If you are neutral in situations of injustice, you have chosen the side of the oppressor. —Desmond Tutu
The institution of medical education in the United States has remained neutral on the topic of racial injustice for far too long. Within all social movements, there are moments that catapult awareness into our collective psyche. In the fight against injustice towards Black people in America we are in a contemporary awakening as both educators and as humans.
Many of us ran 2.23 miles on May 8 in honor of Ahmaud Arbury, a young man chased and murdered while jogging in his neighborhood in February. During the same timeframe, news began to spread about one of our healthcare colleagues, Breonna Taylor, being killed by police on March 13. Only two weeks after #runwithAhmaud, we were shocked as physicians to hear George Floyd say words we routinely treat as life-threatening, “I can’t breathe,” more than 20 times before being murdered by police. Nationwide outrage and protests demanding justice quickly followed. Although we have grappled with many killings in the past (Michael Brown, Trayvon Martin, Tamir Rice, and countless others), some of us are confronting the reality of injustice in a deeper, more conscious way for the first time.
Lack of awareness of white privilege and the racial oppression that results from this privilege has kept us from recognizing our complicity in a racist healthcare system, as well as society at large. Systemic racism and racial injustice are built into nearly every aspect of life in the United States, including medical training. As educators we must recognize that dismantling systemic racism demands more than supportive social media posts. As we join the conversation about race and racism in the medical community, we must start the hard work of evaluating our own culpability.
We recommend starting with reflection, including contemplating how one’s own race has shaped one’s life. Race is a social construct without a scientific basis.1 Sitting with that concept alone can be challenging to one’s worldview and becomes even more difficult when considering what has been previously taught in medicine. This type of reflection and self-education can be discomfiting work. However, as physicians, we have committed to the processes of lifelong learning and constant self-reflection. The discomfort that we experience will prompt us to enact change at the individual, institutional, and systemic levels.
Academic medical centers must also recognize their role in propagating the culture of discrimination and unconscious bias, which is outlined in the 2019 AAMC Diversity in Medicine report.2 Despite increased diversity seen among medical school matriculants and graduates, there has been a persistent lack of minority representation at the faculty level, particularly for Black physicians. This should be a cause of concern for academic medical centers and our society as a whole. Though the medical community has made several commitments towards racial justice and equality over the last few years, this report demonstrates that these efforts have fallen short.
Academic institutions, faculty, and administrators must evaluate practices that propagate racial disparities in medical education and healthcare. We recommend the following additional concrete steps towards espousing anti-racism as medical educators:
As Teachers We Must:
- Identify and remove racist ideas from sessions or courses that we lead. For example, avoid misleading learners to believe that there are important biological differences driving health disparities, or difference in disease risks, when in fact race has little to do with genetic variance.1 Begin anti-racist curriculum development by labelling racism as a social determinant of health and a cause of health disparities, and expand it to become an integral part of a how we learn about an organ system or a disease.
- Mitigate the effects of stereotype threat and understand the triggers experienced by Black and other medical trainees who are underrepresented in medicine (URiM). Create a learning environment where we encourage, welcome, and reward participation from learners who are URiM in the classroom and in clinical setting to diminish stereotype threat.3
- Address racism in the workplace and provide support and action to learners who are targets of racist acts. Every failure to speak up when a colleague or a patient displays micro-aggressive or discriminatory behavior towards a learner who is URiM is an endorsement of the behavior and a propagation of the culture of racism in medical education.3
As Education Researchers We Must:
- Refrain from arbitrarily including race as a participant demographic characteristic, unless the research is specifically focused on elucidating education disparities.
- Mentor students and trainees who are URiM in education research. Teach them how to conduct education research to build the pipeline of academic clinician-educators and education leaders.
- Collaborate with education researchers at historically black medical schools to produce medical education research outcomes that are generalizable to a broader population of learners, as well as to enhance the careers of those researchers through impactful multi-institutional collaboration.
As Education Program Leaders We Must:
- Reduce reliance on metrics that discriminate against students of color, such as standardized test scores and Alpha Omega Alpha (AOA) status.2
- Pro-actively recruit, mentor, and retain teaching faculty from diverse backgrounds, especially Black faculty, and sponsor them for professional development opportunities and positions of leadership.4
- Create system-wide, mandatory faculty development for all faculty to help build and foster a supportive culture for Black and underrepresented trainees.
- Allocate curricular time and resources for teaching faculty and trainees to learn about social justice, advocacy, and activism, to combat racist policies that adversely affect the physical and mental health of both patients and learners.2
- Evaluate programmatic structures that perpetuate disparities. One example is differences in health outcomes in resident panels versus faculty panels. Resident clinics are often a microcosm of the care delivery to underserved populations who tend to be racial/ethnic minority patients. We must consider the structural factors that contribute to differing health outcomes in various patient cohorts and create triage systems for patients who need more continuity and increased experience of an attending level physician.5
Through personal reflection and implementation of specific anti-racist measures, we can create a medical education culture which helps our healthcare system support societal change. Recognizing our individual and institutional culpability and holding ourselves accountable to education, growth, and improvement are necessary steps that will lead us to a place of improved equality in health care and medical education.
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