“Most medical schools are white spaces where explicit and implicit racism occurs constantly and often goes unmentioned and unpunished,” according to a recently published article. Authored by Yale School of Medicine (YSM) Psychiatry Resident Nientara Anderson, MHS, MD; Dowin Boatright, MD, MBA, MHS, assistant professor of emergency medicine; and Anna Reisman, MD, professor and director, Program for Humanities in Medicine, Blackface in White Space: Using Admissions to Address Racism in Medical Education, appeared in the Journal of General Internal Medicine.
To illustrate the point that medical schools are white spaces, the authors note the disproportionately low number of Black medical students and faculty compared to white students and faculty, and the fact that white medical school faculty are promoted more readily than Black faculty. They also cite multiple examples of attendings and residents perpetuating false racist beliefs (e.g., Black people’s skin having more collagen), enforcing racial hierarchies in hospitals, making unchallenged racist remarks, and normalizing racism.
The article acknowledges that many medical schools have made efforts to address pervasive racism in medical education by forming committees and appointing deans focused on diversity and inclusion, adding health equity classes to their curricula, conducting training on implicit bias and microaggressions, and expanding racial and social-economic equity in admissions.
However, Anderson, Boatright, and Reisman believe a more direct way to address racism in medical training is to “stop admitting applicants with racist beliefs.” While recognizing this is a complex undertaking, they argue that it is necessary, and suggest several approaches to achieve this goal.
Many of their ideas build on existing practices to evaluate candidates for “hard-to quantify characteristics and attitudes,” such as commitment, empathy, and integrity. For example, essays, resumes, letters of recommendation, and interviews could be used to evaluate whether applicants “hold racist beliefs or invalid and fixed views on biological differences between races.” More specifically, the authors suggest an essay could ask for a reflection on one’s own race or ethnic identity or for the applicant’s thoughts on scholarly writing on race and medicine. And during interviews, applicants could be asked to comment on vignettes or participate in multiple mini interview scenarios based on discriminatory experiences reported by minority faculty, trainees, and students.
Additionally, evaluative questionnaires or surveys adapted from studies on implicit and explicit bias, could be used “to flag significantly uninformed individuals who may not yet be ready to care for patients or interact with their non-white peers in a respectful manner.”
The authors also raise the idea of evaluating candidates’ racial attitudes in more informal settings, such as during student-hosted discussions with students and trainees of color engaged in racial justice work or affiliated with groups such as the Student National Medical Association (SNMA) or the Latino Medical Student Association (LMSA).
Another approach they suggest is one that has historic precedent in the 1970s––applicants could be interviewed by minority community members and patients. Beyond providing another method to evaluate racial attitudes, it would give patients a voice in their health care and potentially improve relationships between academic medical centers and their communities.
For these ideas to be effective, the authors state that “diversifying and educating admissions committees and interviewers is essential, because they will be responsible for locating a given candidate on a continuum of racial attitudes which would then be weighed as part of their overall candidacy.” Such education, they write, includes being aware of one’s own biases and how to counteract them, as well as being informed about the history of, and current scholarship about, racism in medicine.
Anderson, Boatright, and Reisman make clear that they appreciate that “people’s beliefs can evolve, especially in environments that strive to change curricula, diversify medical schools, and counteract racism in medical culture,” but they still believe that assessing medical school and residency applicants’ racial beliefs is a necessary measure to implement in order to address racism in medical education.
Additionally, the authors point out that such assessments would have the added benefit of providing applicants who are non-white or underrepresented in medicine (URiM) with “more opportunities to express their relationship to medicine, demonstrate their understanding of how race operates within medicine, and display their ability to navigate racially complex scenarios in medical practice.” These are potential strengths for URiM applicants, which may not be noticed if an evaluation of racial beliefs is not part of the evaluative process.
The authors emphasize this effort is important not only to improve the environment for students and trainees, but to create a safer environment for patients. They cite research linking disparities on treatment, outcomes, and death between white and non-white patients to racial beliefs among medical providers.
Anderson, Boatright, and Reisman conclude by stating “medical schools must take active steps to diminish the prevalence of racism in future medical students and doctors. It is a detriment to our profession and to our patients to merely lament the racism we find in our ranks while doing nothing to prevent it in the first place.”