Addressing Racism in Medical Education
Camila M. Mateo, MD, MPH
Associate Director of Antiracism Curriculum and
Harvard Medical School
Division of General Pediatrics,
Boston Children's Hospital
Alden Landry MD, MPH
Assistant Dean, Office for Diversity Inclusion and
Associate Director and Advisor, Castle Society,
Harvard Medical School
Racism in medical education is not a new issue. Health professions education has a long history of policies, practices, and norms that perpetuate racial and ethnic disparities in the physician workforce and patient outcomes. The nation is in the midst of what many are calling the Second Civil Rights Movement, fueled by continued racial inequities across anchor institutions in the United States. It is in this context that the Program in Medical Education is actively engaging students and faculty to ensure that Harvard Medical School devotes time, educational content, and resources to address racism throughout the learning environment.
Harvard Medical School recognizes that addressing racism is the professional responsibility of all health care providers. Without understanding racism and its effects, providers are unable to ask effective research questions, create thoughtful training programs, and care for all patients regardless of background. Informed by critical pedagogy, the focus of this work within student curriculum and faculty development will be on promoting antiracist medical education. Antiracist medical education works to equip students and faculty with the skills, knowledge, attitudes and behavior needed to dismantle racism in clinical practice and within training programs. This includes reviewing the historical roots and modern perpetuations of racism in medicine, identifying and removing racial bias and stereotyping throughout course material, promoting critical self-reflection of personal practices and those of the institution, and creating a culture of inclusion and belonging where students and faculty can learn from one another and respectfully discuss and collaborate to address issues of racism. There are some common pitfalls educators can be aware of and use to review their own curricular content including:
- Not naming racism: While racial and ethnic disparities are regularly presented within curricula, racism often goes unnamed. To omit racism when discussing disparities leaves out an important mechanism by which associations between race and poor health outcomes arise. The disproportionate burden of negative social determinants of health within minority communities includes lack of access to high-quality education, housing, and socioeconomic disadvantage. These inequities have deep roots in systematic racism that must be considered alongside other mechanisms of disease.
- Not defining race as a social construct: Race is a social construct, but race is often represented, implicitly or explicitly, as a biological construct in medical education and research. It is important to understand that the attempt to define race as biologically distinct is a strong lever with which medical institutions legitimized the marginalization of non-white individuals throughout history. It is important to remember this context as we discuss race and ensure that students and faculty understand the definition of race as a social construct.
We are excited that this work is already underway. On August 4th, 2020, students participated in a new 2-hour session as a part of Introduction to the Profession (ITP) focused on addressing racism as a professional responsibility. Further efforts include forthcoming faculty development sessions to foster the skills to address racism in medical education. Addressing racism in medical education will take more than modules. It will require an ongoing commitment to antiracism in professional practice and an institutional culture that enables this commitment. This is a big job, but we are committed to its success and are prepared for the challenge.