The history of medical education: a commentary on race

Abstract

The institution of medicine was built on a foundation of racism and segregation, the consequences of which still permeate the experiences of Black physicians and patients. To predict the future direction of medical inclusivity, we must first understand the history of medicine as it pertains to race, diversity, and equity. In this Commentary, we review material from publicly available books, articles, and media outlets in a variety of areas, including undergraduate medical education and professional medical societies, where we found an abundance of policies and practices that created a foundation of systemic racism in medical training that carried through the career paths of Black physicians. The objective of this Commentary is to present the history of race in the medical education system and medical society membership, acknowledge the present state of both, and offer concrete solutions to increase diversity in our medical community.

The Latino Resident Physician Shortage: A Challenge and Opportunity for Equity, Diversity, and Inclusion

“…[19][20][21][22] Furthermore, equity of opportunity for groups that are underrepresented in medicine is a structural issue, and the current lack of equity of opportunity is effectively a symptom of systemic racism in the United States, including inequities in educational opportunities for students of minoritized racial and ethnic groups. 3,[23][24][25] Latino physicians historically have been underrepresented in the United States' physician workforce. 26 Although Latinos are the largest ethnic minority group in the United States, comprising about 19% of the U.S. population, 27 they make up only about 6% of the nation's practicing physicians.…”

Does the AAMC's Definition of “Underrepresented in Medicine” Promote Justice and Inclusivity?

“…One barrier to diversification in medical schools is that schools and society still grapple with overcoming present-day legacies of US racism and a history of discrimination. 8 Challenges to diversification in higher education persist, despite court decisions. The idea that student body diversity serves as a compelling interest in higher education and that the limited use of race in admissions is permissible was established in 3 Supreme Court cases: Regents of the University of California v Bakke (1978), 9 Grutter v Bollinger (2003), 10 and Gratz v Bollinger (2003).…”

“…9 The AAMC and several national health professions organizations have aligned their policies accordingly. 6,8 From Desegregation to Diversification With few exceptions, prior to 1960, African Americans and other minorities were de facto excluded from enrolling in US medical schools. 8 Amidst the desegregation movement of the 1960s, higher education institutions established policies, programs, and practices that sought to achieve increased student diversity.…”

“…6,8 From Desegregation to Diversification With few exceptions, prior to 1960, African Americans and other minorities were de facto excluded from enrolling in US medical schools. 8 Amidst the desegregation movement of the 1960s, higher education institutions established policies, programs, and practices that sought to achieve increased student diversity. 6 The AAMC's definition of underrepresented minority (URM) as referring to "Blacks, Mexican-Americans, Native Americans … and mainland Puerto Ricans" 12 informed schools' development of initiatives to recruit and prepare URM students for medical school.…”

Informing Equity & Diversity in Primary Care Policy and Practice: Introducing a New Series of Policy Briefs, Commentaries, and Voices in JABFM

“…1,2 Authors have documented how, in the United States, medicine was built on racist and patriarchal foundations that excluded and marginalized Black and other people of color and women from entering medicine. 3,4 Historic (and ongoing), overt (and hidden) systematic oppression of nondominant groups of people, and the related structural determinants of health (including racism, sexism, classism, and heteronormativity), range in impact from individual patient health outcome disparities, to population level health inequities, to health care workforce misrepresentation and discriminatory experiences. 5 While laudable steps are being taken by many in the medical community to identify and correct remnants of discrimination in the health care system (and in health care research) that have contributed to these inequities, there is much work to be done by all if we are to achieve social justice in medicine.…”