Student-Led Efforts to Advance Anti-Racist Medical Education

What to Say When It Matters: Communication Skills to Address Implicit Bias Workshop

Introduction

In academic medicine, learners, faculty, and staff commonly experience microaggressions, which have been linked to multiple negative outcomes (e.g., higher levels of depression, deteriorating well-being, increased anxiety, and feelings of isolation). Workshops teaching communication skills can reduce barriers in responding to microaggressions. Our workshops included students, faculty, and staff as both participants and cofacilitators.

Methods

Each 2-hour, in-person workshop began with a large-group didactic. Next, cofacilitators led skills practice responding to microaggressions. Small-group cofacilitators underwent standardized training. Student and faculty/staff participants were surveyed after each workshop. We conducted factorial analyses of variance comparing the main effects of time, role (student vs. staff/faculty), and prior knowledge, as well as the interaction effects between time and role and between time and prior knowledge.

Results

Fourteen workshops were conducted between 2022 and 2023. Students attended four of the workshops, and faculty/staff participated in 10. Participants reported greater knowledge (p < .001) and comfort (p < .001) identifying and responding to microaggressions after the workshop. The interactions between time and role and between time and prior knowledge on the dependent variables knowledge and comfort were significant (knowledge: p < .01; comfort: p < .05).

Discussion

Active learning workshops constitute an effective method for teaching communication skills to address implicit bias in academic medicine. Including students as cocreators allows for greater relevance for student participants and authenticity for the student experience. Future directions include examining data on cofacilitator experiences and comparing outcomes for students versus faculty/staff.

Proposing the Community Triad Model to action social accountability in medical schools

This article is the third in a series exploring drivers of social accountability (SA) in medical schools across Canada. Findings from the two previous articles have highlighted a central relationship between community, students, and faculty at medical schools, and led to the emergence of a new social accountability model- the Community Triad Model (CTM). The CTM proposes an interconnectedness between community, students, faculty, and the broader institution, and the pathways through which community-based learning directly and indirectly influences decision-making in medical institutions. This article explores the relationships between the three arms of the CTM by examining the literature on community engagement and SA, as well as by revisiting popular models and foundational SA reports to garner insights into authentic community engagement in health professions education. While there is an abundance of literature demonstrating the impact of community placements on students, there are limited studies describing the influence of communities on faculty and the broader institution either directly, or indirectly via students. The authors recommend that institutions be more intentional in engaging students and faculty, and learn from their experiences with community to shape curriculum, practices, policies, and culture of the broader institution. This study offers an operational model of SA that is easy to adopt and implement. It intends to demonstrate how the components of the triad (students, faculty/leadership, community) function together in the community engagement and social accountability of medical schools.

Critical theory and cultural competency in medical QI projects: lessons from Pacific Islander communities

This reflection explores the transformative power of critical theory through a quality improvement (QI) project creating culturally relevant dietary resources for Pacific Islander communities in Washington State, USA. Food injustice and lack of food sovereignty are examined as manifestations of modern-day colonialism perpetuated by capitalist-driven social structures. The methodology employed critical reflection, defined as the process of examining assumptions and power relations that shape practice, central to critical theory. Iterative group discussions aimed to understand the impact of individual and collective assumptions, power dynamics, and oppression on the project's conceptualization, implementation, and evaluation.Specific recommendations are integrated into the discussion to aid those replicating similar protocols, emphasizing actionable steps such as engaging with the community at all project stages. The research team, composed of osteopathic medical students and a critical theory expert, engaged in reflexivity to understand how social locations and lived experiences influenced perceptions. Despite the goal of fostering cultural inclusivity, limitations in engaging the Pacific Islander community throughout the project lifecycle highlighted the need for cultural humility and participatory action methodology.This study underscores the importance of understanding the history and socio-political context of marginalized communities to avoid perpetuating colonial practices and trauma. It emphasizes the necessity for medical schools to incorporate sociological theories into curricula to promote compassionate, culturally appropriate care and research. By critically examining positionality and engaging in transformative learning, the group advocates for systemic changes towards a more equitable global healthcare system.Through critical reflection, the group has come to understand how lived experiences have shaped perceptions of oppression, which are entrenched within and perpetuated by social institutions. Actionable items from these reflections are presented to help future practitioners and educators apply cultural humility, community empowerment, and critical theory in QI projects.

Community-engaged curriculum development using racial justice and biomedical lenses to address COVID-19 vaccine hesitancy in black individuals with rheumatologic conditions

Despite the efficacy of the COVID-19 vaccine in reducing mortality and illness severity, racial inequities in vaccination uptake persist. Among individuals with rheumatologic conditions who are often immunocompromised, the impact of disparities in preventive care threatens to widen existing inequities in adverse outcomes related to COVID-19 infection. There exists an urgent need to develop interventions that reduce COVID-19 vaccine hesitancy and promote vaccine uptake. We leveraged long-standing community-academic partnerships in two cities to develop a curriculum that will be part of an intervention to decrease COVID-19 vaccine hesitancy within Black communities. We describe the collaborative efforts that resulted in the creation of two interactive virtual curricula with similar core content but different theoretical lenses. One lens uses a racial justice approach to acknowledge the effects of historical and current structural racism on vaccine hesitancy, the other utilizes a traditional biomedical lens. In a future trial, we will compare the efficacy of these curricula to empower Black individuals identified as Popular Opinion Leaders (POLs), or trusted community members with large social networks, to disseminate health information to promote COVID-19 vaccine uptake. Strategies to reduce racial inequities in COVID-19 vaccine uptake must begin with accurately identifying and empathetically acknowledging the root causes of vaccine hesitancy, as well as addressing nuanced concerns that drive vaccine avoidance among Black individuals. Community engagement and collaboration are central in creating interventions to develop and test culturally relevant strategies, as observed with our curricula, that bridge scientific efforts with community concerns and practices.

