"Intersections of Social Systems, Race, and Health in America: A Historical Perspective": A Novel Elective for Medical Students to Increase Antiracism Advocacy.

Abstract

There are growing calls for medical education to effectively teach about and explicitly name racism as a driver of inequities in social determinants of health and inspire student action to address health inequities. Using a novel application of the generative co-design approach, in 2020 Perelman School of Medicine students and faculty implemented a student-led, interdisciplinary elective course for preclerkship medical students. The co-design process allowed for an iterative and conversation-based experience emphasizing how social systems and racist policies shape health care access and outcomes. Active student participation was integral to developing discussion questions to elicit how students' positions in power structures can uphold inequities. Community members and nonprofit leaders taught about the current realities of discrimination and how students could best advocate for patients in the future. Enrolled students (n = 17) and a control group of nonenrolled classmates (n = 37) completed the Anti-Racism Behavioral Inventory (ARBI) pre- and post-course to compare changes in antiracist behaviors. Course participants demonstrated a significant increase in ARBI scores (mean = 4.29 (7.30); t(16) = 2.42; P = .01), while students from the control group did not (mean = 1.43 (6.98); t(36) = 1.25; P = .11). The "individual advocacy" subdomain of the ARBI largely drove the change in ARBI scores, suggestive of increased antiracism behavior in the enrolled cohort. Students provided feedback offering praise for course elements and suggestions for improvement. Early findings suggest that this course, created with a co-design approach, generated new experiences for medical students, increased their understanding of systemic racism, and increased individual antiracist advocacy. Future work, with larger class sizes and longitudinal measurement of behavior change, should further investigate the transformative effects of applying co-design strategies to medical education courses about race and health.