What is anti-racist medical education?

The current socio-political environment in the U.S. and worldwide has brought much-needed attention and heightened awareness to the plights of minoritized groups, especially Black and African-American communities.

Police brutality, structural violence, overt racism, and discrimination are only a few examples prompting new activism. Along with the COVID-19 pandemic, they have amplified health inequities and disparities that have pervasively been threatening communities of color.

As a response, academic medicine leaders, equity scholars, and medical educators alike have been restating their institutional commitment to values of equity, diversity, inclusion, and social justice (EDIJ).

For equity scholars and historically underrepresented groups in higher education, this also includes the usual actionable items perpetuating the same responses in higher education and academic medicine:

  • the appointment of chief diversity officers
  • promising climate surveys
  • EDIJ consultants to reiterate what faculty and students of color have been stating for years
  • the examination of culturally competent curricula

Our leaders are quick to respond to challenges, criticism, and calls to actions by pointing to EDIJ initiatives as a success regardless of evidence.

While cultural competence has been long recognized as the only approach in medicine, other concepts have tried to address its gaps:

  • cultural awareness
  • cultural sensitivity
  • cultural humility
  • cultural security
  • cultural safety
  • transcultural effectiveness

Unfortunately, they also have reduced the potential for a shared understanding of what cultural competency represents.

Academic medicine efforts are doubling down on implicit and unconscious bias training and discussing long overdue topics in health disparities within structural and social determinants of health.

The connection to race and ethnicity can no longer be ignored or lightly veiled.

Medical educators and equity champions are scrambling to elevate EDIJ-related education. For some, this has simply meant re-labeling current offerings as “anti-racist education.”

To simply suggest, for example, that implicit bias and (micro)aggressions are the most salient parts of the anti-racist medical education agenda misses the foundation of this work in education. This would be a failure in the achievement of equity, a failure in medical education, and a failure to our patients.

Anti-racist education emerged from the broader field of multicultural education over thirty years ago. It explicitly focuses on power relations, explores identity and its intersections, and institutional structures. It emphasizes the dismantling of systemic barriers that perpetuate racism within our educational environments.

Anti-racist educations seek to correct educational inequities, making education more inclusive while acknowledging discomfort, tension, and vulnerability in addressing conflict and controversial issues centered on race. When combined with critical pedagogy, culturally relevant teaching, and inclusive pedagogies, it equips educators and learners with the confidence skills to own responsibility for their own teaching, learning, agency, and activism.

Importantly, it eases the burden off historically excluded and marginalized groups in facilitating anti-racist education implementation and delivery. It initiates a framework for the development of anti-racist medical educators.

As an educator in academic medicine, equity scholar, and a member of a historically underrepresented group in medicine, I offer that anti-racism in medical education should explicitly first present the historical facts, not those only presented through the lens of whiteness.

This offers an opportunity to speak about the way medicine has failed communities of color from atrocities presented in medical and research ethics to those that acknowledge our profession’s pace in eliminating health inequities. Second, we need to center these discussions on our own identity and positionality within power and privilege. Positionality is the socio-political context that forms our identity in terms of race, class, gender, sexuality, and ability status (to name a few).

In medical education, as in research, our positionality determines our approach as educators, how the questions are constructed, lessons designed, and how we negotiate students’ responses.

Third, we should consider cultural humility and curiosity as the foundation from which to build racial equity conversations with learners and peers.

Lastly, we have to look at medical education and explicitly tackle the power imbalances in physician-patient communications, in the health care system, in the academic and leadership hierarchy, in our institutions’ culture and climate.

Anti-racist medical education may not be the vaccine we are looking for, but it deserves to be properly represented and not mislabeled. Our medical students are demanding a better and all-inclusive medical education.

Sylk Sotto is a bioethicist.

Image credit: Shutterstock.com

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