Trainee resistors: Have our students become our teachers?

The authors urge medical education to move beyond teaching social determinants, advocating for active resistance to systemic injustices and a more politically engaged and justice‐oriented approach to healthcare training.

Anti-oppression pedagogy in health professions: a scoping review

Health professional learners are increasingly called to learn about health inequity to reduce inequities and improve patient care and health outcomes. Anti-oppression pedagogy (AOP) addresses the need for health professional learners to understand multiple health inequities and the structures and systems that produce inequities. However, the inclusion of AOP in health professions education varies and there is a lack of clarity in its conceptualization and integration. A scoping review was conducted to address this gap and to understand how AOP is conceptualized and integrated in health professions education. Thirty-six articles met the inclusion criteria. The articles demonstrated that AOP is not commonly utilized terminology within health professions education. When AOP is integrated, it is not consistently conceptualized but is generally viewed as a broad concept that focuses on antiracism; decoloniality; intersectionality; and supporting learners to understand, critically reflect on, and act against structural and systemic forms of oppressions. In addition, there is variation in the integration of AOP in health professions education with the most common methods consisting of discussions, cases, reflection, learning through lived experiences, and the incorporation of humanities within a longitudinal curriculum. The results of this scoping review highlight the need for health professions education to develop one clear concept that educators use when teaching about anti-oppression, which may reduce working in silos and allow educators to better collaborate with each other in advancing this work. In addition, this review suggests that health professional programs should consider incorporating AOP in curricula with a broad and longitudinal approach utilizing the common methods of delivery. To better support programs in including AOP in curricula, further research is required to emphasize the benefits, provide clarity on its conceptualization, and determine the most effective methods of integration.

Mapping the institutionalization of racism in the research about race and traumatic brain injury rehabilitation: implications for Black populations

PURPOSE

Traumatic brain injury (TBI) is a chronic disease process and a public health concern that disproportionately impacts Black populations. While there is an abundance of literature on race and TBI outcomes, there is a lack of scholarship that addresses racism within rehabilitation care, and it remains untheorized. This article aims to illuminate how racism becomes institutionalized in the scientific scholarship that can potentially inform rehabilitation care for persons with TBI and what the implications are, particularly for Black populations.

MATERIAL AND METHODS

Applying Bacchi's What's the Problem Represented to be approach, the writings of critical race theory (CRT) are used to examine the research about race and TBI rehabilitation comparable to CRT in other disciplines, including education and legal scholarship.

RESULTS

A CRT examination illustrates that racism is institutionalized in the research about race and TBI rehabilitation through colourblind ideologies, meritocracy, reinforcement of a deficit perspective, and intersections of race and the property functions of whiteness. A conceptual framework for understanding institutional racism in TBI rehabilitation scholarship is presented.

CONCLUSIONS

The findings from this article speak to the future of TBI rehabilitation research for Black populations, the potential for an anti-racist agenda, and implications for research and practice.

Introducing the Next Era in Assessment

In this introduction, the guest editors of the "Next Era in Assessment" special collection frame the invited papers by envisioning a next era in assessment of medical education, based on ideas developed during a summit that convened professional and educational leaders and scholars. The authors posit that the next era of assessment will focus unambiguously on serving patients and the health of society, reflect its sociocultural context, and support learners' longitudinal growth and development. As such, assessment will be characterized as transformational, development-oriented and socially accountable. The authors introduce the papers in this special collection, which represent elements of a roadmap towards the next era in assessment by exploring several foundational considerations that will make the next era successful. These include the equally important issues of (1) focusing on accountability, trust and power in assessment, (2) addressing implementation and contextualization of assessment systems, (3) optimizing the use of technology in assessment, (4) establishing infrastructure for data sharing and data storage, (5) developing a vocabulary around emerging sources of assessment data, and (6) reconceptualizing validity around patient care and learner equity. Attending to these priority areas will help leaders create authentic assessment systems that are responsive to learners' and society's needs, while reaping the full promise of competency-based medical education (CBME) as well as emerging data science and artificial intelligence technologies.

Incorporating Faculty and Student Co-leadership in Workgroup Structures

In 2020, the Dean of the University of Cincinnati College of Medicine created a college-wide task force to address inequities in the medical school curriculum. The task force consisted of four workgroups, each co-chaired by a faculty member and a student. This co-leadership model was chosen because it provided diverse perspectives and addressed the typical faculty-student power differentials. This co-leadership model balanced knowledge of medical education curriculum with the student experience. It also provided the opportunity for the co-chairs to take on new roles in leadership development: the student assumed a leadership role running the workgroup with guidance from the faculty member, while the faculty member gained insight and perspective on diversity and inclusion from the student. The purpose of this article is to describe our lessons learned during this co-leadership process.

