n the wake of the brutal killings of Alton Sterling, Philando Castille, Delrawn Small, and police officers in Dallas and Baton Rouge, America is confronting how its long history of racial injustice continues into the present. We must all address these wounds, including those of us in medicine.
As medical students soon to be entrusted with the health and well-being of individual patients and entire communities, we see responding to these tragedies as intertwined with our professional responsibilities.
STAT columnist Jennifer Adaeze Okwerekwu recently urged physicians to ask how they can ensure that their patients can “thrive in an America free of legalized terror and intolerance.” Some have already answered. Just last week, nearly 3,000 physicians and students signed a letter supporting Black Lives Matter, committing themselves to addressing racism in their communities. As medical students, we have been asking the same question. It’s not enough for individual doctors to stand in solidarity — our medical schools must do the same.
A legacy of racial injustice has shaped the institutions that train our doctors. At Harvard Medical School, for example, only 6 percent of the faculty is black, Latina/Latino, or Native American, compared to more than one-third of the US population. In our current first-year class of 165 medical students, 11 students identify as black — and only two of them are women. If that sounds low, keep in mind that Harvard is doing well compared to many other medical schools.
This inequity recapitulates itself in medical curricula. For example, although black Americans with melanoma, a type of skin cancer, are more than four times as likely as white Americans to be diagnosed only after their cancer has already spread to other parts of the body, half of dermatologists report that their medical schools did not prepare them to diagnose cancer on black skin. And barely 1 in 10 dermatology residencies include a rotation in which physicians-in-training gain specific experience treating patients with skin of color.
Patients suffer when medical school training doesn’t address implicit biases. Half of a sample of white medical students and residents endorsed at least one false belief about biological differences in pain perception between blacks and whites. These false beliefs may explain why black patients in the emergency department are 22 percent to 30 percent less likely to receive medication for the same level of pain as white patients.
Failures in medical education are failures of public health. In the Boston neighborhood of Roxbury, an underresourced, predominantly black community, life expectancy at birth — 59 years — is lower than in Haiti and Iraq. A five-minute subway ride away, residents of the affluent, predominantly white Back Bay neighborhood can expect to live more than 91 years — longer than citizens of Switzerland. Our training must prepare us to serve diverse communities and teach us how to actively narrow disparities in health care access and outcomes.
As we face our nation’s fraught race relations, medical training institutions cannot claim innocence or afford ambivalence. That’s why medical and dental students at Harvard have formed the Racial Justice Coalition. It advocates that incoming classes be as diverse as possible, that students be taught about race in ways that reflect biological and social understanding rather than inherited prejudice, and that the administration makes social justice a priority. The coalition was inspired by peers who started White Coats for Black Lives, a national organization run by medical students that is working to eliminate racial bias in medicine.
Students are speaking up, but so too must the leaders of medical schools and teaching hospitals. By intentionally educating the next generation of physician advocates, allocating research dollars to health disparity projects, and providing clinical care in an equitable fashion, these leaders are uniquely positioned to reform the unjust structures they inherit.
What does it mean to uphold these responsibilities? The Duke University Health System is reimagining the role of academic medical institutions via a population health improvement strategy, collaborating with government, industry, and nonprofits to address social and environmental determinants of health.
Boston University School of Medicine is addressing the physician diversity gap via its Early Medical School Selection Program, which offers summer medical courses and mentorship to underrepresented minority undergraduates at 13 historically black universities and schools with significant numbers of Latino and Native American students. By supporting promising undergraduates who may not otherwise attend medical school, the program recruits and prepares students who later succeed in medical training.
Progressive change comes from progressive leadership. Harvard Medical School is about to select a new dean. She or he will set the direction of the school’s curriculum, research, and admissions practices for years to come. Students at Harvard Medical School and Harvard School of Dental Medicine have signed a petition asking Harvard President Drew Faust to make social justice and diversity a priority in the search for the new dean.
Medical school deans across the country need to speak honestly about the ways that social forces like racism jeopardize our patients’ health and well-being. As students, we are eager for role models who will teach us how to change the systems we are about to enter. The times demand that medical school deans provide not just sound medical and fiscal leadership but moral direction as well. They must work together with students and physicians not just against disease but also for justice.
Jocelyn Streid, Margaret Hayden, Rahul Nayak, and Cameron Nutt, students at Harvard Medical School, are writing on behalf of the Racial Justice Coalition. A full list of the authors is available here.