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Hastings Center News

“Hard to Hear” About Racism in Medical Education

“You have to embed structural practices in health professions education to dismantle racism in medicine,“ said Priya Garg, associate dean of medical education at Boston University School of Medicine, at a panel at the health equity summit sponsored by The Hastings Center earlier this year.

Garg, who is also a pediatrician at Boston Medical Center, told the audience about being approached by a group of medical students in her office in October 2019. The students claimed that the school’s curriculum was perpetuating racial biases. They showed Garg incorrect associations that the faculty were making between race and genetics. Their proof? Images in their textbooks that only reflected white skin, and research studies that showed higher rates of disease in Black and Latinx patients—only without a deeper understanding and explanation of why those rates occurred.

“That was hard to hear,” Garg said.

This exchange led Garg to implement several curriculum changes. These included: ensuring diverse images in medical education materials; adding key histories of racism in medicine, beyond Tuskegee; and defining racially based equity competencies in their school’s curriculum.

Garg made the remarks in the panel discussion “From the Walls to the Halls: Changing Health Professions Education to Advance Health Equity,” hosted by Rumay Alexander, scholar-in-residence at the American Nurses Association. On the panel were Garg, Ann-Gel Palermo, Marilyn Oermann, Malika Sharma, Peggy Chinn, and Alec Calac.

Ann-Gel Palermo, senior associate dean for diversity, equity, and inclusion at the Icahn School of Medicine at Mount Sinai, said that in 2015, Black and Brown students presented data to school leadership that highlighted how the school environment was socializing students into treating patients in racially biased ways. As a result of their data, the school began the Racism and Bias Initiative, a series of conversations and dialogue within leadership and the institution to tackle power, privilege, and white supremacy. This process eventually led to a systems-level change. Change at the systems level, Palermo said, is about identifying conditions that hold a problem in place. To center equity in education environments, the institution must redesign, disrupt, and dismantle those conditions.

Marilyn Oermann, professor of nursing at Duke University, explained the necessity for an explicit concept or objective about health equity within the school curriculum. Without it, undergraduate faculty, especially in large programs, cannot integrate diversity, equity and inclusion-related content.

Oermann recommended that faculty develop clinical cases students can use to analyze the impact of systemic racism and discrimination in nursing care. She suggest three ways of teaching health equity: students identify their own individual beliefs, values, and biases; students learn how their values and biases impact others; and students learn about social determinants of health, and the impact of biases on patient populations and health systems.

Malika Sharma, the education lead for the division of infectious disease at St. Michael’s Hospital in Toronto, challenged the audience to ask themselves: If DEI positions are created, are they given enough resources to make change within the institution? Inclusive spaces, she noted, must be created in tandem with encouraging diversity. It is not just about what is taught, but how material is taught. To create meaningful, structural, anti-racist change, scrutiny must be applied to initiatives that simply “add a module” instead of advocating for a reorientation of values and priorities. 

In another portion of the panel, Peggy Chinn, professor emerita of nursing at the University of Connecticut discussed the Overdue Reckoning on Racism in Nursing project, which was created to highlight racism embedded in educational programs. Lessons learned through this project guide initiatives in the clinic as well as in the classroom.

The last panelist, Alec Calac, a PhD and medical student at University of California, San Diego, said his background as a Native American from the Luiseño tribe informs his career in medicine and public health. Calac noted that when there is no one else that belongs to your same demographic group, “you become the textbook.”

Calac said the term that best captures ensuring inclusion is not cultural humility, competency, or proficiency; but rather, cultural responsiveness. Cultural responsiveness ensures that curriculum, pedagogy, and engagement is relevant to all students and is grounded in evidence-based practice.

The discussion took place on January 20, on the second day of the conference, hosted by The Hastings Center with the AAMC Center for Health Justice and sponsored by the American Medical Association, the American Nurses Association, the American Hospital Association, and the ABIM Foundation, and drew more than 2,500 attendees.

Watch a video of the panel.