Improving Pain Management for Marginalized Communities: Educating the Next Generation of Health Care Professionals

Inadequately managed pain has immense negative impacts on children, families, health care systems, and societies. Historically and presently, inadequately treated pain disproportionally affects marginalized communities. Deficiencies in pain education for health care providers are widely recognized as a leading contributor to poorly managed pain. Existing training for providers prioritizes physiological systems and pharmacological interventions for pain, despite decades of evidence supporting the biopsychosocial model and interdisciplinary treatment of pain. Moreover, education for health care providers rarely acknowledges the role of bias, prejudice, and systemic racism in perpetuating disparities in pain care. To address this gap, we sought to develop an innovative curriculum for health care teams to combat racial injustice related to pain management. This curriculum was developed and refined collaboratively with community partners representing diverse expertise, including lived experiences of pain, interdisciplinary pain management, cultural humility and authentic allyship, and curriculum development and evaluation. Four modules delivered across 1 to 2 hours were developed and pilot-tested extensively with multidisciplinary providers across a large pediatric health system. Learner feedback indicated high acceptability and informed iterative changes to the curriculum. Additional research is needed to examine impacts of the curriculum on health care provider knowledge and behavior (eg, clinical decision-making) and patient-reported outcomes as well as to test dissemination and implementation strategies. PERSPECTIVE: We present the development and evaluation of a curriculum for health care professionals to combat racial injustice in pain management. By engaging diverse community partners, using design thinking, applying an antiracist lens, and designing for dissemination, we aim to equip the next generation of providers to deliver equitable pain care.

Trainees as Agents of Change: A Theory-Informed Model for Trainee-Driven Curricular Advocacy in Medical Education

ABSTRACT

Trainees (medical students, residents, and fellows) are beginning to make strides in pushing for changes to their education. While there are many examples of successful trainee-led curriculum reform efforts, the path to success remains unclear. To better understand the process of trainee-driven curricular advocacy, the author analyzes this process through the lens of ecological systems theory (EST) not only to provide readers with context for the barriers and facilitators to trainee-driven curricular advocacy but also to further medical education's understanding of the sociopolitical forces influencing the process of trainee-driven curricular advocacy and reform through the lens of the trainee. EST explains how individuals are influenced by a complex web of social and environmental forces. The theory outlines 5 ecological systems of influence: the microsystem, mesosystem, exosystem, macrosystem, and chronosystem. Using EST to explore the process of trainee-driven curricular advocacy therefore clarifies the many layers of influence that trainees must navigate while advocating for curriculum change. The author then draws on this theory and their own experience as a medical student advocating for local and national curriculum reform to develop a model to facilitate trainee-driven curricular advocacy in medical education. The proposed model outlines concrete steps trainees can take while going through the process of curricular advocacy both within their own institutions and on a national level. Through developing this model, the author hopes not only to empower trainees to become agents of change in medical education but also to encourage faculty members and administrators within health professional training programs to support trainees in these efforts.

Medical students' motivations for participating in an elective focused on social inequalities and health disparities

In this study, we examine students' reasons for pursuing elective training focused on medical racism and systemic health inequities at a midwestern medical school. Data collection included semi-structured interviews with students who participated in an optional course focused on these topics. We analyzed their motivations, goals, and interests using reflexive thematic analysis and created three themes based on students' responses. Theme (1) "pre-existing conditions" focuses on students' knowledge, beliefs, worldviews and experience prior to the class. Theme (2) "enacting change" examines their desires to become effective physicians and improve medicine overall. Theme (3) "creating community" considers their preferences for a supportive and connected learning and social environment. We discuss the findings within the context of adult learning theory and Self-Determination Theory. The research provides insight about the overt and underlying factors that drive medical students' participation in training focused on social inequality. We also share recommendations for curriculum development and future research based on the patterns we found in students' discussions of their needs and expectations.

The Importance of Discussing the History of Racism in Medical Student Education

Racial health disparities are tightly linked to the longstanding and pervasive institution of racism. Efforts to reverse disparities begin with awareness and accountability through education. The health care workforce must be formally educated about racist practices, tools, and ideologies that perpetuate poor health outcomes. This article explores prior efforts to integrate race didactics into medical school education, addresses current legislation, and illuminates lessons learned from a single institution pilot curriculum exploring the history of racism in the field of obstetrics and gynecology. Educating medical school students about the history of racism is an important and necessary tool for positive change.

The enemy within: The new war in medical education

INTRODUCTION

War and military metaphors have long been used in clinical medicine to describe medicine's collective fight against disease. However, recently resistor trainees have used similar language to describe their acts of professional resistance against social harm and injustice. To understand the contours of this war, this study analyzes the metaphoric language these trainees use to describe their acts of resistance.

METHODS

We recruited 18 resisting trainees using our personal and professional networks and snowball sampling. Participants were interviewed from July 2022-February 2023. Using methodological bricolage, we analyzed the data using Wickens' analytical approach, which draws on constant comparative analysis and discursive textual analysis. Data were analyzed in three phases that included a consult with a military historian, isolation of metaphoric language, and a textual analysis using context clues from participants' descriptions of their acts of professional resistance.

RESULTS

Resisting trainees used metaphorical language to signal an insurgency to topple power. These trainees referenced two conflicts: the mistreatment of patients and the mistreatment of trainees. Enemies were conceptualized as anyone who actively protects institutions and the traditions of medicine, such as leaders of medical schools and hospitals, and physicians trained in a more traditional system. Trainees conceptualized the primary battlefield as medicine's process of socialization that integrates trainees into a profession, and accepts mistreatment as the norm. Weapons included LCME site visits and sympathetic faculty members.

CONCLUSION

Whereas metaphorical language around war and the military was previously the purview of physicians, resistor trainees have adopted war metaphors for their own purposes. They do not use these metaphors accidently; they are meant to signal their intentions to restructure medical education. Leaders must begin working with trainees in sincere partnership to create widespread change.

