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CHICAGO -- Delegates who urged the American Medical Association (AMA) to take a firmer stance against medical schools using legacy preferences in their admissions process succeeded during the annual House of Delegates meeting.

While the AMA already passed a policy supporting "," some delegates argued that the association must explicitly oppose legacy admissions policies if it aims to truly advance health equity and promote workforce diversity.

Rather than stating that medical schools be "encouraged to avoid specific questions about legacy status," as a draft resolution recommended by the reference committee suggested, the Minority Affairs Section called for the AMA to leverage its standing to "oppose the use of questions about legacy status" and to acknowledge their "discriminatory impact."

Three-quarters of research universities and elite liberal arts colleges -- and their medical schools -- for admissions, according to the resolution put forward by the Medical Student Section, which drew the support of Luis Seija, MD, of the Minority Affairs Section, and other delegates.

Early in his academic career, Seija said he discovered there was one core difference between himself and his white peers: opportunity.

"I was raised in a single-parent household with a name that doesn't necessarily roll off the tongue," he said.

He took the MCAT five times, applied to medical school twice, and ultimately became the first physician in his family.

Because of various obstacles and the trauma he's endured in his lifetime, Seija said that he's better qualified to empathize with his patients, adding that though he's been called "resilient," he has questioned whether the label would still fit in a more "just and equitable" society absent practices like legacy admissions.

Anna Yap, MD, who spoke on behalf of the Section Council on Preventive Medicine and the Resident Fellows Section, said legacy admission policies were formally enacted in the early 20th century "to protect universities' white, wealthy and Protestant student body from competing with European and Jewish immigrants."

In the decades since, questions around legacy admission status have been used to discriminate against first-generation students, people of color, recent immigrants, and those of lower socioeconomic status, she said.

It was "no secret" that legacy admissions occurred at her own medical school, Yap noted. And despite a large share of the other students also being Asian, this gap in privilege often left her feeling like she didn't belong, she added.

While there are still ways a student who wants to disclose a connection to the university can do so, "we should remove this question that can be used as a filter that further cements structural racism," she said.

Nicole Plenty, MD, speaking as a delegate for the Women Physicians Section, argued that even just listing the legacy section on an application can discourage minority students from applying because they will recognize that they don't have the kinds of connections other applicants have.

"This is a discriminatory act and we should take a stand against it," she said.

Only a few delegates spoke out against the proposed policy and amended language.

O. Lee Berkenstock, MD, a delegate from Tennessee and a first-generation Italian-Polish immigrant, speaking on his own behalf, said that while he is not a legacy student, he has served on admissions committees. The committees are "duty-bound" to choose students who can "handle the rigors of medical school" -- a quality that can be measured in several ways, he noted. In addition, particularly at public institutions, admissions committees look for applicants who are likely to stay and work in and around that community.

"I'm very happy to say that I spent my whole professional career in and around the Memphis area," he said. "So please understand that when we talk about legacy status," there is legacy "in terms of privilege" but "a legacy in your community is also equally important."

George Ellis Jr., MD, a delegate from Louisiana speaking on his own behalf, is a legacy member of a medical school. Medical schools accept legacy members for a lot of reasons, one of which is to increase donations to the school from those families, he said.

"I would suggest that there are many ways to try and promote diversity ... but attacking this one area is not one I think we need to press on ... Personally, I am weakly against this amendment," Ellis said.

Ultimately, the amended resolution -- with language from the Minority Affairs Section and backed by multiple other delegations -- explicitly opposing legacy admissions was adopted in a voice vote by the House of Delegates on Monday.

Correction: This article has been updated to reflect that the Medical Student Section introduced the original resolution on legacy admissions policies.

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