Developing a Medical School Curriculum on Racism Using Multidisciplinary and Multiracial Conversations

Doctors take an oath to treat all patients equally, and yet there are numerous reports throughout the country this does not always happen. The education towards fighting racism and its potential influence on health can take place during a professional’s earliest training. Healthcare professionals must name, understand and talk about racism in order to truly achieve equality. Recognizing this, a team based at the University of Minnesota Medical School set out to develop tools to promote productive conversations about racism. The team recently published their findings about their process of developing an anti-racism curriculum for first-year medical students at the University’s Medical School in a special issue of the journal Ethnicity & Disease.

“Although today’s medical students are more aware of the influence of racial stratification on health outcomes, most medical schools do not address racism in their curricula., and when they do, they often focus only on implicit bias” said Brooke Cunningham MD, PhD, Assistant Professor in the Department of Family Medicine and Community Health at the University of Minnesota Medical School, principal investigator for the study.

The group used a methodology called Public Health Critical Race Praxis (PHCRP) that helps researchers remain attentive to issues of equity in their work.

“We learned that even with those truly, sincerely and genuinely committed to achieving equity, there is a high likelihood of replicating power structures that perpetuate systemic racism across all disciplines,” said Rachel Hardeman, PhD, School of Public Health assistant professor and lead author of the study. “The field of public health, for example, has a long history of working with marginalized communities to promote the health of all communities, but it also has a complicated and problematic relationship to race. PHCRP is critical for moving all health professionals towards achieving health equity in their work.”

In Phase I of the study, a group of seven women primarily from racial and ethnic minority groups and with experience in public health, health care, and community engagement developed small group exercises that focused on structural racism. Participants from this phase described the early meetings as “powerful,” allowing them to “bring their full selves” to a project that brought together people who are often marginalized in their professional environments.

In Phase II, five White (primarily male) colleagues joined them to discuss racism and race in light of their initial curriculum. Working over a year’s time (January 2016 – December 2016) and using PHCRP, this larger group developed an anti-racism curriculum. Even though they were all professionals dedicated to advancing conversations on racial equity, it was not an easy task to come to consensus. They found that, even among themselves, racialized and socialized roles easily dominated. Phase I participants noted that “[our] voices… became quieter…” and “I had to put on my armor and fight in those later meetings…”

The researchers concluded that the process of employing Public Health Critical Race Praxis in the development of an intervention about racism in medicine led to new insights on what it means to discuss racism among people who are marginalized and people with privilege. Conversations in each phase yielded new ideas and strategies to advance a conversation about racism in health care.

The University of Minnesota Office of the Vice President for Research (OVPR) funded the study through a Serendipity Grant.

Dr. Cunningham and fourth-year medical student Andres Scarlato recently examined this topic even further in “Ensnared by Colorblindness: Discourse on Health Care Disparities” which was also published in Ethnicity and Disease.