Student, Staff and Faculty Experience with a Medical School Racial and Sociopolitical Trauma Protocol: A Mixed Methods Study

Problem: Medical students experience racial and sociopolitical trauma that disrupts their learning and wellbeing. Intervention: University of California, San Francisco (UCSF) School of Medicine students advocated for a systems approach to responding to traumatic events. Students partnered with educators to introduce an innovative protocol that affords short-term flexibility in curricular expectations (e.g., defer attendance, assignments, assessments) to empower students to rest, gather, or pursue community advocacy work. This study explored students' protocol utilization and student, staff, and faculty experience with its implementation. Context: UCSF is a public medical school with a diverse student body. Students raised the need to acknowledge the effects of trauma on their learning and wellbeing. Consequently, students and educators created the UCSF Racial and Sociopolitical Trauma protocol ('protocol') to allow students time-limited flexibility around academic obligations following events anticipated to inflict trauma on a school community level. The protocol affords students space to process events and engage with affected communities while ensuring all students achieve school competencies and graduation requirements. Impact: We conducted a two-phase mixed methods study: (1) retrospective analysis of quantitative data on students' protocol use and (2) focus groups with students, staff, and faculty. We used descriptive statistics to summarize students' protocol use to adjust attendance, assignment submission, and assessments and thematic analysis of focus group data. Across eight protocol activations June 2020 - November 2021, 357 of 664 (54%) students used it for 501 curricular activities: 56% (n = 198) for attendance, 71% (n = 252) for assignments, and 14% (n = 51) for assessments. When deciding to utilize the protocol, student focus group participants considered sources of restoration; impact on their curricular/patient responsibilities; and their identities. The protocol symbolized an institutional value system that made students feel affirmed and staff and faculty proud. Staff and faculty initially faced implementation challenges with questions around how to apply the protocol to curricular components and how it would affect their roles; however, these questions became clearer with each protocol activation. Questions remain regarding how the protocol can be best adapted for the clerkship setting. Lessons Learned: High protocol usage and focus group data confirmed that students found value in the protocol, and staff and faculty felt invested in the protocol mission. This student-initiated intervention supports a cultural shift beyond diversity toward trauma-informed medical education. Partnership among learners and educators can contribute to transforming learning and healthcare environments by enacting systems and structures that enable all learners to thrive.

Curriculum Mapping to Enhance Antiracism Education in an Undergraduate Medical Education Program

Antiracism education (ARE) is critical in developing culturally competent physicians. At our institution, the Sidney Kimmel Medical College (SKMC) at Thomas Jefferson University in Philadelphia, United States, the Office of Diversity and Inclusion Initiatives and Educational Leadership created and examined a map of its ARE curriculum. Our efforts were meant to describe our local educational processes with regards to ARE; we did not intend to compare our curriculum and its outputs to national benchmarks. To this effect, diversity deans of other local Philadelphia-area medical schools were queried on their respective ARE maps and educational offerings. Potential changes to SKMC's ARE would be considered, but no other school that was queried had a formal ARE map in place. While all schools had a variety of lectures, modules, and electives, none appeared to have a systematic method to teach ARE. As a result, modifications to SKMC's ARE were made based on an intrinsic examination of its own ARE map. Changes that were made included modifying a pre-clerkship lecture on "Racism and Microaggressions" to a small group discussion session. Additionally, a clerkship-specific lecture on "Bias and Microaggressions" was changed from four 1-hour lectures to 90 minutes of lecture followed by a 2-hour small group session, to reduce content redundancy and promote more student reflection. For both of these changes, faculty participated in a newly developed faculty development session. To guide prospective work, a multidisciplinary task force was created to include formal student input in the process of examining ARE. Future directions to query institutions outside the Philadelphia region for their ARE offerings will also be considered.

Trainee advocacy for medical education on the care of people with intellectual and/or developmental disabilities: a sequential mixed methods analysis

BACKGROUND

Medical trainees (medical students, residents, and fellows) are playing an active role in the development of new curricular initiatives; however, examinations of their advocacy efforts are rarely reported. The purpose of this study was to understand the experiences of trainees advocating for improved medical education on the care of people with intellectual and/or developmental disabilities.

METHODS

In 2022-23, the authors conducted an explanatory, sequential, mixed methods study using a constructivist paradigm to analyze the experiences of trainee advocates. They used descriptive statistics to analyze quantitative data collected through surveys. Participant interviews then yielded qualitative data that they examined using team-based deductive and inductive thematic analysis. The authors applied Kern's six-step approach to curriculum development as a framework for analyzing and reporting results.

RESULTS

A total of 24 participants completed the surveys, of whom 12 volunteered to be interviewed. Most survey participants were medical students who reported successful advocacy efforts despite administrative challenges. Several themes were identified that mapped to Steps 2, 4, and 5 of the Kern framework: "Utilizing Trainee Feedback" related to Needs Assessment of Targeted Learners (Kern Step 2); "Inclusion" related to Educational Strategies (Kern Step 4); and "Obstacles", "Catalysts", and "Sustainability" related to Curriculum Implementation (Kern Step 5).

CONCLUSIONS

Trainee advocates are influencing the development and implementation of medical education related to the care of people with intellectual and/or developmental disabilities. Their successes are influenced by engaged mentors, patient partners, and receptive institutions and their experiences provide a novel insight into the process of trainee-driven curriculum advocacy.

Medical learners' anti-racist activism: Promoting learners to lead social change

The author provides examples of medical learner leadership in anti‐racist activism to support the argument for empowering medical learners to lead social change.

Using an Adaptive Listening Tour and Survey to Promote Faculty Reflection on Diversity, Equity, and Inclusion (DEI) in the Pre-clinical Undergraduate Medical Curriculum

Descriptive studies regarding how to integrate diversity, equity, and inclusion (DEI) into medical education are lacking. We utilized the AAMC's Key Steps for Assessing Institutional Culture and Climate framework to evaluate our current curriculum via listening tours (n = 34 participants) and a survey of the 10 pre-clinical block directors, to better understand the opportunities and challenges of improving DEI in the pre-clinical curriculum. Opportunities included diversifying cases and standardized patients, enhancing information on systemic racism and social determinants of health, and increasing racial humility and population genetics/epigenetics training. Faculty had issues with "correct ways" to incorporate DEI and time constraints.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01924-7.

