As a medical school, Boston University is committed to the health of our very diverse communities. We emphasize the education of medical students who are competent and comfortable taking care of patients from cultures different than their own. Thus providing an education that is focused on health equity and actively antiracist is essential.
In 2019 a group of BUSM medical students objected to race being described as a biologic construct in the classroom, including racial differences reported in research studies without further explanation and also reinforcement of racial stereotypes in case vignettes and in illustrations. When they brought up the topic with Priya Garg, MD, Associate Dean of Medical Education, the BUSM’s Medical Education Committee (MEC) established the a Racism in Medicine Vertical Integration Group (VIG). The group, comprising students and faculty, worked for a year to identify evidence of racism in the curriculum and in the campus climate.
The VIG members were Kaye-Alese Green (BUSM ‘23); Sabreea Parnell (BUSM ’22); Becca Wolinsky (BUSM ’22); Daniela del Campo (BUSM ’22); Ajay Nathan (BUSM ’22); Martine Randolph, (BUSM ’20); Emily Regier (BUSM ’20); and faculty members were Samantha Kaplan, MD; Shoumita Dasgupta, PhD and M. Isabel Dominguez, PhD.
Their report, “Is race a risk factor? Creating Leadership and Education to Address Racism: An Analytical Review of Best Practices for BUSM Implementation” was submitted in June 2020. Its mission was twofold – to document the history of racism within the institution of medicine and its impact on trainees, physicians and patients, and to partner with the Medical Education Office (MEO) in the creation of a longitudinal curriculum to eliminate racism in medical education and medical practice.
The report identified strength and weaknesses related to race within the BUSM medical education curriculum and provided thoughtful antiracist recommendations for faculty to implement in their teaching through specific changes to language and to their choice of images.
To track the implementation of the report’s recommendations, course directors were asked in their annual self-assessment: “What changes did you make to address health equity and gender diversity based on the recommendations of our VIGs?”
To help implement course-specific changes, MD/JD student Kaye-Alese Green (then the inaugural BUSM diversity fellow) answered faculty questions and served as a liaison between the VIG and faculty members.
A review by VIG member Ajay Nathan, MD ‘21 and the MEO found that approximately 80 percent of the VIG recommendations were incorporated within the first year after the report.
Broader changes to the curriculum include a focus on more inclusive pedagogy across the curriculum. Faculty who teach in the first two years of the curriculum and students created an Educators Guide based on their experiences. Faculty now attempt to avoid using race when unnecessary in areas such as clinical vignettes and exam questions.
“The work doesn’t end here,” Garg noted. For immediate next steps, the MEO is analyzing their assessment data to find any racial or gender biases in the clerkship years specifically. They are also working with first-year students to emphasize health equity right from the start of medical school, and developing new competencies related to health equity.
“Medicine has a long history of racism, with structural and systemic factors that have perpetuated racism in medical education for hundreds of years,” Garg said. “As an institution that believes strongly in caring for all patients regardless of background or socioeconomic status, we have to incorporate antiracism, which is directly linked with providing equitable care to all patients.”
Students and faculty in the VIG and MEO have been engaging nationally and regionally to lead this change in medical education, from working with the AAMC to other national organizations and student groups at other universities.
Members of the VIG also wrote a manuscript detailing their process and methods that has been accepted for publication in the journal Academic Medicine.
Garg added that medical education specifically has an important role to play in making large scale changes to address racism in the practice of medicine.
“To make change upstream and ensure actual changes to patient care, medical education has to be the leader in teaching students and helping them to recognize the historical and current factors contributing to racism in medicine, in order to prevent that in the future.”