Abstract
Marginalized populations systematically face greater barriers to adequate health care than persons in the majority. These social determinants of health, including socioeconomic status, geographic location, and sociopolitical influences, lead to racial and ethnic health disparities (REHD). In order to reduce these health disparities, institutions of medical education must acknowledge and address REHD in their curricula, policies, and practices. Here, we provide best practices and strategies to guide institutional administrators and curriculum managers in this work. Key opportunities for curriculum managers exist within curriculum design and continuous quality improvement, feedback gathering, and faculty development. Specifically, strategies for integration of diversity, equity, and inclusivity (DEI) topics within the curriculum are reviewed. Regardless of how this goal is achieved, it is imperative that race is consistently presented as a social construct. Additional tools, tables, and checklists provide guidance for assessing DEI topics on course evaluations and delivery of faculty development to promote cultural humility among faculty. The primary role of the institution is to build and maintain a culture of inclusivity through race-conscious leadership and policies that hold all institutional stakeholders accountable. Key components of this process include hiring and retaining a diverse workforce; required DEI training for faculty, staff, and students; zero tolerance programs for micro- and macroaggressions; and annual assessments to identify and address areas of strength and opportunity. Through these practices and strategies, medical education institutions will advance health equity by producing culturally competent and socially conscious providers.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Caruso Brown A. Creating diverse, equitable and inclusive content in health in medical education. IAMSE webcast audio seminar published March 4, 2021. Accessed 10 Dec 2021. https://vimeo.com/519662907
Goyal RK, Dawson CA, Epstein SB, et al. The design and implementation of a longitudinal social medicine curriculum at the University of Vermont’s Larner College of Medicine. BMC Med Educ. 2021;21(131):1–11. https://doi.org/10.1186/s12909-021-02533-x.
Westerhaus M, Finnegan A, Haidar M, Kleinman A, Mukherjee J, Farmer P. The necessity of social medicine in medical education. Acad Med. 2015;90(5):565–8. https://doi.org/10.1097/ACM.0000000000000571.
DallaPiazza M, Ayyala MS, Soto-Greene ML. Empowering future physicians to advocate for health equity: a blueprint for a longitudinal thread in undergraduate medical education. Med Teach. 2020;42(7):806–12. https://doi.org/10.1080/0142159X.2020.1737322.
Finnie SM, Brach RJ, Dawson CA, et al. A new roadmap for social medicine curriculum design based on mixed methods student and faculty evaluations of the preclinical curriculum. BMC Med Educ. 2021;21(442):1–10. https://doi.org/10.1186/s12909-021-02885-4.
Blue A. Cultural competency interviewing case using the ETHNIC mnemonic. MedEdPORTAL. Published online December 2, 2009. https://doi.org/10.15766/mep_2374-8265.155.
Kobylarz F, Heath J, Like R, Granville L. The ETHNICS mnemonic: clinical tool, didactics, and small-group facilitator’s guide. MedEdPORTAL. Published online May 9, 2007. https://doi.org/10.15766/mep_2374-8265.600.
Cené CW, Peek ME, Jacobs E, Horowitz CR. Community-based teaching about health disparities: combining education, scholarship, and community service. J Gen Intern Med. 2010;25 (Suppl 2):130–5. https://doi.org/10.1007/S11606-009-1214-3.
Kutscher E, Boutin-Foster C. Community perspectives in medicine: elective for first-year medical students. MedEdPORTAL. Published online November 11, 2016. https://doi.org/10.15766/mep_2374-8265.10501.
Kasper J, Greene JA, Farmer PE, Jones DS. All health is global health, all medicine is social medicine: integrating the social sciences into the preclinical curriculum. Acad Med. 2016;91(5):628–32. https://doi.org/10.1097/ACM.0000000000001054.
Bakshi S, James A, Hennelly MO, et al. The human rights and social justice scholars program: a collaborative model for preclinical training in social medicine. Ann Glob Health. 2015;81(2):290–7. https://doi.org/10.1016/J.AOGH.2015.04.001.
Coria A, McKelvey TG, Charlton P, Woodworth M, Lahey T. The design of a medical school social justice curriculum. Acad Med. 2013;88(10):1442–9. https://doi.org/10.1097/ACM.0B013E3182A325BE.
