Education Columns

by Andrea Westby, MD, Michelle Sherman PhD, Kathryn Justesen, MD, and Jason Ricco, MD, MPH

The University of Minnesota’s North Memorial Family Medicine Residency program is located in North Minneapolis, a vibrant predominantly African American community where decades of structural racism have led to significant inequities. Although our program has a long-standing presence in this community (eg, monthly mentoring program for youth, health advocacy talks by community members), we have not always purposefully addressed systemic racism within the medical system or worked to stop our perpetuation of it. We recognize that racism, both interpersonal and systemic, exists in medicine and negatively affects all of us.

After learning that our residents had experienced and witnessed microaggressions from core and community faculty members, and that residents and patients both experienced and observed discrimination at our partner hospital, we were determined to increase awareness and develop skills to transform our trainee and patient experiences. First, we incorporated a resident-led presentation on racism in medicine into our didactic session, which included presentations on Camara Jones’ Levels of Racism and The Gardner’s Tale, historical implications of race and racism on medical practice and outcomes, implicit/explicit bias, and small group discussions/reflections. Additionally, we obtained a faculty development grant from our academic institution (the University of Minnesota) that allowed us to hire an external consultant to provide a series of workshops to faculty and residents on implicit bias; evaluation of those workshops showed that they were well-received by participants and effective at increasing knowledge of bias and strategies to combat bias, but both faculty and residents expressed a desire for more.¹

As a way to further their learning, a group of 13 faculty and residents participated in a four-session series by the YWCA of Minneapolis, which involved presentations on systemic racism by nationally-recognized speakers followed by small-group facilitated discussions and development of a specific plan to interrupt the default racist systems we encounter. Out of these sessions, our group identified “race-based medicine,” the practice of using race as a proxy for genetics or biology in medicine, as a place where we could deepen our understanding, take responsibility for our role, and potentially effect change.

With this in mind, we are focusing our efforts in two areas: addressing microaggressions and working to eliminate the use of socially-defined race as a biologic marker in our clinical practice. First, we plan to develop concrete, research-based tools to empower our trainees with the ability to perform microinterventions as described by Sue et al (e.g., helpful language to validate victims of microaggressions).² Second, we are making the “invisible” visible by documenting our observed incidents of race-based medicine to identify themes and potential curricular targets. Drawing upon the vast research that argues against equating race as genetic or biological but instead as a social construct or risk marker, we are developing talking points and topic-based tip sheets for the common clinical situations in which race is incorporated into clinical decision-making (eg, GFR calculations, spirometry, ASCVD risk, etc). We are in the beginning phase of this project, but these resources will offer respectful communication tips for how to interrupt the status quo when speaking with other medical professionals.

We aim to cultivate a safe environment in which we can challenge each other’s use of racial descriptors in clinical scenarios while thinking critically about the use of race in medical research and practice. We recognize this is a long-term, challenging endeavor. As we develop these curricular activities, we are committed to incorporating evaluation methods to assess acceptability, feasibility, and impact. We are humble about our ability to impact racism at broad societal levels; however, we are confident that (a) keeping this topic alive in our teaching, research and patient care, (b) continuing our learning, and (c) urging personal reflection and interpersonal accountability will strengthen our program’s ability to confront race-based medicine in North Minneapolis—and prepare our residents to be lifelong advocates for change.

References:

1. Sherman MD, Ricco J, Nelson SC, Nezhad SJ, Prasad S. Implicit Bias Training in a Residency Program: Aiming for Enduring Effects. Fam Med. 2019;51(8):677-681. https://doi.org/10.22454/FamMed.2019.947255.

2. Sue, D, Alsaidi, S, Awad, M, Glaeser, E, Calle, C & Mendez, N (2019). Disarming racial microaggressions: Microintervention strategies for targets, White allies, and bystanders. American Psychologist, 74(1), 128-142.