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REVISED CURRICULUM ADDRESSES RACISM
New Curriculum Addresses Racism in Medicine
Societal events and student petition galvanize changes
By Ellen Goldbaum
An emphasis on anti-racism is changing the way students in the Jacobs School of Medicine and Biomedical Sciences are learning medicine. Pictured in Gross Anatomy Lab are, from left: Kyle Kenyon, Joshua Kent, Ali Khan, Brianna Kinley, Class of 2026. Photo by Sandra Kicman
A revised medical curriculum at the Jacobs School of Medicine and Biomedical Sciences— set to launch in 2023—will have anti-racism principles embedded in its core.
Catalyzed in 2020 by the COVID-19 pandemic, as well as by the George Floyd murder and the global protests that followed, the evolving new curriculum is a result of the profound reckoning that these events forced upon those studying and practicing medicine.
“I have never seen so much willingness to change,” notes Margarita Dubocovich, PhD, senior associate dean for diversity and inclusion, and one of four co-chairs of the Diversity, Inclusion and Learning Environment Committee. “This is the moment. This is the opportunity.”
While issues such as the social determinants of health have been part of the Jacobs School’s orientation and required courses, it was a student-written document and petition submitted in June 2020 that launched the comprehensive efforts now underway.
STUDENT PETITION
“The student petition changed the urgency,” recalls Linda Pessar, MD, former director of the Center for Medical Humanities and now professor emerita of psychiatry. “It demanded that the medical school quickly increase its attention to structural racism and social justice, to look at the ways that the curriculum creates and perpetuates racism by not attending to differences among people.”
Former Dean Michael E. Cain, MD, mandated that the requested changes be fast-tracked. His successor, Allison Brashear, MD, MBA, has redoubled those efforts.
“Medical education at the Jacobs School is undergoing fundamental changes addressing structural racism in medicine in an effort that was initially inspired by our students,” says Brashear, vice president for health sciences and dean of the Jacobs School, who came to UB in December 2021. “That fact speaks volumes about the depth of commitment that our students bring to this work collectively as they partner with faculty to achieve health equity in every aspect of patient care.”
Recommendations included providing racial and socioeconomic context behind longstanding health issues in African American communities and directly acknowledging the effects of systemic racism and the threat of police violence on the physical health of
people of color. They included teaching students how to be effective patient advocates and providing instruction in the history of anti-Blackness, discrimination against LGBTQ+ people and other marginalized communities, and how these issues have affected medicine and how it’s taught.
The petition also addressed increasing the diversity of faculty and staff, a goal to which the university as a whole has committed through President Satish K. Tripathi’s Advisory Council on Race. Administrators acknowledge that such diversity is sorely lacking at the medical school, but that change is coming with new diversity requirements for search committees and an emphasis on holistic interviewing.
It is well-documented that having more diversity among instructors benefits all students and faculty, and that mentoring is key, a premise taken for granted throughout the medical and biomedical professions.
COMPREHENSIVE CASE REVIEW
A key focus for curricular change are the patient cases that students are exposed to, both in the classroom and in the clinic, either with standardized patient volunteers or in the community with preceptors.
“We are taking a look at the entire inventory of cases across the curriculum,” says Jennifer Meka, PhD, associate dean for medical education and director of the Jacobs School’s Medical Education and Educational Research Institute.
Faculty have been revising and editing cases and discussing ways to encourage students to reflect on implicit bias and structural racism.
“It really is a systemic look at the entire curriculum,” adds Alan J. Lesse, MD, senior associate dean for medical curriculum, who, with Meka, co-chairs the curricular revision subcommittee.
An early, critical change was the decision in fall 2020 to subscribe to a database that specializes in dermatological manifestations of disease and features a broad spectrum of representation, including many people of color.
Traditionally, most cases have featured patients who are white men aged 40-55, without any mention of race or economic orientation.
