Episode 181: Antiracism in Medicine Series – Episode 9 – Moving Towards Antiracism in Medical Education

Summary

In this special episode of the Antiracism in Medicine Series, originally recorded for the 2021 Society of General Internal Medicine Annual Meeting, the CPSolvers Antiracism team discusses what must be done to make medical education more antiracist. The conversation spans stages of academic medical career progression, ranging from recruitment to training to retention. The ARM team draws upon their own research and personal experiences to provide listeners with recommendations and actionable next steps.   

Learning Objectives

After listening to this episode, listeners will be able to…

1. Explore the common barriers to entering the medical profession that minoritized trainees face and discuss strategies that trainees and institutions can adopt to overcome them.
2. Recognize how racist ideologies are often perpetuated in medical education and ways that academic medical centers can revise their curricula to prepare a physician workforce that is invested in recognizing and addressing the root cause of health disparities.
3. Understand the “minority tax” that minoritized trainees and faculty experience in diversity, equity, and inclusion reform efforts; identify models to properly compensate individuals for their time and expertise.  

Credits

• Written and produced by: Dereck Paul, MD, MS; Chioma Onuoha, Utibe R. Essien, MD, MPH; Rohan Khazanchi, MPH; LaShyra Nolen; Naomi F. Fields; Michelle Ogunwole, MD; Jazzmin Williams; and Jennifer Tsai MD, M.Ed
• Host: Chioma Onuoha
• Infographic: Creative Edge Design
• Guests: Rohan Khazanchi, MPH; Naomi F. Fields; Michelle Ogunwole, MD; Utibe R. Essien, MD, MPH; Jazzmin Williams

Timestamps:

00:00 Introduction

02:15 Barriers to Entry in Medicine 

05:15 How to Identify an Uplifting Institutional Home 

11:40 Racism Ingrained in Medical Education

15:10 Imagining an Ideal Medical School Curriculum

17:40 A Roadmap to Engaging Hyperlocal Communities in Medical Education

20:30 Moving Beyond Ahistorical Conversations about Health Disparities 

27:05 Engaging All Learners as Stakeholders for Health Equity and Antiracism

33:40 Re-examining Who the Experts Are

42:40 Recognizing Privilege and Positionality 

45:25 Patient Safety Analogy and “Racism Saps the Strength of the Whole”

49:44 Where Do You Find Your Hope?

Takeaways:

1. Reimagining the learning environment: Creating a more antiracist learning environment will require institution-level commitments and broader reforms in the medical education regulatory environment (i.e. board examinations and mandated competencies). 
2. Valuing health equity work: antiracism and health equity work must be properly compensated at all levels of training. Such compensation could be monetary or come in the form of academic currency, like co-authorship of publications.
3. How to be a good ally and co-conspirator: Power and access are needed to sustain and amplify antiracist justice within medicine. Many times, granting this power and access will require that individuals with privileged identities historically possessing a disproportionate amount of power transfer that power to individuals from marginalized backgrounds. Rather than centering the importance of individual advancement, we can remember that whenever racism is operational, as Dr. Camara Jones says, it “saps the strength of the whole society.” Using justice to guide our distribution of power will improve everyone’s livelihood. 
4. Advancing beyond ahistorical teaching on racial health disparities: Health equity education must include racism as a driver of health inequities. As prior podcast episodes have highlighted, misleading theories of racialized biological differences cannot be presented as the cause of racial health disparities. 

Pearls:

Acculturation to Medical Education 

While the process of medical education is exciting, progressing through clinical training involves acculturation for all. This acculturation can differentially affect learners based on their own backgrounds and experiences. It is important for learners to reach out to mentors and peers who can offer insight into learning the ropes, and a safe place to land; it is also important for educators to recognize this and offer this to their learners. Additionally, it is important that institutions create environments where students have educators and faculty of similar backgrounds as theirs to learn from.