Chowkwanyun M. Race is not biology. The Atlantic. Published 2013. Accessed 13 Dec 2021. https://www.theatlantic.com/health/archive/2013/05/race-is-not-biology/276174/
Lewontin RC. The apportionment of human diversity. In: Dobzhansky T, Hecht MK, Steere WC, editors. Evolutionary Biology. Springer; 1972. p. 381–2. https://doi.org/10.1007/978-1-4684-9063-3_14.
Vyas DA, Eisenstein LG, Jones DS. Hidden in plain sight – reconsidering the use of race correction in clinical algorithms. N Engl J Med. 2020;383(9):874–82. https://doi.org/10.1056/NEJMms2004740.
Friedman N. Rules for step 1. Crashing resident blog. Published July 21, 2015. Accessed 31 Dec 2021. https://crashingresident.com/2015/07/21/rules-for-step-1/
Caruso Brown AE, Hobart TR, Botash AS, Germain LJ. Can a checklist ameliorate implicit bias in medical education? Med Educ. 2019;53(5):510. https://doi.org/10.1111/MEDU.13840.
Krishnan A, Rabinowitz M, Ziminsky A, Scott SM, Chretien KC. Addressing race, culture, and structural inequality in medical education: a guide for revising teaching cases. Acad Med. 2019;94(4):550–5. https://doi.org/10.1097/ACM.0000000000002589.
Harden RM. AMEE Guide No. 21: Curriculum mapping: a tool for transparent and authentic teaching and learning. Med Teach. 2009;23(2):123–37. https://doi.org/10.1080/01421590120036547.
Bird EC, Osheroff N, Pettepher CC, Cutrer WB, Carnahan RH. Using small case-based learning groups as a setting for teaching medical students how to provide and receive peer feedback. Med Sci Educ. 2017;27(4):759–65. https://doi.org/10.1007/s40670-017-0461-x.
Devine PG, Forscher PS, Austin AJ, Cox WTL. Long-term reduction in implicit race bias: a prejudice habit-breaking intervention. J Exp Soc Psychol. 2012;48(6):1267–78. https://doi.org/10.1016/J.JESP.2012.06.003.
Carnes M, Devine PG, Isaac C, et al. Promoting institutional change through bias literacy. J Divers High Educ. 2012;5(2):63–77. https://doi.org/10.1037/A0028128.
Lupton KL, O’Sullivan PS. How medical educators can foster equity and inclusion in their teaching: a faculty development workshop series. Acad Med. 2020;95(12 Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments):S71–6. https://doi.org/10.1097/ACM.0000000000003687.
American Osteopathic Association. Accreditation of colleges of osteopathic medicine: COM continuing accreditation standards. Commission on Osteopathic College Accreditation. Published online: 2018. Accessed 1 January 2022. https://osteopathic.org/wp-content/uploads/2018/02/com-continuing-accreditation-standards.pdf
Liaison Committee on Medical Education. LCME functions and structure of a medical school: standards for accreditation of medical education programs leading to the MD degree. Association of American Medical Colleges and American Medical Association. Published online March 2020.
American Medical Association and Association of American Medical Colleges. Advancing Health Equity: A Guide to Language, Narrative and Concepts. Published 2021. Accessed 7 July 2022. ama-assn.org/equity-guide
AACOM Member consensus statement on diversity, equity and inclusion. Published October 2021. Accessed 7 July 2022.
American Osteopathic Association. Accreditation of colleges of osteopathic medicine: COM continuing accreditation standards. Commission on Osteopathic College Accreditation. Published online: 2022. Accessed 1 May 2023. https://osteopathic.org/wp-content/uploads/COCA-2023-COM-Continuing-Standards.pdf
Adjo J, Maybank A, Prakash V. Building inclusive work environments. Pediatrics. 2021;148(Supplement 2):e2021051440E. https://doi.org/10.1542/peds.2021-051440E.
Aysola J, Barg FK, Martinez AB, et al. Perceptions of factors associated with inclusive work and learning environments in health care organizations. JAMA Netw Open. 2018;1(4):e181003. https://doi.org/10.1001/jamanetworkopen.2018.1003.
