Landmark study finds GHHS selection is equitable for medical students from many marginalized groups

The first study to look closely at Gold Humanism Honor Society membership in medical schools across four categories – race/ethnicity, sex, sexual orientation, and childhood family income – found selection into GHHS was no less or more likely for students in most marginalized groups, a rarity for prestigious medical accomplishments.

“It is very exciting because I think of all the metrics we’ve looked at, be it attrition in medical school, attrition in academic medicine at the faculty level, promotion, leadership positions such as chair and dean, we see significant disparities pretty much across all identities we look at in all of those areas,” said Dr. Dowin Boatright, the study’s senior author and a New York University faculty member. “Gold Humanism is the only prestigious honor that I think we’ve seen in medicine so far where we don’t see these global disparities.”

For example, whether a student was Black, Hispanic, American Indian, Alaska Native, white, or multiracial did not affect their likelihood of being a member of GHHS. In fact, students from two traditionally marginalized groups – female students and lesbian, gay, bisexual students – were more likely to be members of GHHS. The Gold Humanism Honor Society, which has 180 chapters and nearly 45,000 members, was created by the nonprofit Arnold P. Gold Foundation in 2002 to recognize leaders of humanistic care. The Gold Foundation defines humanistic care as care with three essential elements: compassion, collaboration, and scientific excellence.

The landmark study was published in JAMA Open on Sept. 7. (View full study.) Researchers from Yale University, New York University, Accreditation Council for Graduate Medical Education (ACGME) and University of California Davis looked at a national sample of 50,384 students who graduated from an allopathic (MD) medical school from 2016 to 2019 and whether they have been selected to GHHS, and/or Alpha Omega Alpha, a medical honor society that recognizes high academic achievement. The researchers then compared the proportion of students from the four categories who were GHHS and/or AOA members to the overall proportion of those students in the national sample to identify any disparities.

The findings were starkly different for the two honor societies. Few disparities were found in GHHS selection for students from marginalized groups. The two exceptions were that Asian students and students with very low childhood income were less likely to be members of GHHS, a concerning discovery that the Gold Foundation will be investigating further. In contrast, disparities in AOA existed across many more identities, were often larger, and increased with additional numbers of marginalized identities. For example, Black students were four times less likely to be members of AOA than white students.

In an interview with the Gold Foundation, lead author Katherine Hill of Yale University, described the discoveries: “The big implication that we found is that a lot of marginalized groups are still facing barriers to honor society membership. But the other big message, and the hopeful message, is that these barriers may not be inevitable. The fact that we saw such large differences in membership composition between AOA and GHHS really suggests that changes can be made to honor society admission process to make it less biased and to admit more students from marginalized groups.”

The researchers decided to study “marginalized groups” that have historically faced barriers and discrimination in medicine, rather than solely “underrepresented in medicine” (URM) groups to acknowledge that barriers still exist for some groups, such as women and Asian people, who are not underrepresented in medicine. For example, both female and Asian physicians are far less likely to be in leadership in medicine years later, despite being well represented in medical school.

“We were very pleased to find that there are not the usual barriers to selection for GHHS for students of many marginalized groups,” said Dr. Richard I. Levin, President and CEO of The Arnold P. Gold Foundation, the nonprofit organization that created and oversees GHHS. “We are always interested in improving GHHS. We are committed to investigating more deeply the data on disparities that exist to better understand the possible causes and how we can be an important part of the solution.”

Each honor society chapter selects about 15-20% of a medical class for membership. Honor society membership can be included on the application form for residency, which is highly competitive, and also be helpful in obtaining mentorships, internships, and other benefits. One way that the two honor societies differ is in their selection process. Gold Humanism Honor Society supports a peer-nomination process, which was vetted by researchers when GHHS was founded 20 years ago.

“It is important to note that AOA and GHHS are selecting for very different characteristics. We knew when we created the Gold Humanism Honor Society that the selection process was critical. How do you determine who is a humanistic future doctor? We decided on a peer-nomination process as the first step because students know their fellow students so well. They know which classmates they would want to care for their own mother or child,” explained Dr. Levin, who is a member of AOA and GHHS. The study authors also included members of GHHS and of AOA.

In the future, Ms. Hill and Dr. Boatright said they are interested in studying selection into honor societies in osteopathic (DO) medical schools and possible disparities in honor society selection for medical students with disabilities, who are transgender, and non-binary students. (Data on those segments was not available for this research.)

The peer-nomination process is also a key area for greater understanding, said Dr. Boatright. “I think we have a significant opportunity here to look at the practices and processes of membership selection of the Gold Humanism Honor Society as a template for successful interventions for equity and moving forward.”

Read a Q&A with Katherine Hill and Dr. Dowin Boatright.