Our Recommendations for Race and

Racism Curriculum Changes

White Coats for Black Lives Twin Cities Chapter
12/9/2019
Why Does This Matter?
There is a growing body of research that demonstrates how racism in medicine continues to perpetuate
health disparities among patients of color
Why Does This Matter to UMN Medical School?

● Minnesota has a problem with racial health disparities. The 2014 MDH report to
the state legislature on health equity notes:
○ African American and American Indian babies die in their first year at twice the rate of white babies
○ American Indian, Hispanic/Latino, and African American youth have the highest rates of obesity
○ African American and Hispanic/Latino women in Minnesota are more likely to be diagnosed with
later-stage breast cancer

● We believe that educating our peers in the matters of racial health justice and
health equity should be a priority at our school
Medical School Diversity Statement
● “An atmosphere where differences are valued leads to the training of a
culturally competent healthcare workforce qualified to meet the needs
of the varied populations we serve.”

● We are not there yet.

Diversity and Climate Expert Panel (DCEP) Report

● Committee formed to review the medical school’s diversity statement, current areas of
success, and identify a climate survey tool (AAMC).
● “To date, there has not yet been a comprehensive and collaborative implementation
of diversity-related initiatives within the Medical School to the same degree as other
leading medical schools. The achievement of such goals requires both conscious and
overt acceptance on the part of Medical School leadership, learners, faculty, and staff;
as well as dedicated funds and other resources.”
● Senior Diversity Officer at the Associate Dean level “We also recommend requiring that
search committees or firms searching for supervisory positions compose a diverse
pool of applicants.”
○ Require all search committees to go through implicit bias training with a focus on
skill-building
Diversity and Climate Expert Panel (DCEP) Recommendations
1. "Work with affiliate hospitals to identify areas of health inequity and bias in clinical
outcomes and a plan to address them."

2. “...implementation of implicit bias training for all levels of the Medical School workforce,
faculty development and curriculum reform for all learners as it relates to developing cultural
awareness and its relationship to working on teams and treating patients."

3. “We must offer educational development opportunities that directly address...Racism,

Implicit Bias and Health Disparities.”
4. “...identify gaps and opportunities in cultural competence content in the curriculum...to
fully address how our curriculum is or is not addressing institutional and structural
inequity, for example racism and sexism.”

5. “Utilize established assessment tools or develop instruments specific to our needs to assess
our climate...climate should be assessed systematically and on an ongoing basis.”
(Reference pages 8-9 in DCEP Report)
The Duluth Experience
● Duluth students have 10 hours of required contact time covering issues in
Native American health embedded in the Foundations of Medicine course
which begins the first year

● The Social and Behavioral Medicine course taught in years 1 and 2 covers
social determinants of health in the curriculum

● There is an optional, 2 year, 22 hour, Seminar on Native Health which covers

structural racism and race in health care more broadly.

● According to the the DCEP report, “this campus was identified as being
ahead of others and a leader when it comes to diversity and inclusion.”
White Coats for Black Lives Survey 2019
● What was in the survey?
○ A series of questions about how race and racism have been discussed and incorporated
throughout the first-year medical education, including the ECM-specific lecture and small
group on Race and Racism

● Why did we make a survey?

○ To gather the opinions of our peers
○ To demonstrate that these issues are important to the rest of our student body
○ To provide data on the support for incorporating more race and racism content throughout the
first-year curriculum
Survey Results
n=93

● ECM small groups have the potential to be a good place to integrate race and racism conversations
into the curriculum, though only 29% of students reported having constructive conversations
● Only 44% of students reported that their facilitator was well-equipped to lead these
conversations
● Students feel ill-prepared to respond to microaggressions when they encounter them on the
wards in years 3 and 4
Survey Results (cont.)

● Only 29% of students

responded “frequently” or “very
frequently” when asked if they
engaged in race and racism
conversations before medical
school
● 73% of students want more
content about race and racism
in the first year curriculum
Survey Results (cont.)
Question: Please describe your experience in small group with your facilitator.