Goez H, Lai H, Rodger J, Brett-MacLean P, Hillier T. The DISCuSS model: creating connections between community and curriculum – a new lens for curricular development in support of social accountability. Med Teach. 2020;42(9):1058–64. https://doi.org/10.1080/0142159X.2020.1779919.
Person SD, Jordan CG, Allison JJ, et al. Measuring diversity and inclusion in academic medicine. Acad Med. 2015;90(12):1675–83. https://doi.org/10.1097/ACM.0000000000000921.
Gonzaga AMR, Appiah-Pippim J, Onumah CM, Yialamas MA. A framework for inclusive graduate medical education recruitment strategies: Meeting the ACGME standard for a diverse and inclusive workforce. Acad Med. 2020;95(5):710–6. https://doi.org/10.1097/ACM.0000000000003073.
South-Paul JE, Roth L, Davis PK, et al. Building diversity in a complex academic health center. Acad Med. 2013;88(9):1259–64. https://doi.org/10.1097/ACM.0b013e31829e57b0.
Avery D, King E, Milem JF, Acosta D, Plummer D, Clark V. Assessing institutional culture and climate. AAMC Diversity & Inclusion Webcast and Supplemental Guide Published 2013. Accessed 31 Dec 2021. https://www.aamc.org/what-we-do/equity-diversity-inclusion/learning/webinar-assessing-institutional-culture-climate
AAMC Executive committee. Underrepresented in medicine definition. AAMC Diversity and Inclusion. https://www.aamc.org/what-we-do/equity-diversity-inclusion/underrepresented-in-medicine
Roberts LW. Belonging, respectful inclusion, and diversity in medical education. Acad Med. 2020;95(5):661–4. https://doi.org/10.1097/ACM.0000000000003215.
Dogra N, Reitmanova S, Carter-Pokras O. Teaching cultural diversity: current status in U.K., U.S., and Canadian medical schools. J Gen Intern Med. 2010;25(Suppl 2):S164–8. https://doi.org/10.1007/s11606-009-1202-7.
Peña Dolhun E, Muñoz C, Grumbach K. Cross-cultural education in U.S. medical schools: development of an assessment tool. Acad Med. 2003;78(6):615–22. https://doi.org/10.1097/00001888-200306000-00012.
Lanting K, Dogra N, Hendrickx K, Nathan Y, Sim J, Suurmond J. Culturally competent in medical education – European medical teachers’ self-reported preparedness and training needs to teach cultural competence topics and to teach a diverse class. MedEdPublish. 2019;8:98. https://doi.org/10.15694/MEP.2019.000098.1.
Sue DW, Alsaidi S, Awad MN, Glaeser E, Calle CZ, Mendez N. Disarming racial microaggressions: microintervention strategies for targets, White allies, and bystanders. Am Psychol. 2019;74(1):128–42. https://doi.org/10.1037/amp0000296.
Dovidio JF, Gaertner SE, Kawakami K, Hodson G. Why can’t we just get along? Interpersonal biases and interracial distrust. Cult Divers Ethn Minor Psychol. 2002;8(2):88–102. https://doi.org/10.1037/1099-9809.8.2.88.
Pierce C. Offensive mechanisms. In: Barbour FB (ed), The black seventies. Porter Sargent; 1970. p. 265–82.
American Psychological Association. Stress in America: the impact of discrimination. Stress in America Survey. Published online 2016. https://www.apa.org/news/press/releases/stress/2015/impact-of-discrimination.pdf
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Stone, E., Ramos, S., Aragon, K., Linger, R.M.A. (2023). Acknowledging and Addressing REHD in Medical Education: Best Practices and Strategies for Curriculum Managers and Institutions. In: Powell, J.M., Linger, R.M. (eds) Best Practices for Acknowledging and Addressing Racial and Ethnic Health Disparities in Medical Education. IAMSE Manuals. Springer, Cham. https://doi.org/10.1007/978-3-031-31743-9_6
Download citation
DOI: https://doi.org/10.1007/978-3-031-31743-9_6
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-31742-2
Online ISBN: 978-3-031-31743-9
eBook Packages: EducationEducation (R0)