For trainees: What to consider when evaluating medical schools and residency programs

It can be challenging for students and residents  to decide if an institution is truly committed to antiracism, social justice and equity. While time and action are true measures of this commitment, some things to consider include:

• Is there diversity, which is more than skin deep, in the leadership?
• Does the institution involve community members in training?
• What is the relationship between community members and the academic medical center?
• How does the institution respond to issues of injustice that affect trainees?
• Is advocacy celebrated or at least respected and encouraged?
• Does the institution recognize past historical transgressions? What have they done to address a painful history if one exists?
• Does the curriculum equip learners with a vocabulary to discuss racism?
• Does the curriculum include historical context about the communities served by the academic medical center?

Engaging All Students as Stakeholders

Antiracism education can seem relegated to students with niche interests. Nevertheless, there are ways to engage all students as stakeholders. 

• Board exam writers can shape their learning objectives toward antiracism based on our evolving knowledge base and more accurate paradigms of racism-as-the-risk factor, given that board exams shape what educators include in their curricula. 
• On an institutional level, we can incentivize scientifically accurate, ethically responsible, justice-based means of representing and incorporating race, racism, and health equity within faculty members’ work. These are the people that learners often look up to and after whom they model their careers. 
• Finally, we might eschew the idea that learners are disinterested in these topics, and commit to deep education regarding race/racism in medicine. Learners are often intellectually curious with a heart to learn what is needed to provide the best care for their patients. 

Curricular Reforms to Operationalize Antiracism

Curricula seeking to address health inequities cannot be ahistorical. Health disparities are not created in a vacuum; thus, discussion of disparate outcomes should include conversations about the systemic and structural underpinnings of inequity.

Similarly, medical curricula must become comfortable reframing who the “experts” are on health disparities topics. In brief, community stakeholders are crucial experts on the lived experiences and health of their neighbors. Community engagement, as well as prioritization of hyperlocal issues impacting communities proximate to academic institutions, can and should be integrated in health equity curricula.

References:

1. Amutah C, Greenidge K, Mante A et al. Misrepresenting Race — The Role of Medical Schools in Propagating Physician Bias. New England Journal of Medicine. 2021;384(9):872-878. doi:10.1056/nejmms2025768
2. Nolen L. How Medical Education Is Missing the Bull’s-eye. New England Journal of Medicine. 2020;382(26):2489-2491. doi:10.1056/nejmp1915891
3. Sharma M, Pinto A, Kumagai A. Teaching the Social Determinants of Health. Academic Medicine. 2018;93(1):25-30. doi:10.1097/acm.0000000000001689
4. Phelan S, Burke S, Cunningham B et al. The Effects of Racism in Medical Education on Students’ Decisions to Practice in Underserved or Minority Communities. Academic Medicine. 2019;94(8):1178-1189. doi:10.1097/acm.0000000000002719
5. Khazanchi R, Keeler H, Marcelin J. Out of the Ivory Tower: Successes From a Community-Engaged Structural Competency Curriculum. Academic Medicine. 2021;96(4):482-482. doi:10.1097/acm.0000000000003927
6. Tsai J, Ucik L, Baldwin N, Hasslinger C, George P. Race Matters? Examining and Rethinking Race Portrayal in Preclinical Medical Education. Academic Medicine. 2016;91(7):916-920. doi:10.1097/acm.0000000000001232
7. Jones C. Toward the Science and Practice of Antiracism: Launching a National Campaign Against Racism. Ethn Dis. 2018;28(Supp 1):231. doi:10.18865/ed.28.s1.231
8. Tsai J, Lindo E, Bridges K. Seeing the Window, Finding the Spider: Applying Critical Race Theory to Medical Education (MedCRT) to Make Up Where Biomedical Models and Social Determinants of Health Curricula Fall Short. Front Public Health. 2021. doi: 10.3389/fpubh.2021.653643

Transcript

Download the transcript here

Disclosures

Mr. Khazanchi is a member of the American Medical Association’s Council on Medical Education, but the views presented herein represent his own and not necessarily those of the AMA or the Council. The hosts and guests report no other relevant financial disclosures.

Citation

Onuoha C, Khazanchi R, Fields N, Ogunwole M, Williams J, Essien UR, Tsai J,  Nolen L, Paul D. “Episode 9: Moving Towards Antiracism in Medical Education.” The Clinical Problem Solvers Podcast. https://clinicalproblemsolving.com/episodes. June 10, 2021.