Structural racism is so deeply woven into public policies, institutions, beliefs, and cultural norms that we often don’t even recognize it. As an historic and contemporary influence in the health care system, it can create disastrous results for patient care.
History is rife with examples of racism in medicine and they extend into the present day, from the Tuskegee Syphilis Study (1932-1972) to how pain medicine is currently administered. A 2015 study in JAMA looked at 1 million cases of appendicitis in youth under 21 years of age. It found that black patients with severe pain received opioid pain killers significantly less frequently (12 percent) than white patients (33.9 percent). Other research has shown that the reason for the dichotomy may be that doctors believe, as was taught in many medical schools, that black people don’t feel as much pain as white people, or that a black patient will abuse drugs more readily than a white patient. (In reality, the Kaiser Family Foundation found that opioid overdose deaths for white people are 7-fold those for black people.)
Racism has a deep impact on the social determinants of health, like where people live and their education level, yet it is rarely addressed in medical schools.
“Racism is a fundamental cause of racial inequities in health, preventing populations of color from thriving,” says School of Public Health assistant professor Rachel Hardeman. “If our health care system fails to examine racism and structural inequity, it’s missing a critical opportunity to help people.”
Hardeman, with leadership from UMN physician Brooke Cunningham and a multidisciplinary, multi-racial group of professionals, developed and piloted a model half-day curriculum to promote effective dialogues on racism for first-year medical students at the University of Minnesota Medical School.
Their curriculum fits into Essentials of Clinical Medicine, a course that runs throughout the year. It includes a lecture by Cunningham and four exercises: a reflection that explores privilege; a clinical vignette; an exercise aimed at gaining comfort in talking to patients about racism and health; and a fourth exercise related to considering how physicians diagnose and choose treatments based on a patient’s race.
“The long-term goal of work like ours is to cultivate a physician workforce that has a genuine and accurate understanding of how racism has an impact on health and that is able to relate to patients in ways it hasn’t been able to previously,” says Hardeman.
The Model
Currently, the model is for a half-day curriculum for first-year medical students to make them aware of the structural racism inherent in their education and society at large, and how it has an effect on the health of their patients. Students also learn about white privilege. The long-term goal of the curriculum is to have the impact of structural racism a fundamental part of a physician’s working knowledge. Hardeman and Cunningham are continuing to test and build their curriculum to increase it effectiveness.
The Impact
Hardeman and Cunningham are receiving requests from medical organizations around the U.S. who want to adopt or adapt their curriculum for specific contexts and groups. Hardeman is also using elements in her School of Public Health course on structural racism and public health.