By Medical Students, for Medical Students: A Narrative Medicine Antiracism Program

Objectives

Medical schools have sought to incorporate concepts of race and racism in their curricula to facilitate students' abilities to grapple with healthcare disparities in the United States; however, these efforts frequently fail to address implicit bias or equip students with cultural humility, reflective capacity, and interpersonal skills required to navigate racialized systems in healthcare. The purpose of this study was to develop and evaluate an antiracism narrative medicine (NM) program designed by and for preclinical medical students.

Method

Preclinical medical students at a single center were eligible to participate from June-July 2021. Program evaluation included a postprogram qualitative interview and electronic survey. The semistructured interview included questions about program experience, lessons learned, and perspectives on antiracism curricula in medical education. Interviews were qualitatively analyzed using open and axial coding. Survey data were analyzed with descriptive statistics.

Results

A total of 30 students registered. All (100%) respondents reported "somewhat true" or "very true" in the postprogram survey when asked about their ability to reflect on their own racial identity, racial identity of others, and influence of their racial identity on their future role as a healthcare worker through the program. Qualitative analysis revealed 3 themes: (1) curricular engagement; (2) racism and antiracism in medicine; and (3) group experience. Subthemes included: meaningful theoretical content; multimodal works and unique perspectives; race, identity, and intersectionality; deeper diversity, equity, and inclusion engagement; reconstructive visions; future oriented work; close reading and writing build confidence in discomfort; community and support system; and authentic space among peer learners.

Conclusion

This virtual, peer-facilitated antiracism NM program provided an engaging and challenging experience for participants. Postprogram interviews revealed the program deepened students' understanding of racism, promoted self-reflection and community building, and propagated reconstructive visions for continuing antiracism work.

The stories about racism and health: the development of a framework for racism narratives in medical literature using a computational grounded theory approach

INTRODUCTION

The scientific study of racism as a root cause of health inequities has been hampered by the policies and practices of medical journals. Monitoring the discourse around racism and health inequities (i.e., racism narratives) in scientific publications is a critical aspect of understanding, confronting, and ultimately dismantling racism in medicine. A conceptual framework and multi-level construct is needed to evaluate the changes in the prevalence and composition of racism over time and across journals.

OBJECTIVE

To develop a framework for classifying racism narratives in scientific medical journals.

METHODS

We constructed an initial set of racism narratives based on an exploratory literature search. Using a computational grounded theory approach, we analyzed a targeted sample of 31 articles in four top medical journals which mentioned the word 'racism'. We compiled and evaluated 80 excerpts of text that illustrate racism narratives. Two coders grouped and ordered the excerpts, iteratively revising and refining racism narratives.

RESULTS

We developed a qualitative framework of racism narratives, ordered on an anti-racism spectrum from impeding anti-racism to strong anti-racism, consisting of 4 broad categories and 12 granular modalities for classifying racism narratives. The broad narratives were "dismissal," "person-level," "societal," and "actionable." Granular modalities further specified how race-related health differences were related to racism (e.g., natural, aberrant, or structurally modifiable). We curated a "reference set" of example sentences to empirically ground each label.

CONCLUSION

We demonstrated racism narratives of dismissal, person-level, societal, and actionable explanations within influential medical articles. Our framework can help clinicians, researchers, and educators gain insight into which narratives have been used to describe the causes of racial and ethnic health inequities, and to evaluate medical literature more critically. This work is a first step towards monitoring racism narratives over time, which can more clearly expose the limits of how the medical community has come to understand the root causes of health inequities. This is a fundamental aspect of medicine's long-term trajectory towards racial justice and health equity.

The Paradoxical Criticism of Gender Parity in Surgery

The present work explores a controversy surrounding gender equity in surgical residency programs, particularly focusing on the Stanford University and University of Washington (UW) General Surgery Residency cohorts. While the Stanford cohort, which consisted mostly of women, faced criticism from nonmedical audiences claiming that gender was prioritized over qualifications, the all-male radiology residents received less attention and fewer criticisms. The article highlights the double standards and challenges the notion of meritocracy. It discusses the gender and racial disparities in surgical residency programs, emphasizing the need for diversity and inclusion. The presence of diverse female representation is seen as a valuable asset that brings compassion, teamwork, and inclusive leadership to the field. The article calls for active support from institutions, male allies, and transparency in collecting applicant demographic data to address biases and promote gender diversity in surgery.

The impact of a student-led anti-racism programme on medical students' perceptions and awareness of racial bias in medicine and confidence to advocate against racism

INTRODUCTION

Systemic racism impacts personal and community health; however, education regarding its role in perpetuating healthcare inequity remains limited in medical curricula. This study implemented and evaluated the impact of a student-led anti-racism programme on medical students' perceptions of racial bias in medicine, awareness of, and confidence to advocate against racism in medicine.

METHOD

A total of 543 early stage medical students were invited to participate in the programme. Participants were assigned readings and videos exploring racial injustice in medicine and attended a virtual small-group discussion facilitated by faculty and students. Online surveys were used to collect pre- and post-programme data using Likert scales for response items. Open-ended questions were independently reviewed by three authors using reflexive thematic analysis.

