Black Lives Matter: Moving from passion to action in academic medical institutions

Introduction

For Americans, the murder of George Floyd marked 2020 as the year of the “racial awakening” in the United States. Largely led by the Black Lives Matter (BLM) movement, protests and calls for racial justice spread across the country and inevitably reached medical institutions too. In collaboration with White Coats for Black Lives—a national medical student-run racial equity organization started in 2014—leaders at academic medical centers (AMCs) across the nation bent the knee in honor of George Floyd and made public denunciations against racism. The authors raised an important question—are these actions enough? 

They are not. The authors provide evidence to argue the imperative that AMCs move past empty platitudes and move toward specific and sustainable action that promotes racial equity. Mary T. Bassett reminds us of three avenues for action that must be considered, “critical research, internal reform, and public advocacy”. These pathways for action also include recognizing the painful past of medical institutions, such as the American Medical Association’s (AMA) sponsoring of the Flexner report that led to the closure of 5 of 7 historically Black medical schools. Even more, the call for action calls for interrogating the teaching of systemic racism in medical school curriculums while also uplifting the concerns and solutions of the marginalized communities surrounding AMCs. Only through intentional, action-oriented, and local community-led change by AMC leadership can medical centers truly improve the conditions of Black communities and Black, Indigenous, People of Color (BIPOC) healthcare workers. 

This piece was written by Bich-May Nguyen, Jessica Guh, and Brandi Freeman. Bich-May Nguyen is a clinical associate professor in the Department of Health Systems and Population Health Sciences for the Tilman J. Fertitta Family College of Medicine at the University of Houston. Jessica Guh is the site director and associate program director at Cherry Hill family medicine residency in Seattle, WA. Brandi Freeman is an associate professor of general pediatrics and Associate Vice Chair for Diversity, Equity, and Inclusion at the University of Colorado School of Medicine. 

Methods and Findings

Ultimately,  the authors highlight the following ways to promote equity in AMCs:  

Focus on Culture 

Create an inclusive culture in AMCs that treats antiracism training as a moral imperative at all levels of training– including medical students, residency trainees, fellows, attendings (senior physicians), and staff– to ensure that medical professionals are better equipped to respond to instances of racism. For example, if microaggressions are made, there should be training at all levels on how to respond and support the person on the receiving end of such aggression. Additionally, accountability standards that hold educators responsible for acts of racism within the classroom is essential to create systemic changes in academic medicine. Problematic teaching must have clear consequences regardless of academic stature. 

It is also important to examine the ways race and racism permeate clinical training and patient care. Race is still used in the clinical setting to justify clinical examination, like kidney function, despite growing common knowledge that race is a sociopolitical construct– not a biological one. Researchers, practitioners, and educators within AMCs must provide more clarity when using race (i.e., how much melanin one has, weathering impacts of racism, birth in a region with high disease prevalence). 

Focus on People 

It is essential for AMCs to increase the diversity of their physician workforce because it has several implications for care accessibility and care quality for racially minoritized patients. Studies have shown that ethnic/racial concordance (when physician and patient are the same race) leads to improved health outcomes (cardiovascular procedures, diagnostic colon procedures, lung cancer treatment, etc.).

To increase diversity within the AMC context, the authors make the following suggestions: 

At the medical student level—

• Increase recruitment and retention of BIPOC students 
• Develop curriculum that focuses on increasing the number of physicians in primary care and medically underserved areas
• Deprioritize standardized tests in medical school admissions 
• Use blind academic information (i.e. Medical College Admission Test (MCAT) scores and grades) prior to interviews for medical school so that personal characteristics and leadership skills have equal weight  
• Change admission rubrics so that life experiences and personal qualities have equal weight for medical school admission 
• Standardize the medical school interview scoring system so it is less biased 

At the medical faculty level—

• Treat research and efforts around diversity, equity, and inclusion (DEI) with the same institutional and financial support the biomedical sciences receive 
• Create academic pathways for promotion for DEI work, including training and support for methodology, teaching skills, and scientific writing 
• Create quality metrics to reach set goals around the aforementioned suggestions  

Focus on Environment 

It is imperative to consider the ways the environment of AMCs is harmful not only to BIPOC people that learn and work within them but also to the communities these institutions seek to serve. Therefore, the authors suggest the following solutions to address how the built environment contributes to medical racism:  

• Examine hallways of AMCs and academic buildings to search for photos, building names, and other symbolic representations of individuals who have caused harm to BIPOC communities.  These photos should be replaced with symbolism that reflects social justice and equity, such as imagery celebrating BIPOC and other minoritized communities.
• The history behind such symbols and the general history of medical racism should be elucidated to bring light to the ways the medical institution has contributed to the systemic harm of BIPOC communities. 
• There should be a clear understanding that the medical institution must earn the trust of communities and communities are not responsible for repairing the harms done by medical institutions.
• AMCs should invest in surrounding communities, like investing funds in initiatives like pipeline programs for students underrepresented in medicine, while also being mindful of the effects of hospital operations, like the potential displacement of local communities due to hospital expansions. 

Conclusions

The authors conclude that words must be followed with action; yet, they also highlight some of the pushback encountered engaging physicians with DEI work. Physicians have proclaimed that the role of the academic medical center is to improve health and not society. Others have argued that awareness of bias/racist actions will not change culture. Yet, the authors refute these arguments by re-emphasizing that conversations about equity are hard, but important. They additionally highlight the fact that medicine cannot and does not exist within silos and must address the social determinants of health to achieve optimal health outcomes for marginalized populations.