Medical schools must play a role in addressing racial disparities

From the article by Jocelyn Streid, Margaret Hayden, Rahul Nayak, and Cameron Nutt on STAT:

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 timesas 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 10dermatology 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.

Read the full article.

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