“As a student, not having an AΩA chapter has been one of the many experiences that have shaped my medical education compared to my friends at other medical schools. A couple of my first-generation and low-income peers actually didn’t learn about AΩA until after the selection process at their medical school—and by then, it was too late for them to try to work towards AΩA.”
Mytien Nguyen, MS, a rising sixth-year MD-PhD student at Yale School of Medicine (YSM), who identifies as first-generation and low-income, shared this observation about the Alpha Omega Alpha (AΩA) Honor Medical Society. YSM is one of a few medical schools without an AΩA chapter. Concerns about the disparities of AΩA membership—and the reasons for it—led Nguyen, Dowin Boatright, MD, MBA, MHS, assistant professor of emergency medicine, and colleagues to research if disparities in AΩA membership exist across socioeconomic strata. Their study, which they report on in Analysis of Socioeconomic Status and Medical Student Alpha Omega Alpha Honor Society, published in JAMA Network Open on June 2, is the largest and only examination of AΩA membership by socioeconomic status to date.
“Alpha Omega Alpha (AΩA) honor society membership is the hallmark of academic achievement in undergraduate medical education, and AΩA membership is associated with future success in academic medicine,” their manuscript begins, noting that AΩA members are chosen based on academic performance, leadership, patient care, and service. AΩA’s website reflects this prestige stating that nearly 75% of deans of U.S. medical schools are members.
There are 132 AΩA chapters in medical schools across the US and students are elected through their individual chapters. While the process varies, each chapter must maintain the attributes of AΩA – academic achievement, research, education, leadership, humanism, professionalism, service – throughout the election process. Additionally, only 20% of a medical school’s graduating class may be selected.
While the AΩA website makes explicitly clear that no applicant shall be denied admission based on a broad list of demographic factors that include race or socioeconomic status, studies have shown racial/ethnic disparities in AΩA membership. Nguyen, Boatright, and their team were interested in determining if there were similar disparities based on socioeconomic status.
To do this, they first obtained de-identified data from the Association of American Medical Colleges (AAMC) describing medical students applying to residency between 2018 and 2020. The socioeconomic measures they looked at included parental education, childhood household income, Pell grant assistance, and whether the student had been a beneficiary of state or federal financial assistance programs for low-income families.
Among 30,265 students in the final study cohort, 14.9% were first-generation college graduates, 30.2% reported childhood income below $75,00, and 22.7% and 19.2% were Pell grant and state or federal financial assistance recipients, respectively. These percentages were lower for AΩA members compared to non-members.
Childhood household income was the economic factor the authors selected for inclusion in the multivariate model, to provide the greatest distinction in economic advantage between students. Students reporting a childhood household income below $125,000 were less likely to be AΩA members compared to those reporting a household income of at least $200,000. This disparity was greatest for students reporting a childhood household income below $50,000. For this group, the odds of membership were 46% lower than for students whose childhood household income was $200,000 or more.
The study looked at other demographics and found, in part, that white students were more likely to be members than Asian, Black/African American, Hispanic, and multiracial students. The authors found no significant interaction between socioeconomic measures and race/ethnicity, demonstrating “persistent and striking racial/ethnic disparities in AΩA membership, even after adjusting for socioeconomic measures and standardized test scores.” They conclude, “although AΩA membership has been recognized as marker of merit, our findings suggest that AΩA membership may also be an indicator of privilege. Medical schools must ensure that the learning environment allows all students to thrive irrespective of their backgrounds.”
The membership selection process is so important because membership has cascading beneficial impacts. As Nguyen explains, “In addition to the honor, AΩA plays an important role in connecting students to networks and resources that help them succeed in their path to physicianhood. For first-generation and low-income students who already enter medical school with significantly less social capital and resources compared to their peers, our finding that low-income students were significantly less likely to be AΩA members puts socioeconomically disadvantaged students even further behind.”
AΩA membership is given substantial consideration when students apply for residencies. Boatright says some directors of highly competitive programs have admitted to only interviewing AΩA members. Moreover, across nearly every specialty, AΩA members are more likely to match than non-members, even when restricting to those with the highest standardized test scores.
Boatright and Nguyen believe schools should suspend their AΩA chapters until they have conducted a rigorous examination for membership disparities and if disparities are found, implemented a comprehensive plan to address them. Boatright notes that several schools, including UCSF School of Medicine, Icahn School of Medicine at Mount Sinai, and Washington University School of Medicine in St. Louis, have suspended their chapters over the last two to three years for this reason. Nguyen adds, “I hope that residency programs recognize that both racial and socioeconomic disparity exists and de-emphasize AΩA membership status in residency ranking.”
The other authors of Analysis of Socioeconomic Status and Medical Student Alpha Omega Alpha Honor Society from YSM are Darin Latimore, MD, deputy dean; Marcella Nunez-Smith, MD, MHS, associate dean for health equity research; and Patrick O’Connor, MD, MPH, chief, General Internal Medicine. Hyacinth R.C. Mason, assistant dean for student support and inclusion, Albany Medical College PhD, MPH and William A. McDade, MD, PhD, ACGME chief diversity and inclusion officer, also were authors.
Featured in this article
- Marcella Nunez-Smith, MD, MHSAssociate Dean for Health Equity Research and C.N.H. Long Professor of Internal Medicine (General Medicine), of Epidemiology (Chronic Disease) and of Public Health (Social And Behavioral Sciences) & Professor of Internal Medicine (General Medicine); Associate Dean, Health Equity Research; Affiliated Faculty, Yale Institute for Global Health; Founding Director, Equity Research and Innovation Center (ERIC), Yale School of Medicine; Director, Center for Research Engagement (CRE); Director, Center for Community Engagement and Health Equity; Deputy Director for Health Equity Research and Workforce Development, Yale Center for Clinical Investigation (YCCI); Director, Pozen-Commonwealth Fund Fellowship in Health Equity Leadership