In spite of an evidence-based understanding that racial groups do not differ from one another significantly in biological terms, there are still many examples in medicine where race-based thinking emerges in diagnostic processes, in approaches to patient care and in unintentional propagation of health disparities.
A new paper in the journal Academic Medicine aims to dismantle the frameworks that support these structures so that physicians in training do not go on to propagate biases rooted in systemic racism.
BUSM researchers present a blueprint for medical schools to use to identify problematic instances of racism in medicine as it is represented in medical education. The publication also presents best practices and key recommendations for schools to create more inclusive, anti-racist medical curricula.
“This approach has the power to address healthcare disparities head on, to inspire a generation of advocates for change and to transform the way we think about medical science and the patients we serve,” said corresponding author Kaye-Alese Green, MA, a third-year medical student and the Inaugural Diversity & Inclusion Fellow at BUSM.
A Vertical Integration Group (VIG), a curriculum group comprising faculty and student advocates was formed to perform a comprehensive internal curriculum assessment as well as a parallel assessment of peer institutions. The assessment involved students reviewing a wide range of curricular materials as they navigated the curriculum as learners and examined approaches used at peer institutions to promote equity and inclusion. Their findings and processes were guided and reviewed by the faculty members and, with the endorsement of the Medical Education Office, were released to the medical school community with accountability processes to guide implementation.
The curricular recommendations fall into the following domains of guiding principles: (1) challenging the persistence of biological/genetic notions of race, (2) embedding structural practices in medical education to dismantle racism in medicine, and (3) promoting institutional climate change. Initial steps to implement these recommendations are also described.
The historic and present reality of racism in America and in medicine has impacted medical education specifically, and more broadly, the practice of medicine, trainee experience and patient outcomes. “The findings and recommendations of the working group were released during the summer of 2020 as our nation mourned the continued, violent loss of Black Lives. People were hungry for change and for a community already deeply committed to the work of equity in healthcare, there was even greater momentum for change,” explained senior author Shoumita Dasgupta, PhD, professor of medicine and assistant dean of admissions.
According to the researchers, it is important to recognize that this work occurs in the context of a national reckoning with racism in America. “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,” said coauthor Priya Garg, MD, associate dean of education.
BUSM is now in the implementation phase of the findings.