Race and Medicine
Race and Medicine
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Disclosures: May reports no relevant financial disclosures.
June 17, 2020
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From words to actions to change: How medicine, academia can respond to racial injustice

Source/Disclosures
Source:


Disclosures: May reports no relevant financial disclosures.
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Racial injustice is in plain view. Most understand and agree what happened to George Floyd was appalling and that Breonna Taylor, Ahmaud Arbery, Michael Brown, Freddie Gray and Eric Garner represent inexcusable police brutality and abuse of power.

But participating in meaningful conversations about these atrocities among colleagues, friends and even family in some cases can feel daunting enough that we opt for silence instead. As a Black woman (and mother, wife and academic) in America, I ask you to put aside your discomfort and welcome these conversations so that these tragedies have purpose — meaningful conversation followed by action is the only way forward.

Fola May quote: Only by breaking the silence on issues of race and racism and shifting from words to action can we move forward as a scientific community.

Don’t shy away

For those in positions of influence in academic medicine, my plea is even more personally directed. Please, we cannot shy away from sensitive conversations about race and racism in the weeks to come. Instead, we must embrace these conversations so that they can be amplified by those who look for examples and signals for how to react and behave.

Discussing the Black Lives Matter Movement, white privilege and discrimination may be extremely uncomfortable. Realize though that just by virtue of the color of our skin, Black Americans face unpleasant interactions and unfair bias in the Ivory towers of academic institutions almost daily (see #blackintheIvory thread on Twitter).

Many of us have been mistaken for hospital janitorial staff despite wearing a long white coat and donning clearly demarcated credentials on our hospital ID badge. Having to overcome a sense of inner turmoil to provide health care for the racist patient that won’t let us touch her despite her emergent state is not uncommon. Most of us have been told by peers or others whom we once respected that we only received an award, position or promotion because we are Black.

We are now asking everyone to bear a bit of our discomfort — these are the teachable moments that will ultimately lead to the betterment of our profession and academic community. We know from experience that, though not easy, these discomforts are merely the growing pains that, in the end, only make us better and stronger.

I feel that many of my colleagues think they are avoiding undue strain on our relationship by not discussing the current racial climate for fear of being clumsy or even offensive. In reality, however, the omission of a stance against racism can be more harmful to the relationship in the long run. There is a problem with silence.

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From words to action

As America faces two deadly and converging crises — racism and COVID-19 — we no longer have the luxury of exercising patience while these two contagions kill Blacks at a faster rate than any other group in America.

We have been dealing with social and civil unrest since Black people were brought to this country over 400 years ago. During the Civil Rights Movement of the 1960s, my grandparents fought against racism and discrimination knowing that if their voices were heard it might lead to slow change over time.

In 2020, the calling is different. Today, the protesters in the streets lament that so little has happened in the past 60 years. We cannot afford to trade human lives for slow change any longer. It is time for us all to recognize the long history of systemic racism in this country and to do something to offset this vicious cycle of gross racial injustice followed by social uprising followed by an eventual return to the status quo.

The protests outside our doors and in our streets are not just about being heard. They are meant to be a catalyst for change here and now.

From activism to agents of change in academia

A medical student from another academic institution contacted me through social media last week. At her medical school, leadership asked the Black students and faculty to design a curriculum to educate non-Black peers about racism in the wake of George Floyd’s death and the ongoing social protests.

I was appalled. Right now, Black Americans “can’t breathe” as they process the raw emotion of repeated injustices against people who resemble them while also grieving the disproportionate impact of COVID-19. Adding to that the responsibility of educating peers on why people like them are disaffected, disenfranchised and abused was unfathomable to me.

It is the responsibility of medical schools and academic institutions to produce “woke” doctors. Institution leaders are obligated to play an active role in identifying platforms to discuss race and locating the resources needed to provide training for all students and faculty on racial injustice, overt and implicit bias, and cultural competency.

In some settings, these resources will come from within; however, there is often the role of involving experts and consultants when needed (see Shut down STEM). While engaging Black students and faculty is critical to the undertaking, Blacks in academia should not bear the weight of both coping with the pain of repeated injustices and fixing the problem.

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The change necessary to eliminate racial injustice in academia and health care requires a multipronged approach. Four specific areas must be addressed: strengthening pipelines for Blacks in science, technology, engineering and math (STEM); increasing representation in leadership; assuring robust mentorship of Black students and early-career faculty in STEM; and improving inequities in health care delivery.

1. Strengthening pipelines to increase workforce diversity:

Blacks are 12.7% of the U.S. population, but only 5% of physicians and a paltry 0.7% to 2.9% of faculty in STEM fields. America has produced fewer than 100 Black females with PhDs in physics.

