Can US Medical Schools Teach About Structural Racism?

Policy Points There need to be sweeping changes to medical school curricula that addresses structural racism in medicine and how to attend to this in medical practice. The Liaison Committee on Medical Education should develop and promulgate specific learning objectives and curricular offerings that require medical schools to teach about structural racism and antiracist medical practice in ways that are robust and standardized. The federal government, through the Health Resources and Services Administration, should prioritize support for antiracism education in medical schools, residency, and continuing medical education in similar ways and with similar effort in scale and scope to its support for primary care, providing technical assistance and grants for programs across the educational spectrum that provide antiracist training. State governments should mandate, as part of continuing education requirements for physicians, 2 or more hours per recertification cycle of antiracist training. CONTEXT: Since the beginning of COVID-19 and the rise of social justice movements sparked by the murders of George Floyd and Breonna Taylor in the summer of 2020, many medical schools have made public statements committing themselves to become antiracist institutions. The notions that US society generally, and medicine, are rife with structural racism no longer seems as controversial in the academic community. Challenges remain, however, in how this basic understanding gets translated into medical education practice. Understanding where the profession must go should start with understanding where we currently are. METHODS: Prior to the events of 2020, in the spring of 2018, we conducted nine key informant interviews to learn about the challenges and best practices from schools deemed to be positive deviants in teaching about structural racism. FINDINGS: Our interviews showed that even those schools deemed positive deviants in the amount of teaching done about structural racism faced significant barriers in providing a robust education. CONCLUSIONS: Significant structural change, perhaps far beyond what most schools consider themselves willing and able to engage in, will be necessary if future US physicians are to fully understand and address structural racism as it affects their profession, their practice, and their patients.

Struggles and Tensions in Antiracism Education in Medical School: Lessons Learned.

PURPOSE: Faculty from different racial and ethnic backgrounds developed and piloted an antiracism curriculum initially designed to help medical students work more effectively with patients of color. Learning objectives included developing stronger therapeutic relationships, addressing the effects of structural racism in the lives of patients, and mitigating racism in the medical encounter. METHOD: The antiracism curriculum was delivered and evaluated in 2019 through focus groups and written input before and after each module. The process and outcome evaluation used a grounded theory approach. RESULTS: Three emergent themes reflect how medical students experienced the antiracism curriculum and inform recommendations for integrating an antiracism curriculum into future medical education. The themes are: 1) the differential needs and experiences of persons of color and Whites, 2) the need to address issues of racism within medical education as well as in medical care, and 3) the need for structures of accountability in medical education. CONCLUSIONS: Medical educators must address racism in medical education before seeking to direct students to address it in medical practice.

Framing the future's expert panel report on the MPH degree: a step backward?

Framing the Future Task Force, a group assembled by the Association of Schools and Programs of Public Health to identify key issues facing public health education as it enters its second 100 years, has recently released a report, "A Master of Public Health Degree for the 21st Century." The report calls for a significant shift in emphasis for the MPH degree away from a generalist, core curriculum in favor of a greater emphasis on areas of specialty. This commentary argues that such a shift would reverse the progress made since the 1988 Institute of Medicine report called on academia to better meet practice needs. Rather, the MPH of the 21st century should continue to focus on methods to better teach core competencies in public health practice at an advanced level.

Reforming medical education: a review and synthesis of five critiques of medical practice.

For physicians to provide appropriate healthcare at a reasonable cost, health reform may not be enough. This essay discusses the scope of educational reform needed in the U.S. to train tomorrow's physicians to practice effectively in an increasingly complicated health care arena. We undertook a review and synthesis of five critiques of medical practice in the U.S.: of quality, evidence-based medicine, population medicine, health policy and heuristics. Our findings suggest that physicians are inadequately trained to function in the complex organizational and social systems that characterize modern practice. Successful health care reform in the U.S. will require physicians who are trained not only in bio-medicine, but also in the social sciences. Other developed countries, which have both greater government control of health care and a culture less oriented to individualism, may have less need for specific efforts to train physicians in the social sciences but could still benefit from considering an expanded curriculum. Effective educational reform must address the medical admissions process, academic and intellectual preparation, and professional and clinical training.

Teaching health departments: meeting the challenge of public health education.

Since the 1988 Institute of Medicine report The Future of Public Health, educators and practitioners have sought to better prepare students for practice. A review of these efforts suggests that they have yet to achieve an adequate synthesis of academic and practice-based education. The authors argue that a fundamental change in the structure of pubic health agencies is required so that all public health students receive practice training in teaching health departments. Academic programs must partner with these agencies but must also continue to teach students about the intellectual framework of public health.

The combined master of public health program at Tufts University.

The Combined Master of Public Health program at Tufts University unites medical and veterinary medical students in a four-year curriculum that integrates students' clinical studies with simultaneous studies on population health. Thirty years ago, Tufts University adopted a "One Medicine" approach to teaching health professionals. That perspective has been updated as "One Health" and is now being applied in a university environment that emphasizes interdisciplinary education, a global outlook, and civic engagement.

Lack of national primary care organization partnerships with community groups to promote health care reform.

Coalitions are necessary for successful political change. Few national primary care provider organizations partner with community, consumer, or labor organizations, and very few do so to promote policy on access to health care. Many of these provider organizations do work on health care access policy issues and do work in partnership with a variety of organizations, suggesting that community-provider partnerships may be a promising but overlooked strategy for promoting health care reform.