Medical schools have increasingly been describing themselves as anti-racist. The term seems straightforward and as a result has been easy to incorporate into our lexicon.
Being anti-racist and translating anti-racism into action is far more challenging. In “The Racial Healing Handbook,” Anneliese Singh defines anti-racist as “someone who is actively seeking not only to raise their consciousness about race and racism but also to take action when they see racial power inequities in everyday life.”
Racism has been accomplished not only by overt bias and segregation, but also by putting requirements, expectation and rewards in place that are more familiar to the majority group and therefore easier for that group’s members to achieve, generation after generation. There is extensive evidence that people of color are consistently at a disadvantage when it comes to entry, advancement, mentorship and research funding in the health professions. One might attribute this to flaws in the system, but we contend that these requirements, expectations and rewards may be a product of values, beliefs and norms that are intended to preserve power and influence in our white-dominant society.
We have a responsibility to address the ways academic medicine has helped preserve structures of power to the detriment of our peers, colleagues and the communities we serve.
This will require elevating the voices of students and staff; explicitly naming racism; centering racial justice in our work and learning environments; embracing discomfort; and redistributing power, privilege and social capital. Our profession has a well-known reputation for finding solutions to difficult problems: becoming anti-racist is no different.
We offer three examples of anti-racist interventions at our school as a model for consideration.
In July 2020, our Student National Medical Association representatives submitted an open letter to school leadership asking that, among other interventions, we “provide financial support for Black, Indigenous and Latinx medical and graduate students” in recognition of anti-racism work that is highly valued by the medical school, is disproportionately undertaken by these students and has historically not garnered meaningful recognition. In collaboration with students, we created stipend-supported, closely mentored year-long Anti-Racism in Practice Fellowships for students who want to serve as a resource for school and institution-wide anti-racism initiatives.
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In 2019, after learning that students of color were persistently underrepresented among those selected for Alpha Omega Alpha—the national medical honor society—we undertook a concerted effort to reduce bias in the selection process and ultimately decided to suspend medical student selection. Together with students, we came to the conclusion that the process reinforces the structural biases and social privilege that are embedded in medical education and undermines the ability to deliver an educational experience that has as its core tenets equity and wellness.
Medical schools across the country are trying to establish sustainable efforts to address and mitigate racism and bias. We have had modest success in taking on racism using a change management approach, shifting from problem-solving to cultural transformation. Our Racism and Bias Initiative, co-created with students, has steadily shifted the way we work, teach and learn. We are currently scaling up the RBI framework in a long-term partnership with 11 other medical schools in the U.S. and Canada.
These examples illustrate the value of faculty, staff and students working in close collaboration, the willingness to challenge norms and conventional wisdom, and the importance of cross-cutting measures that address the full range of racism and bias in our learning and work environments: from the personal, to the institutional and the systemic. In this way we can begin the lifelong process of dismantling bias and transforming the culture of academic medicine.