Deconstructing Racism, Hierarchy, and Power in Medical Education: Guiding Principles on Inclusive Curriculum Design

Abstract

In the context of current U.S. racial justice movements, analysis of racism in medicine within medical education is a critical task for all institutions. To educate the next generation of physicians about racism in medicine and out of concern that the curriculum required critical assessment and change, a group of students and faculty at Boston University School of Medicine (BUSM) initiated a longitudinal curricular analysis through a vertical integration group, commissioned by the Medical Education Committee, from May 2019 to June 2020. The curriculum analysis and the major outcomes and guiding principles that emerged from it are described as a path forward, toward a more inclusive curriculum. The major elements of this analysis included a comprehensive internal curricular assessment and an external assessment of peer institutions that led to the development of key curricular recommendations and overarching equity and specific racially focused equity competencies. The curricular recommendations fall into the following domains: (1) challenging the persistence of biological/genetic notions of race, (2) embedding structural practices in medical education to dismantle racism in medicine, and (3) promoting institutional climate change. Initial steps to implement these recommendations are described. The authors believe that the historic and present reality of racism in America and in medicine has impacted medical education specifically, and more broadly, the practice of medicine, trainee experience, and patient outcomes. The key findings of the BUSM analysis are transferable to other medical education institutions, and the described review process can support peer institutions as they engage in the imperative work of institutional reflection and addressing the salient ideas and practices that uphold racism in medicine.

Latent Tuberculosis Infection Treatment Outcomes in an At-Risk Underserved Population in Rhode Island

“…Additionally, historical and sociopolitical factors that worsen health outcomes among patients are often missing in medical curricula. As proposed by Green et al 27 curriculum reform that incorporate equity competencies and embed structural practices to dismantle racism in medicine could be a potential strategy to enhance medical education and positively impact care for racial and ethnic minorities. A strong comprehension of why racial and ethnic minorities are disproportionately impacted by TB in addition to understanding TB infection and disease could build a foundation for mastering LTBI testing and treatment.…”

Racial and oral health equity in dental school curricula

“…Previous studies have assessed the medical curriculum in relation to anti-racism education. A group of students and faculty at Boston University School of Medicine (BUSM) initiated a longitudinal curricular analysis through a vertical integration group commissioned by the Medical Education Committee, from May 2019 to June 2020 [6]. Student-led efforts to advance anti-racism education in medical schools and to address the concern for systemic racism in medical education was the premise for student involvement in the BUSM study.…”

“…Student-led efforts to advance anti-racism education in medical schools and to address the concern for systemic racism in medical education was the premise for student involvement in the BUSM study. Student involvement was initiated by a group of eight first-year BUSM medical students gathering to discuss the multiple instances of racism, microaggressions, noticeable conflations of race with biology, and concerns that racially grounded teaching of medical science was propagating systemic racism [6]. The major elements of the analysis included a comprehensive internal curricular assessment and an external assessment of peer institutions that led to the development of key curricular recommendations and overarching equity and specific racially focused equity competences [6].…”

“…According to the authors, the findings from the study can be translated to other medical schools. In addition, the authors believe that the historic and present reality of racism in America and in medicine has impacted medical education specifically, and more broadly, the practice of medicine, trainee experience, and patient outcomes [6]. Having a more thorough understanding of the curriculum in medical schools can help restructure medical school assessments and competencies to provide more inclusive training for medical students/ residents that can ultimately be the foundation to help address the health inequities that exist in the population.…”

“…Student involvement was initiated by a group of eight first-year BUSM medical students gathering to discuss the multiple instances of racism, microaggressions, noticeable conflations of race with biology, and concerns that racially grounded teaching of medical science was propagating systemic racism [6]. The major elements of the analysis included a comprehensive internal curricular assessment and an external assessment of peer institutions that led to the development of key curricular recommendations and overarching equity and specific racially focused equity competences [6]. According to the authors, the findings from the study can be translated to other medical schools.…”