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Wednesday May 23, 2018

Report: Med Schools Can Do More To Combat Racism

Medical schools and their associated hospital systems are some of the largest employers of physicians, providers of patient care, and distributors of research funding. They have much power and therefore are often perceived as insurmountable and unchangeable.

[young female doctor in foreground of group]

It is therefore helpful to have a group distinct from school administration that can provide a critical lens from within. Historically, students have been essential in providing this consciousness, helping to shift the culture in the United States during the civil rights and Vietnam eras, and most recently as part of Black Lives Matter and in the movement to end gun violence.

The student voice is no less important in medicine than it is for our culture at large. Recently, the student-led organization White Coats for Black Lives(whitecoats4blacklives.org) showed why this is true. The group, founded in 2014, has active chapters in at least 21 states and has charged itself with a mission to eliminate racism in health care. The organization recently released an intensive, 135-page Racial Justice Report Card(whitecoats4blacklives.org) reviewing 10 U.S. medical schools' efforts to combat racism. I have professional affiliations with two of the schools (Harvard and Mount Sinai), so my curiosity was piqued.

The report card assessed 15 metrics, including discrimination policies, use of adequate anti-racism training in curriculum, proportional representation of students based on U.S demographics, support of underrepresented groups on campus, immigration policy, and employee compensation and benefits. The scoring structure ranged from A to C, and the best overall score attained by an institution was a B-.

The report is ambitious and thorough in its efforts to address a comprehensive list of issues that continue to lead to race-based health disparities. Now that we have a report card, we can start to ask ourselves and our institutions specific questions: Why aren't we achieving what we want to? Are we actively working to change a broken system, or are we making only minimal efforts in a pretense of progress? Notably, the focus of the report card was beyond the diversity initiatives we have become accustomed to seeing in recent decades on medical school campuses (the centers, departments and scholarships for diversity).

This was a point of contention for some school administrators who thought the report card failed to take into account the existing efforts that are established parts of many institutions. But the report card emphasizes that these efforts do not go far enough. Some may argue the existing efforts are shallow, and are only small consolation prizes in a system that instead needs a dramatic overhaul to create a real cultural shift.

Among the interesting things the report identified were issues that are often discussed on the sidelines of medicine (largely among people of color who are most impacted by the not-so-hidden subtleties of racism).

For example, the report highlighted

  • the need for more widespread medical pipeline programs that can help young students from local communities have the academic and financial means to get into medicine;
  • the pressure on underrepresented minority students to recruit other students of color as an uncompensated extracurricular activity that prohibits their full involvement in other professional and academic activities;
  • the inherent bias of free clinics at medical schools and the care of already vulnerable populations by undertrained first- and second-year students;
  • the discriminatory practices of large academic medical systems, where insurance status is used as a proxy for race and may subsequently determine a patient's care by a less well-trained physician.

This report is an important tool for moving forward, even if some schools felt the measures weren't specific enough. It provides an opportunity to highlight areas of need related to diversity, inclusion, workforce development and translation to improved health care -- not only for underserved communities, but for everyone. I believe a similar report should be issued annually by a non-biased, third-party evaluator to assess all medical schools and hospital systems across the country.

The EveryONE Project, launched by the AAFP in 2017, identifies workforce diversity as one of the four pillars to achieving health equity, along with advocating for health equity, interdisciplinary collaboration, and education and practice-based resources.

Studies suggest that students from backgrounds underrepresented in medicine are more likely to care for underserved populations in their careers, and are more likely to choose careers in primary care. The EveryONE Project highlights a few programs founded by family physicians that are making a positive impact on pathways to medicine for underrepresented students starting in grade school. The AAFP is also collaborating with the Society of Teachers of Family Medicine and others to provide tools and training to address both implicit and explicit bias in medical education settings, and will have new programs and resources as The EveryONE Project grows.

The AAFP also will host a Health Equity Roundtable meeting this month in Washington, D.C., bringing together stakeholders from across medical education to identify opportunities to collaborate on improving health equity. Organizations involved include the Association of American Medical Colleges; the National Medical Association; National Association of County and City Health Officials; National Rural Health Association; Gay and Lesbian Medical Association; Association of American Colleges and Universities; Association of State and Territorial Health Officials; National Hispanic Medical Association; American Public Health Association; Indian Health Service and more.

Venis Wilder, M.D., is a board-certified family physician who practices in New York City. She is a community health activist working at the intersection of primary care and public health.

Posted at 08:41AM May 23, 2018 by Venis Wilder, M.D.

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