Race and Medicine
Race and Medicine
August 03, 2020
3 min read
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Q&A: ‘Stop the line’ practice needed to end systemic racism in academia

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Structural racism has been observed in many parts of society including local communities, health care settings and academia and academic medicine.

Nature Reviews: Gastroenterology and Hepatology published an article on how academia should respond to racism and described the framework for the anti-racism action plan. Healio Gastroenterology spoke with Darrell M. Gray II, MD, MPH, associate professor at The Ohio State University Medical center, to discuss how academia can end structural racism with an anti-racism action plan.

Gray offers the 'stop the line' approach as a way to end structural racism in academia and academic medicine.

Healio: Can you describe the systemic racism seen in academia and academic medicine?

Gray: Systemic racism is pervasive in our society, in our local communities and not surprisingly in our health care delivery and science. It impacts how learners (including medical students, residents, fellows, faculty, nurses, and staff) are educated, how and what research is conducted, and how patients, their families, and the healthcare workforce are treated. It also rears its ugly head in practices (such as hiring, promotion, and grading), policies, funding allocation and engagement with and in communities. Unfortunately, all of this culminates in poor health outcomes among those whom we should be aiming to serve and provide equitable, high-quality care.

Healio: How can institutions ends systemic racism?

Gray: There is an old saying: ‘No money, no mission.’ Institutions must put dollars behind efforts such as anti-racism action to support and sustain them. Without a financial investment, there is no real commitment to becoming anti-racist at their core.

Institutions should also transform the education and engagement of learners in a manner that goes beyond implicit bias training and computer-based learnings on cultural competence and diversity and inclusion. These are important and needed, but alone they do not adequately provide a lens to dismantling structural racism and understanding the downstream impact of structural racism.

Many of our community members, particularly those who live in underserved communities, are most proximal to systemic inequity. It would behoove us to engage them, learn from them and see how we can better care for them.

Another critical strategy is to review policies through an anti-racism lens. Take policies surrounding promotion and tenure, for example. Do they unfairly lead to attrition of some faculty compared to others? Do all faculty have a just opportunity to advance and/or get mentored into leadership positions? What service to the institution and community is looked upon favorably on the promotion dossier and what is not?

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Last, but surely not least, institutions must continually evaluate whether their practices reflect anti-racism being interwoven in the fabric of their mission, vision, and culture. One practice that many institutions have the opportunity to adopt is ‘stop the line’ racism. As a gastroenterologist, before I perform any procedure on a patient, I do what is called a timeout. In the timeout, among other things, I read the patients name, medical record number and date of birth and I describe what procedure I am going to do and why I am going to do it. If at any point during the timeout, anyone in the room hears me say something that is not right they are empowered to stop the line and speak up. Similarly, we need to have ‘stop the line’ for racism practice in which patients, community members, doctors, families, nurses and learners feel empowered to speak when they witness or experience racism. Notably, this is not just for academia. The aforementioned strategies can be applied to private practice medicine or other health care settings.

Healio: Can you explain the framework for the anti-racism action plan?

Gray: Our intent was to create a practical framework that can be adapted across academic medical centers. The main pillars are education and engagement, policies, practices and at the core, funding can support and sustain the work. The way in which we can continuously improve and adequately track out process and learn from mistakes or challenges is to be meticulous with evaluation.

As I reflect on this article and the times in which we live, there is certainly an urgency of now. We are living amidst two pandemics that disproportionally burdened communities of color – COVID-19 and systemic inequity. It is incumbent upon us as health care providers, community advocates and scientists to to leverage this moment for sustained action.