RESULTS

Sixty-three early-stage medical students enrolled in the programme, of which 42 completed the pre-programme survey. There was a 76% (n = 32) response rate for the post-programme survey. The majority of students (60%, n = 25) had no previous education about racism in medicine. From pre- to post-programme, there was a significant change in students' perceived definition of race from genetic, biological, geographical, and cultural factors to socio-political factors (P < 0.0001). Significant increases in almost all factors assessing student awareness of racism and confidence to advocate against racism were observed. Student-identified barriers to discussing racism included lack of education and lived experience, fear of starting conflict and offending others. All survey respondents would recommend this programme to peers and 69% (n = 32) engaged in further topical self-directed education.

CONCLUSION

This simple and reproducible programme improved awareness and confidence to advocate against racism in medicine and resulted in a change in opinion regarding race-based medical practice. These findings are in line with best practice towards addressing racial bias in medicine, decolonizing medical curricula and strengthening anti-racism teaching of future physicians.

Communication skills in practice vs. communication in the real world: Insights from an international medical student symposium

OBJECTIVE

To explore and compare medical students' experiences with communication skills training (CST) in medical education.

METHOD

Five medical students from the U.S., U.K., and Ireland shared their experiences with CST at a 90-minute symposium held at the 2022 International Conference on Communication in Healthcare (ICCH).

RESULTS

Students identified two areas of CST that may affect their preparedness for real-world clinical practice: 1) the impact of the COVID-19 pandemic on communication teaching and learning, and 2) the need to effectively communicate with diverse patient populations.

CONCLUSION

The COVID-19 pandemic brought major changes to CST, and though training programs varied in their approach, students found that they were able to successfully adapt while gaining valuable skills needed to navigate communicating with patients on virtual platforms. When learning to communicate with patients from diverse backgrounds, students perceived generalized strategies that equipped them with the skills needed to adapt to uncertainty to be the most valuable.

PRACTICE IMPLICATIONS

Collaboration between medical schools, both nationally and internationally, provides opportunity to share areas of strength and avenues for improvement in CST. Representation of learner perspectives is essential in order to better understand how well current educational methodologies prepare learners to enter real world clinical practice.

Preparing Medical Students for Anti-racism at the Bedside: Teaching Skills to Mitigate Racism and Bias in Clinical Encounters

Introduction

Systemic racism perpetuates health disparities and negatively impacts health care delivery and patient outcomes. Racism and bias can affect every aspect of clinical care, including history-taking, physical examination, laboratory interpretation, note-writing, oral presentation, and decision-making. Medical students must learn racism- and bias-mitigation skills early in their professional development to provide high-quality, equitable care.

Methods

In November 2021, senior medical students and faculty with expertise in promoting health equity and justice in medicine designed and cotaught a Zoom-based, 75-minute, interactive session for second-year medical students. Participants prepared by reading assigned articles. Breakout rooms were used to facilitate small-group discussions. Session topics included use of a structural vulnerability assessment tool, examples of how bias can impact the physical exam, demonstration of how language can transmit bias, and skill practice using neutral instead of stigmatizing language.

Results

Forty second-year medical students participated in the session. Thirty-one students (78%) completed Likert-type surveys evaluating reaction and learning. Results showed improvements in students' perceptions of their abilities to assess for structural factors that influence health, recognize ways bias can impact clinical encounters, and apply skills to minimize bias in clinical care and decision-making.

Discussion

Providing opportunities for health care learners to think critically about how bias impacts patients and communities and equipping them with tools to begin dismantling exclusionary, racist practices in medicine are achievable and crucial to actualizing a just and equitable health system. This educational session can be adapted for training across health care professions and the educational continuum.

A Novel Narrative Medicine Approach to DEI Training for Medical School Faculty

Problem:Diversity, Equity, and Inclusion (DEI) trainings for medical school faculty often lack self-reflective and pedagogically focused components that may promote incorporation of anti-racism and social justice into medical school curricula. Intervention: A four-session Narrative Medicine (NM) anti-racism program was designed for medical school faculty using critical race theory, phenomenology, and NM methods. Each workshop consisted of a lecture on key NM concepts and a small-group breakout session incorporating group discussion, close reading, and reflective writing. Context: This NM anti-racism program was developed and implemented in April 2021 by two medical students for faculty at an institution in the southeastern U.S. The program was supported by the Office of Inclusive Excellence at the institution and held in collaboration with the institution's medical education teaching academy. Program evaluation consisted of pre- and post-program surveys, which queried participants' previous experiences with DEI and medical humanities programs, perceptions of self-identity and privilege, and confidence in teaching concepts of anti-racism. Of the total program participants (n = 32), 19 completed both surveys (54.3%). Survey data were analyzed using bivariate testing methods and qualitative thematic analysis. Impact: Post-program surveys showed 13 (68.4%) participants felt "somewhat more" or "more" comfortable engaging in concepts of race, and 12 (63.2%) participants felt "somewhat more" or "more" comfortable including topics of race into their teaching compared to before the program. Five themes were generated following qualitative analysis: (1) the value of longitudinal narrative reflection in a small-group setting for DEI work; (2) desire to commit more time to DEI, anti-racist, and social justice work while balancing busy teaching and clinical schedules; (3) the value of storytelling in DEI and anti-racism programming; (4) an understanding of deconstructive and reconstructive work of anti-racism in medicine; and (5) an increased ability to educate and enact change through teaching, activism, and institutional cultural and policy changes. Lessons Learned: This novel NM DEI training for medical school faculty was successful in increasing comfort discussing and teaching concepts of race in the medical school classroom, while providing a uniquely reflective space for personal growth. Participation in this longitudinal reflective experience was limited by physician schedules, therefore efforts to make time to participate in similar longitudinal interventions must be undertaken.

