In recent years, the national spotlight has focused on the impact of racism in the United States with many faculty in academic medicine asking themselves difficult questions and searching for meaningful ways to address structural racism within academia. Most academic centers have diversity, equity and inclusion initiatives and messages of condemnation when overt racial violence flares nationally. Though the acknowledgement of systemic racism is new for many, it has been long recognized, endured and lived by faculty and communities of color.
Discussions of dismantling structural racism intersect at every imbalance of power, status and relationship in society from the macro to micro-levels. An appreciation of the larger historic forces that entrench racism into the DNA of our country, though necessary, can leave many overwhelmed with the task at hand. The focus of this blog will be what we can do as individuals working within our own spheres of influence within the different missions of academic medicine.
Dr. Taneja and Mr. Catlett from College of the Holy Cross have developed a “How to Write an Anti-Racism Action Plan” Self-Paced guidebook.1 Aimed at the beginner level and highly transferable to a multitude of disciplines and sectors, the guide contains many great activities and can be found at the following link: https://www.holycross.edu/anti-racism-guidebook.
An activity I found particularly helpful was assessing “spheres of influence.” After listing the spheres of influence which can include but does not need to be limited to people (self, family, friends), relationships (social, school, work), community (formal or informal), greater society and organizations, they ask us to consider critical 4 questions:
- What are examples of the verbal and nonverbal messages you received around race, racism, and anti-racism in each of the various spheres?
- How do you think these individuals or groups developed those perspectives? What life experiences do you think led them to these views?
- Using these Spheres of Influence, what are the areas where you have expertise where you could meaningfully contribute to change?
- What strategies, if any, might be effective to use in each sphere of influence that you have?1
All this work starts at a deeply personal level. It is not comfortable and requires we interrogate where we learned our messages, how we internalized them and became their standard bearer.
The following section will focus on question #4 and how individual faculty can challenge the status quo within the various missions of academic medicine specifically. This is not meant to short circuit the deliberate process of self-discovery or meant to be exhaustive but only to show how others have started to think through navigating an anti-racist approach to their work.
Education Mission
Questions to Ask | Potential Interventions |
How are you mitigating bias in the curriculum (GME and UME)? |
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How are you teaching race as a social construct (GME and UME)? |
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How are you training faculty on mitigating their biases and teaching with an anti-racist lens? |
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If faculty of color are providing most of the training, are they getting adequately compensated and recognized for their time, skills, and perspective? |
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What is the diversity of the classes, residency programs, faculty, staff, etc? What are the yearly trends? |
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What are recruitment efforts to increase diversity? |
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What efforts are underway to decrease bias from the admissions process and promote diversity? |
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What pipeline programs are developed and supported? |
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How are underrepresented minority (URM) students and residents being mentored and supported throughout their education and training? |
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What are the rates of student mistreatment with reports of racism, sexism, homophobia, etc? What are the efforts to improve this? |
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What elements of institutional or hospital culture are barriers to students, residents, faculty or staff who are URM to thrive? |
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What bias reporting mechanisms have been created? |
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Clinical Mission
Questions to Ask | Potential Interventions |
What are the differences in patient experience among your patients depending on gender, race, sexual orientation, disability, etc? |
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What are the differences in patient outcomes among your patients depending on gender, race, sexual orientation, disability, etc? |
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What are the differences in patient access to care among your patients depending on gender, race, sexual orientation, disability, etc? |
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Does your patient population resemble the demographics of your community or region? |
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What are the barriers to healthcare access in your area and how is the healthcare system addressing this? |
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Does the insurance status of the patient dictate which clinician they can be seen by? |
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How is language used in verbal or written form to reinforce or create bias or stigma in the medical record, clinic, or inpatient service? |
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What systems are in place to systematically evaluate health disparities based on marginalized status? |