“We are working on guidelines to revise cases to better reflect the diverse population our local students will be working with,” Meka explains. “The goal is to develop the cultural humility and advocacy skills that are required for practicing medicine, to examine the intersectionality of race and its impact on health and wellness. We are also training our faculty facilitators to talk with students about how to raise issues related to social determinants of health, incorporating respect for other cultures in their interactions with patients.”
MORE DIVERSE ‘STANDARDIZED’ PATIENTS
The Clinical Practice of Medicine course, which students take during their first two years, is a key focus. It relies on volunteers from the community who are trained to act as “standardized” patients with specific medical symptoms, who are then diagnosed by medical students.
“Most standardized patients are white,” says Tatiana AmayeObu, a member of the Class of 2024. “I had my first non-white patient last year in my second semester, but some students have never had a non-white standardized patient.”
Diversifying the pool of standardized patients will be challenging. “Minority communities are already distrusting of medicine,” Amaye-Obu says. “So in order to improve that, we have to go out into the community and truly explain what we’re doing. That’s the whole point of doing standardized patients: caring for others in the future.”
Toward that end, the school introduced the Health in the Neighborhood course as a pilot elective in 2018.
The course pairs medical students with members of the Hopewell Baptist Church congregation in Buffalo. The goal of the course is for students to become familiar with the realities of medical disparities and how they affect individuals.
“The intent of the course was to explore the effect of racism on the Black community and to engage with the African American community,” says David Milling, MD ’93, executive director of the Office of Medical Education and senior associate dean for medical education.
“It had little to do with us providing care, but instead had to do with listening to the community, to finding out what are the barriers to providing care and how can we be better physicians,” adds Milling, who established the course with Pessar, Henry Louis Taylor Jr., PhD, professor of urban and regional planning in the School of Architecture and Planning and director of UB’s Center for Urban Studies, and community leaders Pastor Kinzer Pointer of Agape Baptist Fellowship Church and Pastor Dennis Lee of Hopewell Baptist Church.
The course has now been expanded to include a clinical component, blending what students are learning in the classroom with culturally sensitive interviewing as they work with clinical preceptors in underserved communities.
Instructors throughout the school have been incorporating anti-racism into their courses, not only for those pursuing medical degrees, but also for those in undergraduate and graduate programs in biomedical sciences.
Jennifer Surtees, PhD, associate professor of biochemistry, and David Dietz, PhD, chair of the Department of Pharmacology and Toxicology, have explicitly integrated anti-racism into their ethics course, Introduction to Scientific Investigation and Responsible Conduct (BMS 514LEC). One component of the class engages students in addressing the attitude—still prevalent among some scientists—that “we don’t need to discuss this in science.”
Tatiana Amaye-Obu, Class of 2024
Tatiana Amaye-Obu, Class of 2024 Photo by Sandra Kicman
David Milling, MD, executive director of the Office of Medical Education and senior associate dean for medical education. Photo by Sandra Kicman Jennifer Meka, PhD, center, associate dean for medical education and director of the Jacobs School’s Medical Education and Educational Research Institute, helps review all of the cases that comprise the medical curriculum to better reflect a diverse patient population. Photo by Douglas Levere
LEADERSHIP FELLOWSHIPS
Students urged school administrators to work to alleviate the burden on students of color who are affected by structural racism while also serving as the primary leaders of diversity and inclusion efforts.
These efforts led to establishment of the Social Justice and Equity Administration Leadership fellowships, launched last year by the Office of Inclusion and Cultural Enhancement. Funded initially by the Jacobs School’s Office of the Dean, the fellowships give medical and biomedical sciences graduate students a chance to work on specific projects that address social, educational or health care inequities while providing $3,500 each in scholarships, as well as funding for travel expenses.
Five fellowships were awarded in the first round and topics ranged from assessing the impact of the Health in the Neighborhood course and improving vaccine equity in communities of color, to developing a curriculum on the history of racism and ways to improve the learning environment for members of the LGBTQ+ community.
And while the institution has clearly embraced these changes, Lesse notes, they all still need to fit into the medical curriculum.
“The question is, we have four years right now to develop students into physicians,” Lesse says. “What do they need to learn when? These changes will make them much more aware of their roles as physicians in society.”