Antiracist Curriculum Implementation for Pediatric Residents

Objectives

Racism has been recognized as a public health crisis, with calls for greater focus on antiracism in medical training. We sought to evaluate a longitudinal antiracist curriculum among pediatric residents.

Methods

In 2020-2021, we delivered seven educational sessions to pediatric trainees in a single residency program. We administered pre-/post-surveys to assess changes in awareness of structural racism, knowledge of health inequities, antiracist clinical skills, and individual/institutional advocacy behaviors. Awareness was measured with 27 Likert-type items spanning five conceptual domains (schools, healthcare, justice system, employment, and housing/transportation). We evaluated knowledge with 18 true/false or multiple-choice questions. Participants indicated comfort with clinical skills using 13 Likert-type items drawn from national toolkits and policy statements. Individual/institutional advocacy behaviors were measured with 14 items from the Antiracism Behavioral Inventory. McNemar or paired Wilcoxon signed-rank tests compared measures before and after implementation.

Results

Out of 121 residents, 79 (65%) completed pre-surveys, 47 (39%) completed post-surveys, and 37 (31%) were eligible for matching across responses. 78% of respondents were female and 68% identified as White. We found significant increases in awareness across several conceptual domains (schools: p = 0.03; healthcare: p = 0.004; employment: p = 0.003; housing/transportation: p = 0.02). Mean knowledge score increased after implementation (p = 0.03). Self-reported clinical skills improved significantly (p < 0.001). Individual advocacy behaviors increased (p < 0.001); there were no changes in institutional advocacy.

Conclusion

We demonstrate improvements in several educational constructs with a novel antiracist curriculum. Efforts to scale and sustain this work are ongoing, and additional teaching and evaluation methodologies may be incorporated in the future.

Implementing a Social Determinants of Health Curriculum in Undergraduate Medical Education: A Qualitative Analysis of Faculty Experience

PURPOSE

Following shifts that broadened the medical profession's conceptualization of the underlying drivers of health, medical schools are required to integrate curricula on health disparities and the social context of medicine into undergraduate medical education. Although previous research has focused on student experiences and outcomes in these curricula, less attention has been paid to the experiences of the physician-faculty involved. This study aimed to capture faculty insights to improve understanding of the challenges and opportunities of implementing this curricular reform.

METHOD

In-depth, semistructured interviews were conducted with 10 faculty members at one U.S. medical school in spring 2019 to capture their experiences designing and teaching a new curriculum related to the social determinants of health and health disparities. Study design, including interview guide development, was informed by the critical pedagogy perspective and social constructionist approaches to curriculum implementation. With the use of a constructivist grounded theory approach, interview transcripts were analyzed using open, thematic, and axial coding techniques. Primary themes were categorized as professional, organizational, interactional, or intrapersonal and organized into the final model.

RESULTS

Participants processed their experiences at 4 concentric levels: professional, organizational, interactional, and intrapersonal. Faculty generally embraced the movement to incorporate more discussion of social context as a driver of health outcomes. However, they struggled with the shortcomings of their training and navigating structural constraints within their school when developing and delivering content. When confronted with these limitations, faculty experienced unexpected tension in the classroom setting that catalyzed self-reflection and reconstruction of their teaching approach.

CONCLUSIONS

Findings highlight the challenges that faculty encounter when integrating social determinants of health and related curricula into undergraduate medical education. They also speak to the need for a broader conceptualization of relevant expertise and have implications for how medical schools select, train, and support medical educators in this work.

Doing the Work-or Not: The Promise and Limitations of Diversity, Equity, and Inclusion in US Medical Schools and Academic Medical Centers

While the number of positions, committees, and projects described as "Diversity, Equity, and Inclusion (DEI)" work has grown rapidly in recent years, there has been little attention to the theory, praxis, or lived experience of this work. In this perspective, we briefly summarize the research and concepts put forth by DEI leaders in higher education more broadly, followed by an analysis of the literature's application to academic medicine. We then discuss the ways in which language obscures the nature of DEI and the necessity of scholarship to evaluate the extensive range of practices, policies, statements, and programs the label is given to.

Student-Led Initiatives and Advocacy in Academic Medicine: Empowering the Leaders of Tomorrow

Trainees' value as effective leaders within academic medicine has been increasingly recognized. From their perspective as adult learners who enter medical education from diverse backgrounds, trainees offer significant value to the teaching, learning, and practice of medicine. As such, trainees have developed and led various successful initiatives throughout academic medicine. In this Invited Commentary, 2 medical students with national leadership roles provide their perspectives on how student-led initiatives and advocacy can help push academic medicine forward. The authors first provide an overview of the success of student-led initiatives throughout medical education as evidenced by the Trainee-Authored Letters to the Editor in this issue, highlighting the unique contributions and perspectives of trainees in the development and implementation of new initiatives or ways of thinking. Although trainees add value to many areas in academic medicine, here the authors highlight 4 current areas that align with Association of American Medical Colleges priorities: (1) public health emergencies including the COVID-19 pandemic; (2) equity, inclusion, and diversity; (3) wellness and resilience amongst trainees and health care providers; and (4) recent changes to the United States Medical Licensing Examination and the transition to residency. By sharing their experiences with student-led initiatives within each of these domains, the authors provide lessons learned and discuss successes and obstacles encountered along the way. Overall, there is a critical need for increased engagement of trainees in medical education. Empowering trainees now ensures the academic medicine leaders of tomorrow are prepared to face the challenges that await them.

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

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.

