In 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.
In order to prepare people to be future practitioners of medicine, you must start early. 7th grade isn’t too early. This, of course, is a cultural issue – not a racial issue. Broken homes, and almost any home that does not make education the top concern, and a cogent interest of their young children, will more often fail miserably at adequately preparing their youngsters for such careers as medicine. It’s a cultural issue, not a racial issue, far from a racist issue. You simply cannot make a silk purse out of a sow’s ear, no matter how hard you try. And we’re not even talking about ears here – we’re talking about people. Black and Hispanic people relate better to, and are more prone to be up front with physicians of their own color – in most cases, having little to do with their own personal proclivities, but they watch TV and go to movies that insist that that must be the case. I still see far too few female Hispanic doctors. Why? It’s a cultural thing.
Unless you actually barge into these people’s houses and stir things up, you’ll be spinning your wheels – forever.
When I attended PHARMACY School I was subjugated to a 45 minute speech on how woman were ruining the profession of pharmacy.
Thank you for your piece and for your leadership. As a premedical student concerned about equity in health and health care, I am inspired and energized by your activism. I wanted to share a piece I wrote on a very similar theme, published by In Training last week (“Why Black Lives Matter Ought to Matter to Medical Students”). It is longer and more detailed, but makes a related argument that I think will be of interest to the authors of this piece and its readers. You can read it here: http://in-training.org/black-lives-matters-matter-medical-students-familiar-message-revisited-11747
Best wishes as you continue your important work.
Equity? You probably mean “equality.” BTW, on that subject, I always recommend a year of Latin at some point before you take the MCAT. Very helpful. Verbal ability is quite important for med school success – more than you think. We look at those scores.
While it is heartening that some medical students appreciate the significance and complexity of the challenges facing minority populations in the United States, I worry that most students are less knowledgeable about the actions they can take to change our country’s situation for the better.
Asking for adjustments to medical school curricula is an excellent start, but I’m worried that this article focuses too heavily on increasing racial diversity in medical school. While it’s important that doctors reflect the demographics of the society they serve, posing increased student diversity as a solution to health disparities sounds suspiciously like “we need more minority doctors to that THEY can treat the minority patients.” There are good reasons why we might want that, but I worry that this thinking can create an excuse for white medical students to avoid reflecting about their own racial bias and choices about how they practice medicine.
What can students do to educate themselves about political advocacy and organizing when their schools are resistant to incorporating these ideas into the curriculum? Where can students find venues venues for their particular skills in the fight against inequality in their own communities? How can students work responsibly with leaders in marginalized communities to manifest much-needed reforms? How should students approach their schools about adjusting their curricula? How can medical students ensure that graduates will practice in prisons and in low-income and minority communities?
I believe that most medical students already understand that health disparities along racial lines are a problem, but few understand what they can do to solve it. An article that helps medical students think about what concrete steps they can take might have been more useful. Anyone who watches the news has heard the call, but what do we do next?
Thank you for the validation and inspiration of this timely and profound article. The intersectionality of public health and medicine is long overdue and needed now more than ever. More research and peer reviewed articles alone are not sufficient to address the race, inclusion, diversity and health equity issues that are pervasive across our nation. Action, advocacy and solutions oriented efforts are paramount. As a Harvard alum, social justice and health equity champion….I applaud the leadership efforts of the HMS medical students. Only when institutons, leadership and hospitals are held accountable via accreditation, reimbursement and funding sources (as NIH did with minority and women enrollment for grant funding) will there be expeditous policy implementation and revisions. This is a pivotal opportunity for the AAMC, ACGME, NIH, CDC, Joint Commissions, CMS (for residencies), accrediting bodies, medical societies, AMA, NMA etc. to include underrepresented minority representation as well as other examples of diversity, equity and inclusion as accountable priorities with substantial consequences and/or rewards. Thank you for shining the light on this important topic and providing a spotlight on our nation’s future health care leaders.
I congratulate all of you for taking a brave stand for Social Justice.
This piece of advocacy was succinct, informative and well written.
For, too many of us in the Healthcare field, tend to over inform.
Using prolixity & excessive amounts of statistics, tend to muddy the message.
All of you, young women & men, wrote a very nice article.
So, again, please accept my appreciation for your brave stand, as I give you my encouragement to keep up the fight.
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