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What training have health care workers in the clinical space received to provide non-biased and inclusive trauma-informed patient care? |
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To what extent are underlying SDOH being assessed with appropriate interventions put into place? |
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To what extent are clinicians advocating for SDOH policies at the state, national or international levels? |
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Research Mission
Questions to Ask | Potential Interventions |
How are diverse research participants recruited, communicated with, and cared for during the duration of the study? |
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How are you building trust with communities made marginalized? |
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How are you using interpreters? |
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Have all the people associated with the research from the coordinators to the project investigator been trained in non-biased and inclusive trauma-informed care? |
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How are you mitigating implicit bias in the design of research trials? |
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Are you capturing information about race in your research? If so, how is this being assessed? What is the utility? |
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Will your research be of relevance to diverse populations? |
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How are discussions about authorship conducted and decisions made? |
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How diverse is your network of research collaborators, assistants, graduate students, etc? |
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How diverse are your mentees? How do mentees gain access to your mentorship? Are you a part of formal mentorship programs? |
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What pipelines programs for research mentorship do you participate in? |
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Administrative Mission
Questions to Ask | Potential Interventions |
What is your involvement in committees, organizations, boards, professional groups, working groups and conferences at the local, regional, and international levels? |
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Are those spaces as diverse as they can be? Who is missing from the table? Who is present but their voices are silenced or not listened to? Does the composition of those groups preserve the status quo or disrupt it? How can you build a longer table or relinquish your seat to someone else? |
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Do you need leadership positions for career advancement? If you are mid or late career, which leadership positions can you vacate and groom someone else to take over? |
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Are you actively advocating for more diversity, equity, and inclusion? |
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How diverse are your mentees? Who are you providing opportunities for? Who has access to you? |
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Do you make recruiting, hiring, promotion, performance evaluation or firing decisions? If so, how do you ensure you are mitigating bias during that process? Have you interrogated the recruiting process? |
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How is diversity, equity and inclusion baked into every policy that you oversee? |
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How are decisions made? Who gets to decide? How are you getting input from diverse voices, avoiding group think and ensuring inclusion? |
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Conclusion
Academic institutions are embedded in systems and structures of power, politics, and hierarchy where structural racism flourish. Though transformations in high level leadership may be needed, individual faculty have a critical role in advocating for change and taking an anti-racist approach to their individual work as well. We can all “start where we are” in the spheres of influence we exert. Building coalitions to push for policy change can create dramatic ripples of change throughout the culture of an institution.
-Premal Patel, MD Community of Practice Member
Dr. Premal Patel is a board-certified Physician and an Associate Professor in the Department of Internal Medicine. She also serves as the Associate Director of the Global Health Education Program at UTMB and is co-coordinator of the Global Health Inter-Professional Core Course.
References:
- https://www.holycross.edu/anti-racism-guidebook.
- Brown, A et al. Can a checklist ameliorate implicit bias in medical education? Really Good Stuff: Lessons learned thorough innovation in medical education. Medical Education. March 2019. https://doi.org/10.1111/medu.13840
- Amutah, C et al. Misrepresenting Race-The Role of Medical Schools in Propagating Physician Bias. NEJM. 2021; 384:872-878
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- Vyas D, Einestein L and Jones D. Hidden in Plain Sight- Reconsidering the Use of Race Correction in Clinical Algorithms. NEJM. August 2020; 383:874-882
DOI: 10.1056/NEJMms2004740 - Rodríguez, J.E., Campbell, K.M. & Pololi, L.H. Addressing disparities in academic medicine: what of the minority tax?. BMC Med Educ15, 6 (2015). https://doi.org/10.1186/s12909-015-0290-9
- Mateo, Camila M. MD, MPH; Williams, David R. PhD, MPH More Than Words: A Vision to Address Bias and Reduce Discrimination in the Health Professions Learning Environment, Academic Medicine: December 2020 – Volume 95 – Issue 12S – p S169-S177 doi: 10.1097/ACM.0000000000003684
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