I am distracted and exhausted with my own thinking these days. I write this against the backdrop of the COVID-19 pandemic and the protests around the United States in response to the murder of George Floyd. It is overwhelming. I’m left to wonder if there will be any concrete change that comes out of all this. I’m left to question exactly what change I personally would want to see. For example, I question if our current educational model, at all levels, is doing enough to address the lack of understanding within our society. Specifically, is medical education doing enough to address future physicians’ abilities to understand the perspectives of their patients? As a medical student, my growing disillusionment begins with medical school and the lack of opportunities afforded to us during our education to discuss matters such as racial inequality.
Just because we have achieved a higher level of education does not afford us the right to assume we have achieved an equally higher level of understanding about social constructs. It takes constant self-reflection, thought and discussion to achieve even a baseline understanding of topics such as racial inequality — an understanding which cannot be garnered solely through reading textbooks and earning degrees. However, our education as medical students does not actively challenge us to have these discussions with ourselves or with each other. This lack of opportunity for discussion impedes our ability to understand how race affects ourselves, our peers, and our future patients. For many students of color, especially Black individuals, the discussion regarding racism is one they have already been forced to have with themselves every moment of their lives given their lived experience. Therefore, if we all do not actively engage in such discussions with each other in school, we neglect a collective responsibility we have towards not only our patients, but also our colleagues.
We spend so many hours learning how to treat patients on a scientific level that less emphasis is placed on how to treat patients on a human level. But the responsibilities of a physician are split 50/50, necessitating both an understanding of medical principles and an understanding of people, including their perspectives and backgrounds. Just as we are expected to know more than the average person regarding medical science, we should also recognize we are expected to have an above-average understanding of topics such as racial inequality. Ultimately, such topics directly affect our patients.
The requirement that we master both these concepts is what I believe makes the medical profession unique. Unfortunately, while the responsibilities of a physician are split 50/50 in practice, I am disheartened to think that the focus of our education is perhaps split 90/10 with the heavier emphasis placed on scientific knowledge. You hear all the time that education is the key to uprooting ignorance. So I’m now left wondering, what is my education doing to help further my understanding of people?
Yes, we will all be working with patients during rotations and that will help a little with understanding the patient experience. But is it enough? Is it enough to leave the task of mastering the other half of a physician’s responsibilities solely to an individual’s personal desire to learn from their own isolated experiences? The onus falls heavily on the individual student to extract meaning and grow from interactions during clerkships. However, if students are not guided properly, there is no guarantee that we will truly learn about how racial factors impact medicine on a systemic scale as well as how they impact people’s daily lives. When left to their own devices, the students who already engaged with racial issues will continue to engage. For others, without an outside force such as an educational curriculum challenging them to put in more effort than they currently give, the inertia to not engage is too strong to overcome. Without formal training, it is difficult to successfully nurture a deeper understanding of racial issues.
If there is anything medical school teaches us, it is that passively reading or watching something doesn’t actually help you understand the material. There has to be an active learning component to it. As a physician, a superficial understanding won’t be enough. Active learning can be achieved either independently or by working with others. When trying to understand scientific concepts, learning can be easily achieved individually. However, actively learning about the topic of racial inequality is far more difficult to do by ourselves. To nurture a deeper level of understanding, this learning requires discussion with others, especially others who might not share the same opinions or perspectives as you. After all, there is no point in having discussions if you aren’t challenged during them. Or if you aren’t open to having your opinions grow and change. Unfortunately, a sufficient forum for such discussion is not built into our current education. Until systemic changes occur in our education, we will continuously sideline the discussion of race as an “independent study.” However, a topic so important should not be left up to the individual.
What type of systemic changes could help medical education provide a better environment to develop an understanding of issues that plague Black patients? In a report published in 2019 by WhiteCoats4BlackLives, they detail a list of what an anti-racist curriculum would look like. They call on changes to the existing curriculum including the use of appropriate language that does not refer to race as a risk factor, the creation of mandatory in-person training to teach students about how to be actively anti-racist, and access to structures that allow honest feedback from students on how the curriculum is accomplishing its goals. These are only a few things they outline in their report, and I encourage you to read more of what they propose here.
Furthermore, from the conversations I have been hearing personally, there is a newfound emphasis on increasing the diversity of medical students. In addition, I believe it is just as important to increase representation among lecturers so that Black students are able to easily see and seek physicians like themselves as mentors. Simply put, it is important to increase representation of Black individuals in medical training. Increasing representation also inherently creates more opportunities to have meaningful discussions about race. These discussions could serve as a catalyst for change in the system of medical education or as a catalyst for deeper understanding within individual students.
Moreover, these discussions can be constructed in small-group discussion-based classes that provide space to talk about issues like race in a candid manner. In the end, I believe that every medical school should have the following two objectives in mind as they discuss curriculum changes: 1) medical education must help students first become comfortable talking about the subject of race, and 2) medical education must help students become confident in our understanding of systemic racism and how it affects medicine.
These ideas are not groundbreakingly new. I question why there have not been speedy and active changes already occurring. As members of higher education, to some extent, we are all privy to the problems with what we aren’t taught. Medical educators need to self-reflect: what has been holding us back to enact change and how do we move past that? This moment in history is the ultimate opportunity to create lasting, systemic changes within medical education. I fear if we miss this chance now, we might not get it again.
Image credit: “lecture hall” (CC BY-SA 2.0) by Genista