Betial Asmerom, a fourth-year medical student at the University of California-San Diego (UCSD), had never shown interest in becoming a doctor.
As a teenager, she helped her parents, immigrants from Eritrea who spoke little English, navigate the health care system in Oakland, California.
She saw doctors who were disrespectful to her family and who didn’t care about her mother’s treatment of cirrhosis, hypertension, and diabetes.
“All of those experiences made me dislike doctors,” Asmerom said. “In my community they always said: ‘You only go to the doctor if you are about to die.’
But that changed when he took a college course on health disparities. He realized that other communities of color suffered the same as his Eritrean family and friends. Asmerom thought that, as a doctor, she could help change things.
Teachers and student activists across the country have long called on medical schools to increase the number of students and practitioners from underrepresented communities, to improve treatment and promote inclusion.
But to identify the roots of racism and its effects on the healthcare system, they say, fundamental changes must be made to the curricula.
Asmerom is one of many voices calling for a strong anti-racist education. It calls for schools to eliminate the use of race as a diagnostic tool, to recognize how systemic racism harms patients, and to have talk about racism in the history of medicine.
This activism is not something new. White Coats for Black Lives (WC4BL), a student-run organization fighting racism in medicine, emerged in the wake of the Black Lives Matter protests in 2014.
But after George Floyd’s murder in Minneapolis in May, medical schools and medical organizations are under more pressure to take concrete action.
STOP USING BREED AS A DIAGNOSTIC TOOL
For many years, medical students have been taught that genetic differences between races had an effect on health. But in recent years, studies have found that breed does not reliably reflect that.
The National Human Genome Research Institute observes very little genetic variation between races, and more differences between people within the same race. Therefore, more doctors accept that race is not an intrinsic biological difference, but a social construct.
But Dr. Brooke Cunningham, a physician and sociologist at the University of Minnesota School of Medicine, said it’s a tough idea to give up. It’s part of the way doctors diagnose and measure disease, he explained.
Some doctors say that it is helpful to consider race when treating patients; others argue that it leads to prejudice and poor care.
Those views have led to a variety of false beliefs, such as that blacks have thicker skin, that their blood clots faster than whites, or that they feel less pain.
When race plays a role in medical calculations, it can lead to less effective treatments and perpetuate inequalities based on race.
In light of this research, medical students are asking schools to rethink curricula that address race as a risk factor for disease.
Briana Christophers, a sophomore at Weill Cornell Medical College in New York, said it doesn’t make sense for race to make someone more prone to disease, even though economic and social factors play a role.
Naomi Nkinsi, a junior at the University of Washington School of Medicine in Seattle (UW Medicine), recalled hearing that blacks are more prone to illness at a medical conference.
“It felt very personal,” Nkinsi said. “That is my body, those are my parents, those are my siblings. Now, every time I go to an office, I will feel that not only do they not consider me a whole person, but that I am physically different from all other patients just because I have more melanin in the skin. “
RECOGNIZING THE ADVERSE EFFECTS OF RACISM ON HEALTH
The Liaison Committee on Medical Education (LCME), the official accreditation body for medical schools in the United States and Canada, says that students should be taught to recognize biases “in themselves, in others, and in the process. provision of health care services “.
But the LCME does not explicitly require accredited institutions to teach about systemic racism in medicine.
This is what students and some teachers want to change.
Dr. David Acosta, chief of diversity and inclusion for the American Association of Medical Schools (AAMC), reported that about 80% of colleges offer a required or elective course on health disparities. But he explained that there is little data on how many schools teach students to recognize and combat racism.
An antiracist curriculum should explore ways to mitigate or eliminate the harm of racism, said Rachel Hardeman, a professor of health policy at the University of Minnesota.
“You have to think about how this penetrates the learning of medical education,” he said. Courses that delve into systemic racism should be required, Hardeman added.
Edwin Lindo, a professor at the University of Washington School of Medicine, said an interdisciplinary model should be adopted, allowing sociologists or historians to lecture on how racism harms health.
Acosta said the AAMC has organized a committee of experts to develop an anti-racism curriculum for each level of medical education. They hope to go public with their work this month and speak with the LCME about standards development and implementation.
RECOGNIZING RACISM IN MEDICAL EDUCATION
Activists want their institutions to acknowledge their own missteps, as well as the racism that has accompanied past medical achievements.
Dereck Paul, a medical student at the University of California-San Francisco, said he wants all faculties to include lectures on people like Henrietta Lacks, the black woman who was dying of cancer when cells were removed without her consent, which they were used to develop cell lines that have been instrumental in medical research.
Asmerom pointed out that he wants the faculty to recognize the racist past of medicine in classes. He cited an introductory anatomy course at his school that failed to point out that in the past, when scientists tried to study the human body, blacks and other groups had been mistreated.
“It’s like, OK, but aren’t you going to tell that they took black bodies out of their graves to use in the anatomy lab?” I ask.
Although Asmerom is happy to see his faculty listen to student demands, he feels that administrators must acknowledge their mistakes from the recent past.
“Someone has to admit how anti-black racism was perpetuated in this institution,” Asmerom said.
Asmerom, one of the leaders of the UCSD Anti-Racist Coalition, said the administration has so far responded favorably to the coalition’s demands to invest time and money in anti-racist initiatives. And she feels cautiously hopeful.
“I don’t dare hold my breath until I see real changes,” he concluded.
KHN (Kaiser Health News) is a non-profit news service that covers health topics. It is an editorially independent program from KFF (Kaiser Family Foundation) that is not related to Kaiser Permanente.
Original English version: https://bit.ly/36IzBzh