To change the complexion of academia, academic institutions must affiliate with and support local STEM pipeline programs that engage Black youth in the sciences. In many cases, pipeline programs are the first exposure a Black student will have to STEM careers or physicians and scientists that look like her. It is these interactions in the formative years that will reinforce that a career in science is feasible for them.

As is, Black people (and women and other underrepresented minorities) are more likely to realize an interest in the sciences late in life. Thus, there should be pipeline entry points available early and often along the educational trajectory.

The next step is to assure the effective transition of Black students from the educational pipeline to the workforce. Currently, Black people who pursue STEM fields have substantially lower faculty promotion rates than non-Black faculty, differences that are not necessarily explained by differences in aptitudes. Clearly, we must also critically evaluate and reform admissions, recruitment, hiring, and tenure criteria and practices to remove institutional biases that hinder the elevation of Black students and promotion of early-career Black scientists. In this way we can diversify the pool of health care providers serving our communities and impact health equity.

2. Increasing representation in leadership:

Academia suffers grave disparities in leadership. In U.S. medical schools, only 2% of professors and 3.6% of department chairs are Black. Thus, in addition to the critical task of bringing Blacks into STEM fields, there must be separate strategies to assure diverse representation in leadership roles — and not only as directors of diversity and inclusion but also as deans, division chiefs and department chairs. When there are Black and other underrepresented minority leaders at the table, they provide a unique perspective — the exact perspective necessary to prevent insensitive emails to students and assure fair admissions practices in medical and graduate school programs (see Time to look in the Mirror; Holden Thorpe).

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3. A new approach to mentorship:

Effective mentorship can heavily influence whether a Black student or early-career faculty member remains in science and help combat feelings of isolation and imposter syndrome that plague retention and career advancement. Historically, mentorship in academia has been spontaneous, informal and haphazard.

More recently, medical and graduate schools have instituted more formal mentorship programs in which students are assigned mentors to make sure no one is left to navigate the complicated world of academia alone.

Moving forward, a more structured approach is necessary that includes formal training for mentors and mentees on best practices and frequent reevaluation of career and mentorship goals. Strong mentors should be rewarded financially, with relief from other responsibilities, or by scholarship that benefits promotion. At the same time, mentors who are ineffective should have access to the necessary resources and training to improve mentoring capabilities.

4. Delivery of equitable health care

The COVID-19 pandemic highlights how social determinants of health can contribute to grave race-based differences in health outcomes. We must realize that for all its steeped tradition and conventional wisdom, U.S. health care fundamentally fails to deliver fair and equitable care to Black populations, and in doing, so has imparted the very harm on populations it is sworn to protect.

As someone who has dedicated her career to research in health disparities, I can say confidently that we are a long way from fully understanding and correcting differences in health and health care between Blacks and non-Blacks.

In this time of introspection, conversation, and action planning, academic departments — even beyond public health and social sciences — should increase funding for community-based research and studies that address health care disparities. In addition, resources are necessary to establish task forces, Grand Round series and other platforms to implement anti-racism initiatives and address issues of race and equity in health care.

Accountability for change

What we are witnessing in America right now is the culmination of 400 years of unresolved racial injustice. If we seek the kind of change that heals social wounds, we must critically analyze how Black people are treated in every profession and sector. Today holds hope for those activists of the 1960s — the opportunity to move our country and society forward in a fundamental way.

In academia, we must also step up. We must participate in meaningful conversations about race and engage in the current social movement. It is no longer acceptable to be passive as a non-racist. We must actively be anti-racist to educate, elevate and empower Black people in academia. Deans, chiefs and department heads must use their position of influence to prioritize representation of Black people in STEM, nurture young Black academics and contribute to the fight against health disparities. Only by breaking the silence on issues of race and racism and shifting from words to action can we move forward as a scientific community. The time for formative change is finally here. Whether we make that change is up to us.

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References:

Association of American Medical Colleges. Faculty Roster: US Medical School Faculty. 2019; https://www.aamc.org/data-reports/faculty-institutions/interactive-data/2019-us-medical-school-faculty. Accessed June 15, 2020.
Espinosa LL, et al. Minority Serving Institutions. 2019;doi:10.17226/25257.
Li D, et al. Educational Researcher. 2017;doi:10.3102/0013189X17726535.
National Academy of Sciences. Investing in Interventions that Address Non-Medical, Health-Related Social Needs. 2019;doi:10.17226/25544.

National Academy of Sciences. The Sciences of Effective Mentorship in STEMM. https://www.nap.edu/resource/25568/interactive/index.html#section3. Accessed June 15, 2020.
Nunez-Smith M, et al. Am J Public Health. 2012;doi:10.2105/AJPH.2011.30552.
Valentine Miller J. Physics Today. 2019;doi:10.1063/PT.6.3.20190529a.