The Model Minority Myth, Data Aggregation, and the Role of Medical Schools in Combating Anti-Asian Sentiment

The COVID-19 pandemic has resulted in an alarming increase in hate incidents directed toward Asian Americans and Pacific Islanders (AAPIs), including verbal harassment and physical assault, spurring the nationwide #StopAsianHate movement. This rise in anti-Asian sentiment is occurring at a critical time of racial reckoning across the United States, galvanized by the Black Lives Matter movement, and of medical student calls for the implementation of antiracist medical curricula. AAPIs are stereotyped by the model minority myth, which posits that AAPIs are educated, hardworking, and therefore able to achieve high levels of success. This myth acts as a racial wedge between minorities and perpetuates harm that is pervasive throughout the field of medicine. Critically, the frequent aggregation of all AAPI subgroups as one monolithic community obfuscates socioeconomic and cultural differences across the AAPI diaspora while reinforcing the model minority myth. Here, the authors illustrate how the model minority myth and data aggregation have negatively affected the recruitment and advancement of diverse AAPI medical students, physicians, and faculty. Additionally, the authors discuss how data aggregation obscures health disparities across the AAPI diaspora and how the model minority myth influences the illness experiences of AAPI patients. Importantly, the authors outline specific actionable policies and reforms that medical schools can implement to combat anti-Asian sentiment and support the AAPI community.

Racial and oral health equity in dental school curricula

Objectives

The objective of this study was to assess the current efforts to move dental school curriculum beyond diversity and inclusion toward an anti‐racism approach to racial equity.

Methods

In this cross‐sectional study, an electronic Qualtrics survey was sent to 67 Dental School Associate Deans/Deans of Academic Affairs and 15 Dental Public Health (DPH) Residency Program Directors. Survey topics included oral health equity, Critical Race Theory (CRT), racism and the physiologic impacts of racism on oral health. Descriptive statistics were used to demonstrate frequencies.

Results

Overall response rate was 31.7% (DPH = 6, predoctoral Dental = 20). The majority of respondents that answered the question stated that the educational program offered instruction in oral health equity (96.2%), racism (75%), and the physiologic impacts of racism on oral health (83.3%). Only 17.4% of the respondents stated that the educational program offered instruction in CRT. The main barriers to providing the instruction was limited faculty trained in the topics to offer the instruction or there was limited time to offer additional content in the curriculum.

Conclusions

Findings demonstrate that oral health equity, racism and the physiologic impacts of racism are being discussed in dental education to some extent, but there is limited instruction in CRT. More robust efforts are needed to ensure dental students and DPH residents are competent in providing anti‐racist and unbiased health care; there should be an incorporation of anti‐racism standards in the Commission on Dental Accreditation (CODA)'s predoctoral and Advanced Education Program standards.

The Propagation of Race and Racial Differences as Biological in Preclinical Education

Modern scientific research has demonstrated that race is a social construct rather than a biological construct. Yet, medical education research suggests that medical faculty still sometimes characterize race and racial differences as biological during lectures. To explore this dynamic, we reviewed (1) how race is presented in the preclinical curriculum of an undergraduate medical institution and (2) how preclinical faculty both define race and attribute disparate health outcomes to race. In part 1 of the study, the authors conducted a retrospective summative content analysis of all first-year preclinical lectures during the 2018-2019 academic year. In part 2, the authors administered a survey to preclinical faculty on the understanding of race, and responses were assessed through conventional content analysis. A number of faculty suggested a biological basis for racial differences during lectures, though survey results suggested that the majority characterize race as a social construct. Faculty knowledge of race and racial differences as a social construct was not reflected in the majority of the curricular analysis. Instead, the lectures showed that faculty predominantly discussed race without context (e.g., as a standalone epidemiological statistic or an unexplained factor of risk, diagnosis, prognosis, or treatment), or with a biological context. We conclude that there is a discrepancy between preclinical faculty knowledge of race and the presentation of race and racial differences in lectures. This discrepancy has implications on medical education. We offer possible explanations for this discrepancy as well as resources for preclinical faculty development to bridge this gap.

The future of global health is inclusive and anti-racist

In global health, a discipline with a racist and colonial history, white supremacy, white privilege and racism are still present today.¹ Although many believe we are witnessing a resurgence of racism in global health, because of a recent rise of extreme right comments and racism in the community and online^{2, 3}. In reality racism has always been an inherent aspect of global health and its predecessors: tropical health and international health by prioritizing the health issues of the colonizers over those of the native populations.⁴ As such, we are rather bearing witness to long standing issues that have been persistently overlooked. There is a need for a paradigm shift to enable true authentic leadership that promotes the values of our shared humanity.

Future developments in training

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has demonstrated the value of highly skilled and extensively trained specialists in clinical microbiology (CM) and infectious diseases (ID). Training curricula in CM and ID must constantly evolve to prepare trainees for future pandemics and to allow trainees to reach their full clinical and academic potential.

OBJECTIVES

In this narrative review, we aim to outline necessary future adaptations in CM and ID training curricula and identify current structural barriers in training with the aim of discussing possibilities to address these shortcomings.

SOURCES

We reviewed literature from PubMed and included selected books and online publications as appropriate. There was no time constraint on the included publications.

CONTENT

Drawing from the lessons learnt during the pandemic, we summarize novel digital technologies relevant to CM and ID trainees and highlight interdisciplinary teamwork and networking skills as important competencies. We centre CM and ID training within the One Health framework and discuss gender inequalities and structural racism as barriers in both CM and ID training and patient care.

IMPLICATIONS

CM and ID trainees should receive training and support developing skills in novel digital technologies, leadership, interdisciplinary teamwork and networking. Equally important is the need for equity of opportunity, with firm commitments to end gender inequality and structural racism in CM and ID. Policy-makers and CM and ID societies should ensure that trainees are better equipped to achieve their professional goals and are better prepared for the challenges awaiting in their fields.