Making ‘Good Trouble’: Time for Organized Medicine to Call for Racial Justice in Medical Education and Health Care

Introduction

The article acknowledges the history of racism in medicine, including how medicine centers and normalizes white dominance over people of color in our society. The authors argue that medical doctors, educators, and other leaders must recognize this inevitable truth to actively engage in making organized medicine antiracist.

David A. Acosta is the Chief Diversity Officer for the Association of American Medical Colleges. He is a family medicine physician with a long career in diversity, equity, and inclusion (DEI) leadership. David J. Skorton is the President and Chief Executive Officer of the Association of American Medical Colleges. He is a cardiologist who has served as the President of the University of Iowa and Cornell University. Skorton was previously Secretary of the Smithsonian Institution. One of the priorities throughout his career has been and continues to be diversity, equity, and inclusion (DEI) is one of the key priorities. 

Methods and Findings

This article is a literature review, compiling findings and perspectives on racism, health disparities, and the need for institutional change.  The authors provide an overview of existing knowledge and recommendations based on prior studies and theoretical insights.

This piece outlines four strategies that organized medicine should employ to address racism in their field: 

• Understand, Acknowledge, and Reconcile Medicine’s Racist Past: Medical leaders should hold personal accountability in recognizing implicit and explicit biases that uphold both racial inequalities and inequities, and simultaneously “acknowledge the truth of each organization’s racist past.”. 
• Create and Commit to a Shared Vision for Becoming Equitable, Inclusive, and Anti-Racist Institutions, Organizations, and Societies: Medical organizations should collectively partner to align their visions for racial justice.
• Focus on Building Racial Healing, Trustworthiness, and Relationships with Those Communities that Our Systems Have Impacted the Most: Healthcare providers and institutions should identify aspects of their organizations that perpetuate systemic racism and dismantle policies that discriminate, and introduce policies that address prior discrimination and advance equity.
• Emphasize Transformative Change with Systems-Based Solutions that Impact Multiple Systems
  • Leadership: Organized medicine should elevate strong leaders who prioritize racial justice.
  • Investment: Organized medicine should invest financially and via human capital in diversity, equity, and inclusion (DEI) initiatives, diverse leadership, and data collection efforts to promote and advance racial justice.
  • Accountability: Organized medicine should promote transparency and adopt a Continuous Equity Improvement Model to “[…] collectively design, standardize, and share racial equity and racial justice metrics to assess the effectiveness of interventions implemented, performance trends, and anticipated outcomes.”

Conclusions

The authors end their piece with a resolute call to action: “It is time to be bold, courageous, and take the lead to invoke transformative change utilizing systems-based solutions that will permanently dismantle systemic racism in medical education and health care once and for all.” Strong leadership is critical to exposing racism in healthcare organizations and to implementing antiracist policies and programs in those organizations meaningfully.