That is especially true in the required first-year course, Medicine and Society, which focuses on the physician’s role. The course has been redesigned with a stronger emphasis on health inequities.
James N. Jarvis, MD, clinical professor of pediatrics, who is of Akwesasne Mohawk ancestry and has worked on American Indian and Alaska native child health issues for more than 30 years, has addressed the class.
He told the students: “You can’t just say to Indigenous groups: ‘We’re here to help, this is what we think you ought to do.’ Instead, you need to spend time with them. Ask them what they think. Sit down with these communities. Be humble and listen.”
These principles, now an integral part of the Jacobs School curriculum, will ultimately benefit not just the individual students being educated, but also, by extension, all of the communities where they will eventually practice.
What the Community Has to Teach
Diversity research mentorship project has a surprise beginning
By Ellen Goldbaum
A summer program launched in 2020 by the Department of Surgery and designed to encourage underrepresented medical students to pursue surgery turned into a dramatic learning opportunity, for both the students and the department.
The Summer Diversity Research Mentorship program was established as part of the department’s Anti-Racism and Health Care Equity initiative that aims to address and mitigate the effects of systemic racism and inequality in health care.
Steven Schwaitzberg, MD, SUNY Distinguished Service Professor and chair of the Department of Surgery, launched the initiative as critical to the education of all surgeons, while also highlighting the urgent need to train more surgeons from underrepresented groups, who currently comprise just 10% of all surgical trainees in the U.S.
The goals were to provide candidates with mentoring from attending surgeons, experience in the operating room, and an opportunity to conduct research on health disparities in the majority-Black Fruit Belt community adjacent to the UB medical school.
The original plan was to find out how residents viewed screening for colorectal cancer and breast cancer with an eye toward eliminating obstacles to care.
But early in the process, Fruit Belt residents candidly told the students and their director how ill-advised that approach would be.
“We quickly came to see that that idea was wildly over optimistic in a community that sees itself as getting the short end of the stick research-wise,” says Mike Lamb, PhD, research associate professor in the Department of Surgery and mentorship program director.
In a paper currently out for review on the experience, Lamb and the students write: “In retrospect, it’s easy to see how inadvisable it would have been to venture forth into the Fruit Belt greeting residents with a ‘Good morning, I’d like to ask about your colorectal health.’”
Conversations with community residents quickly revealed that past research efforts in the Fruit Belt had often been conducted with little regard for the community’s needs and goals.
“In most cases, what would happen is what’s called extractive research, which works out well for the researcher, whose CV is burnished, but once finished they fall out of touch with the community,” Lamb explains. “I’m interested in research founded in a shared sense of what should be studied.”
Upon reflection, the fellows completely rethought their approach.
“We spent our days interviewing residents and stakeholders,” says Lamb. “We understood that we needed to find out all that we did not know. We met with as many local residents and stakeholders as we could. We hosted lunch and dinner meetings. And we shared their priorities with the medical school.”
That effort led the medical school to award a Fellowship in Social Justice, Equity Administration and Leadership to Lamb and his students to develop a neighborhood oral history—Voices of the Fruit Belt Community: Amplifying and Empowering our Neighbors. The fellowships are designed to encourage students to develop leadership skills to advance equity and justice.
The project seeks to document and amplify the voices of Fruit Belt residents by developing an oral history, a compelling chronicle of the relationship between the neighborhood and the medical campus.
“Some people operate under the mistaken impression that there was ‘nothing there’ in the neighborhood before construction of the Buffalo Niagara Medical Campus, and are thus ill-positioned to work in good faith for real change,” says Lamb. “This project offers a platform for community voices to be fully heard and engaged.”
Faculty mentors and students in the Department of Surgery’s 2021 Summer Diversity Mentorship Program are, from left, Timothy Adams, Nigel Marine, Abena Ansah-Yeboah, Stuti Tambar and Mario Carrillo.
Mike Lamb, PhD, research associate professor, Department of Surgery, and mentorship program director.