- Positives:
- When peers were open to leaning into discomfort and stretching themselves, they report
getting more from the experience.
- Some facilitators have knowledge, comfort, and confidence discussing and leading a
conversation about race
- “...seemed very well-informed on the topic and provided examples from own career.”
- “Both of our facilitators came well prepared to talk about race and how they think about
their real professions.”
Survey Results (cont.)
- Negative:
- Conversations skirted the issue of race. Students noted that the conversation may have
focused more on socioeconomic factors and health outcomes than the topic of race.
- Conversations/discussion didn’t seem to have a focus or clear objectives
- Facilitators knowledge, comfort, and confidence discussing the subject dictated the tenor
for the small group.
- “I felt as though our facilitator did no preparation to have this conversation”
- “Our facilitator said several things that seemed insensitive to issues of race and
racism in healthcare”
- Peer personal perspectives/bias got in the way of dialogue
- “I don’t really get what this race business is all about”
- Expectation from peers that individuals of an ethnic group speak to and represent their
ethnic identity to the class.
Survey Results (cont.)
Question: Where in our curriculum do you think this content could be integrated?
Please be as specific as possible.

- Skills/scenario practice
- More information/discussion
- Integration into courses
Health Equity Week 2019
- Lunch lectures:
- Native American Health - 58
- Latino Youth Healthcare: Aqui para ti - 73
- Linking Structural Racism and Birth
Outcomes - 75
- Healthcare for the Homeless of Hennepin
County - 99
- Health and Incarceration - 80
- Evening workshop:
- Race, Racism, and Whiteness - 37
Health Equity Week Survey Results (43 responses)
● “clearly...these topics shouldn’t be just lunch lectures, but things that
everyone should be learning and gaining from our curriculum.”
● “I would like to see more of the information from health equity [week]
incorporated into our curriculum”
● “Every week should be Health Equity Week!! The fact that we have a Race
Lecture or one week dedicated to equity reveals some serious gaps in
content and attitudes in our school. Equity is a lens that we should… be able
to apply to every single lecture in our pre-clinical education”
● “I think it’s of absolute necessity that we prioritize open conversations about
this topic within our curriculum to become hyper aware of our
representation of the health care system when in the clinic”
Health Equity Week Survey Results (continued)
“How informed were you on issues of health “How informed are you about health equity after
equity before attending any of the Health Equity Health Equity week?”
week events?
Health Equity Week Survey Results (continued)
“More of the content such as that presented during Health Equity Week should be
incorporated into our first and second year medical school curriculum.”
Course Specific Suggestions - FCT
● Foundations of Clinical Thinking
○ Utilizing race as a lens in some of our cases
○ Differentiating between socioeconomic status and race as a determinant of health outcomes
Course Specific Suggestions - ECM
● Essentials of Clinical Medicine
○ Spend more time discussing race and racism in medicine. One session is not sufficient to
cover the content and ensure that individuals at different stages of thought can benefit from
the conversation.
○ Required training for all ECM facilitators prior to sessions on racism. If facilitators are not able
to complete training, bring in other experts to lead these sessions
○ We could utilize standardized patients in training on how to deal with bias in medicine (i.e.
standardized patient can make biased statement that we would have to respond to)
○ Evenly distribute content of ECM in 1st and 2nd year. In order to make more time for
conversations about racism, social determinants of health, and health equity, we suggest
reducing amount of classes dedicated to Quality Improvement in the first semester of MS1.
○ Making the Harvard Implicit Association Test required before by the small group discussions
Other Specific Suggestions
● Use of race-based medicine:
○ For lectures that discuss race as a factor in medical testing/measurements (PFTs, GFR, etc.),
there needs to be a discussion of where this use of race-based decision-making began. There
needs to be acknowledgement that race is not biological and that differences between races
are arising from racism and other social determinants of health.
■ If professors are not willing or comfortable doing this, we suggest bringing in someone
else for this part of the lecture.
■ MAFP recently passed resolution denouncing use of race-based decision-making in
medicine, and other professional organizations are moving to do so.
● More diversity in patients shown in lectures
○ For example, skin conditions should be shown on a variety of skin colors (throughout lectures,
more than single lecture). Majority of the pictures we have been shown in the 1st and 2nd year
curriculum is on white patients.
Next Steps
● Overall, there needs to be integration of race throughout our curriculum
instead of one or two lectures. We suggest the use of a racial justice lens
throughout all of our courses.
● Look at what other schools are doing. Instead of creating a new curriculum
from scratch, we recommend emulating best practices in institutions that
already have a system in place
● Analyzing the curriculum using AAMC’s Tool for Assessing Cultural
Competence Training in Medical Education
● Utilizing experts/consults
Vice Dean for Diversity, Equity, and Inclusion

● We hope that the Vice Dean for Diversity, Equity, and Inclusion can oversee
curriculum changes around health equity. We suggest adding this to the job
description.
Thank You