkships. These subjective evaluations have consistently been prone to bias and racial inequities, and while we appreciate the creation of a Bias in Assessment Committee to address these concerns, it is likely to be an ongoing, lengthy process while current students continue to be impacted by bias. Further, the decision to change USMLE Step 1 reporting to a pass-fail outcome starting January 2022 will likely change the measurement of applicant competitiveness, potentially placing increased emphasis on clinical performance and AOA membership, both of which are prone to bias. It is counterintuitive for Feinberg to work towards diversity and inclusion while continuing to uphold an honorific that puts BIPOC medical students at a disadvantage. Participating in AOA perpetuates the bias and racism we are actively trying to eliminate. 

We understand that there is an effort underway to update the AOA selection process at Feinberg, however there is a complete lack of transparency as to what that entails. Further, other medical schools, such as Icahn School of Medicine at Mount Sinai, have tried to change their selection process in an effort to be more holistic and found no change in outcomes for AOA membership [5]. There are many reasons for inequality in AOA membership, including those preceding and during medical school. Until we address bias in all aspects of medical education and create an equitable educational experience, AOA membership will continue to privilege certain students over others and perpetuate racial inequalities.

References
1. National Resident Matching Program. Charting Outcomes in the Match. Characteristics of Applicants Who Matched to Their Preferred Specialty in the 2018 Main Residency Match. 2018. https://www.nrmp.org/wp-content/uploads/2018/06/Charting-Outcomes-in-the-Match-2018-Seniors.pdf Accessed June 4, 2020.
2. Rinard, J. R., Garol, B. D., Shenoy, A. B., & Mahabir, R. C. (2010). Successfully matching into surgical specialties: an analysis of national resident matching program data. Journal of graduate medical education, 2(3), 316-321.
3. Brancati, F. L., Mead, L. A., Levine, D. M., Martin, D., Margolis, S., & Klag, M. J. (1992). Early predictors of career achievement in academic medicine. Jama, 267(10), 1372-1376.
4. Boatright, D., Ross, D., O’Connor, P., Moore, E., & Nunez-Smith, M. (2017). Racial disparities in medical student membership in the Alpha Omega Alpha Honor Society. JAMA internal medicine, 177(5), 659-665.
5. Leadership Letters: AOA, Equity, and Wellness. Icahn School of Medicine at Mount Sinai. 2018. http://changenow.icahn.mssm.edu/leadership-letters-aoa/ Accessed June 4, 2020.