Discontinuation of Affirmative Action: Consequences for Black Educational Equity, Neurosurgical Residency, and Medical Diversity, with Consideration of Potential Adversity as a New Path Forward

Introduction: The underrepresentation of the Black community in neurosurgical subspecialties is concerning, especially given projections that racial minorities will become the majority in the U.S. by 2044. Yet, despite these forecasts, Black candidates make up less than 4% of those in neurosurgical training programs. The recent Supreme Court decision to end Affirmative Action underscores the urgency of addressing this disparity. This research delves into the implications of eliminating Affirmative Action on neurosurgery admissions and residencies.

Methods: A comprehensive literature search was performed using PubMed, OVID Embase, and OVID Medline, employing the keywords "Black," "Neurosurgery," and "Residency." To enhance the assessment of applicants' experiences, particularly regarding adversity, we developed a novel point-based system based on Maslow's hierarchy of needs. Assigning more points to the unmet physiological and safety needs during one's formative years, this method aimed to objectively evaluate adversity and incorporate it into residency selection processes.

Results: After Affirmative Action, Black college enrollment increased, peaking at 36% by 2020. However, Black medical students remain underrepresented in neurosurgery residencies. ALDC (Athletes, Legacies, Dean’s List, Children of faculty/staff) admissions criteria favor White students. Furthermore, studies have highlighted the beneficial impacts of racial concordance on patient outcomes. The end of Affirmative Action necessitates new diversity strategies in admissions. A points-based assessment, inspired by Maslow's hierarchy, recognizes adversities faced by underrepresented applicants. This method could help residency programs enhance diversity, inclusivity, and equity in selection.

Conclusion : Despite the growth in Black college attendance, disparities persist in specialized medical fields like neurosurgery. The recent end to Affirmative Action policies might exacerbate these disparities. Embracing holistic admission approaches, through the points-based assessment, rooted in Maslow's hierarchy can account for personal experiences and challenges, becomes crucial for inclusive representation in education and specialized professions, influencing patient care and overall health outcomes.