Confronting Racism Special Section
Combating Oppression:
ACKNOWLEDGING OUR HISTORY AND MOVING TOWARD EQUITY AND JUSTICE IN MEDICAL EDUCATION Denise M. Connor, MD Oppression is deeply and painfully woven into the fabric of U.S. society; experiences with racism, homophobia, transphobia, and sexism (to name just a few instruments of oppression) profoundly impact countless individuals in our culture. Throughout its history and into the present day, medical education has been complicit with these and other forms of oppression, supporting and sustaining them in both seen and unseen ways. Alarming data about the beliefs and practices of modern-day medical students provides evidence for the ways in which medical education is, at best, failing to interrupt, and at worst, perpetuating the harmful impact of these destructive forces on individuals and communities. For example, we are graduating medical students in the modern era who believe that the skin of Black persons is thicker and has fewer nerve endings than that of white people 1— dangerous beliefs rooted in a false notion of race as biology that leads directly to harmful decisions to provide less pain medication to Black patients, including Black children suffering with appendicitis.2 We are graduating medical students in the modern era who, when seeing standardized patients with an identical set of symptoms meant to depict angina, are significantly more likely to diagnose angina in a white man than in a Black woman, and at the same time are more likely to rate the Black woman’s general health status as lower than the white man’s.3 These findings are deeply disturbing and relate directly to the hidden curriculum that exists in medical education that quietly supports and operationalizes racism in medicine, often in ways that are unintentional yet extremely impactful.4 Similarly problematic and harmful messages, both implicit and explicit, related to individuals from many other communities that have been historically marginalized abound in our system of medical education. Because medical education propagates harmful beliefs and practices and sustains them over time, it is one of the key 10
SAN FRANCISCO MARIN MEDICINE APRIL/MAY/JUNE 2021
levers we must use to move toward equity and justice within our healthcare system. With this goal in mind, many medical schools have begun to consider how to become forces for anti-oppression and anti-racism. At the University of California, San Francisco (UCSF), we are launching a new Anti-Oppression Curriculum (AOC) that will build upon prior work focused on diversity, equity, and inclusion at UCSF, including the recent Differences Matter campaign.5 Through intentional, longitudinal changes across our entire fouryear curriculum, we hope to impact learners, clinicians, and ultimately patients and their communities. This effort aims both to shape the next generation of physicians’ views on how racism and other forms of oppression harm individuals and communities, and to offer opportunities for students to learn how to engage with strategies to disrupt those harms in partnership with patients and their communities. In parallel, we hope to expand the understanding of practicing clinicians and trainees who work with UCSF medical students in the clinical setting in ways that will ultimately have a positive impact on individuals seeking healthcare. Students engaging in a curriculum focused on anti-oppression will be encouraged to raise questions when they arrive in the clinical setting—for example, our learners will be equipped with a critical lens that will promote inquiry into how race is being used in clinical risk scores and algorithms and whether that use is appropriate or harmful. In a positive and respectful learning climate, these queries will have the power to raise awareness of issues that have been previously normalized and unquestioned in the way we practice medicine. To support these discussions, our AOC will focus on providing faculty development opportunities for clinicians to expand their understanding of these critical domains, to enable faculty to engage effectively with students on these topics. The arc of how race has been incorporated (or not) into clinical teaching cases can provide us with helpful insights WWW.SFMMS.ORG
