A call for curricular reform: Recognising the importance of race-based medical education.

Abstract

The social uprising of 2020 led to the redoubling of efforts to recognise and eradicate racist practices in all aspects of the US social system, including the health care complex. The medical school system is no exception. Traditionally, medical school curricula have focused on the treatment of medical ailments with little emphasis on the considerable influence social factors—particularly race and ethnicity—have on treatment outcomes. In fact, a 2016 study reported that both medical students and residents held false beliefs about biological differences between Black and White individuals (e.g. Black people have thicker skin and feel less pain than White people).1 We recognised that for medical students to become physicians committed to mitigating the negative effects of racism, radical reform of our curriculum's portrayal of race and racism with strategic ingraining of anti-racism teaching is vital. Three second-year medical students developed a landmark educational intervention—Race-Based Medical Misinformation: History's Impact on Today's Medical Practices. We aimed to increase knowledge about racial disparities and provide tools to mitigate implicit biases that underscore discrimination in patient care. Using a teaching module, we explored the relationship between the historical origins of racialised medical mistruths and present-day health disparities. To encourage engagement and discourse, the lecture was paired with a case-based exercise that highlighted various clinical consequences of specific medical mistruths. The impact of the educational programme was assessed using a pre-survey and post-survey completed at the beginning and end of the intervention. By explicitly addressing the sordid history of race, racism and medicine and recognising the connection between past deeds and present-day health care disparities, we believe that medical students will gain essential knowledge and an anti-racist perspective that will benefit future patients. This educational intervention—now a formal course within the M1 curriculum—proved effective in increasing knowledge regarding medical mistruths. Still, students' expressed comfort levels discussing race, and their attitudes towards race-related constructs remained unchanged, perhaps because established beliefs more often shift when people are exposed to different environments, cultures and ideologies. In a feedback survey, numerous students regarded the intervention as eye-opening and were shocked at the poverty of education on this topic throughout the curriculum. However, there were students who found the material to be too extreme, too far-fetched and too focused on the impact of racism on the health outcomes of Black patients. These comments highlight that changing ingrained beliefs requires ongoing interventions. For substantive change, institution-driven escalation of these efforts is necessary. Medical schools must create environments that normalise exploring and discussing the impact of internalised, interpersonal and institutional racism in medicine. Nevertheless, our experience has shown us that, when given the opportunity and the resources, medical students are responsive to curricular reform and are, in fact, eager to learn more about the topic of race and racism in medicine.