Abstract
The majority of approaches used in medical education to teach about health disparities and racism have been applied at the level of undergraduate medical education and taught through the lens of cultural competence. The dearth of curricula that directly address the experience of racism and its impact on access to health care, diagnosis, and treatment is notable. In this chapter, the limitations of using cultural competence training as a proxy for teaching about racism and the surprisingly few efforts to teach about health inequities and racism at the residency level are reviewed and discussed. With this background, the authors describe a recently developed psychiatry residency–level, racism-focused curriculum and propose broader training efforts that are needed. Finally, a more robust approach to teaching race equity than has been systematically implemented at either the undergraduate or residency level of medical education is proposed.
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References
Jones CP. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. 2000;90:1212–5.
Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care; Smedley BD, Stith AY, Nelson AR, editors. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press; 2003. http://www.nationalacademies.org/hmd/Reports/2002/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care.aspx.
Kumagai AK, Lypson ML. Beyond cultural competence: critical consciousness, social justice, and multicultural education. Acad Med J Assoc Am Med. 2009;84:782–7.
Wear D. Insurgent multiculturalism: rethinking how and why we teach culture in medical education. Acad Med. 2003;78(6):549–54.
Wear D, Zaroconi J, Aultman J, Chyatte MR, Kumagai AK. Remembering Freddie Gray: medical education for social justice. Acad Med. 2017;92:312–7.
Department of Health and Human Services, Health Resources and Services Administration. Cultural competence in medical education. 2004.
Kripalani S, Bussey-Jones J, Katz BS, Genao I. A prescription for cultural competence in medical education. J Gen Intern Med. 2006;21:1116–20.
Brach C, Fraserirector I. Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Med Care Res Rev. 2000;57:181–217.
Kleinman A. Clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978;88:251–8.
Cross TL, Bazron BJ, Dennis KW, Isaacs MR. Towards a culturally competent system of care: a monograph on effective services for minority children who are severely emotionally disturbed. Washington, DC: CASSP Technical Assistance Center, Georgetown University Child Development Center; 1989.
Betancourt JR. Cultural competence and medical education: many names, many perspectives, one goal. Acad Med. 2006;81:499–501.
Betancourt JR. Cross-cultural medical education: conceptual approaches and frameworks for evaluation. Acad Med. 2003;78:560–9.
Eiser AR, Ellis G. Viewpoint: cultural competence and the African American experience with health care: the case for specific content in cross-cultural education. Acad Med. 2007;82:176–83.
Beach MC, Price EG, Gary TL, Robinson KA, Aysegul G, Palacio A, Smarth C, Jenckes MW, Feuerstein C, Bass EB, Powe NR, Cooper LA. Cultural competency: a systematic review of health care provider educational interventions. Med Care. 2005;43(4):356–73.
Gregg J, Saha S. Losing culture on the way to competence: the use and misuse of culture in medical education. Acad Med. 2006;81:542–7.
van Ryn M, Hardeman R, Phelan SM, Burgess DJ, Davidio JF, Herrin J, et al. Medical school experiences associated with change in implicit racial bias among 3547 students: a medical student changes study report. J Gen Intern Med. 2015;30:1748–56.
Greenwald AG, McGhee DE, Schwartz JLK. Measuring individual differences in implicit cognition: the implicit association test. J Pers Soc Psychol. 1998;74(6):1464–80.
Brooks KC, Rougas S, George P. When race matters on the wards: talking about racial health disparities and racism in the clinical setting. MedEdPORTAL Publ. 2016:2374–8265. https://doi.org/10.15766/mep_2374-8265.10523.
Bereknyei S, Foran S, Johnson K, Scott A, Miller T, Braddock C III. Stopping discrimination before it starts: the impact of civil rights laws on healthcare disparities—a medical school curriculum. MedEdPORTAL Publ. 2009;5:7740. https://doi.org/10.15766/mep_2374-8265.7740.
Metzl JM, Hansen H. Structural competency: theorizing a new medical engagement with stigma and inequality. Soc Sci Med. 2014;103:126–33.
Culhane-Pera KA, Like RC, Lebensohn-Chialvo P, Loewe R. Multicultural curricula in family practice residencies. Fam Med. 2000;32:167–73.
Zakaria S, Johnson EN, Hayashi JL, Christmas C. Graduate medical education in the Freddie Gray era. N Engl J Med. 2015;373:1998–2000.
United States Census Bureau. QuickFacts, United States. Washington, DC: United States Census Bureau, 2018. https://www.census.gov/quickfacts/table/PST045216/0017.20.
Office of Community Planning and Development. The 2016 annual homeless assessment report (AHAR) to Congress. Washington, DC: US Department of Housing and Urban Development, 2016. https://www.hudexchange.info/resources/documents/2016-AHAR-Part-1.pdf.
Viron M, Bello I, Freudenreich F, Shtasel D. Characteristics of homeless adults with serious mental illness served by a state mental health transitional shelter. Community Ment Health J. 2014;50(5):560–5.
Alexander M. The new Jim Crow: mass incarceration in the age of colorblindness. New York: The New Press; 2010.
Medlock M, Weissman A, Wong SS, Carlo A, Zeng M, Borba C, Curry M, Shtasel D. Racism as a unique social determinant of mental health: development of a didactic curriculum for psychiatry residents. MedEdPORTAL Publ. 2017;13:10618. https://doi.org/10.15766/mep_2374-8265.10618
Acosta D, Ackerman-Barger K. Breaking the silence: time to talk about race and racism. Acad Med. 2017;92(3):285–8.
Singleton GE. Courageous conversations about race: a field guide for achieving equity in schools. 2nd ed. Thousand Oaks: Corwin; 2015.
Holm AL, Rowe Gorosh M, Brady M, White-Perkins D. Recognizing privilege and bias: an interactive exercise to expand health care providers’ personal awareness. Acad Med. 2017;92(3):360–4.
Tervalon M, Murray Garcia J. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J Health Care Poor Underserved. 1998;9(2):117–25.
Hardeman RR, Medina EM, Kozhimannil KB. Structural racism and supporting black lives—the role of health professionals. N Engl J Med. 2016;375(22):2113–5.
Okwerekwu JA. The patient called me ‘colored girl.’ The senior doctor training me said nothing. Stat. April 11, 2016. https://www.statnews.com/2016/04/11/racism-medical-education/.
Nivet MA. Commentary: diversity 3.0: a necessary systems upgrade. Acad Med. 2011;86(12):1487–9.
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Shtasel, D., Carlo, A.D., Trinh, NH.T. (2019). Medical Education and Racism: Where Have We Been and Where Might We Go?. In: Medlock, M., Shtasel, D., Trinh, NH., Williams, D. (eds) Racism and Psychiatry. Current Clinical Psychiatry. Humana Press, Cham. https://doi.org/10.1007/978-3-319-90197-8_11
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DOI: https://doi.org/10.1007/978-3-319-90197-8_11
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