Skip to main content
SpringerLink
Log in

The Propagation of Race and Racial Differences as Biological in Preclinical Education

  • Original Research
  • Published:
Medical Science Educator Aims and scope Submit manuscript

Abstract

Modern scientific research has demonstrated that race is a social construct rather than a biological construct. Yet, medical education research suggests that medical faculty still sometimes characterize race and racial differences as biological during lectures. To explore this dynamic, we reviewed (1) how race is presented in the preclinical curriculum of an undergraduate medical institution and (2) how preclinical faculty both define race and attribute disparate health outcomes to race. In part 1 of the study, the authors conducted a retrospective summative content analysis of all first-year preclinical lectures during the 2018–2019 academic year. In part 2, the authors administered a survey to preclinical faculty on the understanding of race, and responses were assessed through conventional content analysis. A number of faculty suggested a biological basis for racial differences during lectures, though survey results suggested that the majority characterize race as a social construct. Faculty knowledge of race and racial differences as a social construct was not reflected in the majority of the curricular analysis. Instead, the lectures showed that faculty predominantly discussed race without context (e.g., as a standalone epidemiological statistic or an unexplained factor of risk, diagnosis, prognosis, or treatment), or with a biological context. We conclude that there is a discrepancy between preclinical faculty knowledge of race and the presentation of race and racial differences in lectures. This discrepancy has implications on medical education. We offer possible explanations for this discrepancy as well as resources for preclinical faculty development to bridge this gap.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Availability of Data and Material

https://haro.shinyapps.io/RaceMedEd/ for survey results.

Code Availability

Qualtrics, DisplayR, WordArt, shinyapps.io by RStudio.

References

  1. Gould SJ. The mismeasure of man. Rev. and expanded: Norton; 1996.

    Google Scholar 

  2. Morning A. Reconstructing race in science and society: biology textbooks, 1952–2002. Am J Sociol. 2008;114(S1):S106–37. https://doi.org/10.1086/592206.

    Article  Google Scholar 

  3. Roberts DE. Fatal invention: how science, politics, and big business re-create race in the twenty-first century. New Press; 2011.

  4. Power-Hays A, McGann PT. When actions speak louder than words — racism and sickle cell disease. N Engl J Med. 2020;383(20):1902–3. https://doi.org/10.1056/NEJMp2022125.

    Article  Google Scholar 

  5. Schrijver I, Pique L, Graham S, Pearl M, Cherry A, Kharrazi M. The spectrum of CFTR variants in nonwhite cystic fibrosis patients. J Mol Diagn. 2016;18(1):39–50. https://doi.org/10.1016/j.jmoldx.2015.07.005.

    Article  Google Scholar 

  6. Westney GE, Judson MA. Racial and ethnic disparities in sarcoidosis: from genetics to socioeconomics. Clin Chest Med. 2006;27(3):453–62. https://doi.org/10.1016/j.ccm.2006.04.002.

    Article  Google Scholar 

  7. Cappellini M, Fiorelli G. Glucose-6-phosphate dehydrogenase deficiency. Lancet. 2008;371(9606):64–74. https://doi.org/10.1016/S0140-6736(08)60073-2.

    Article  Google Scholar 

  8. Korbet SM, Genchi RM, Borok RZ, Schwartz MM. The racial prevalence of glomerular lesions in nephrotic adults. Am J Kidney Dis. 1996;27(5):647–51. https://doi.org/10.1016/S0272-6386(96)90098-0.

    Article  Google Scholar 

  9. World Health Assembly 59. Sickle-cell anaemia: report by the Secretariat. https://apps.who.int/iris/handle/10665/20890. Published online 2006. Accessed 5 Jun 2021.

  10. CDC. Data & statistics on sickle cell disease | CDC. Centers for Disease Control and Prevention.

  11. Bryc K, Durand EY, Macpherson JM, Reich D, Mountain JL. The genetic ancestry of African Americans, Latinos, and European Americans across the United States. Am J Hum Genet. 2015;96(1):37–53. https://doi.org/10.1016/j.ajhg.2014.11.010.

    Article  Google Scholar 

  12. Vyas DA, Eisenstein LG, Jones DS. Hidden in plain sight — reconsidering the use of race correction in clinical algorithms. Malina D, ed. N Engl J Med. 2020;383(9):874–882. https://doi.org/10.1056/NEJMms2004740.

  13. Centre for Metabolic Bone Diseases U of S UK. FRAX Fracture Risk Assessment Tool. https://www.sheffield.ac.uk/FRAX/index.asp. Accessed 27 Jul 2020.

  14. MDRD GFR equation. MDCalc. https://www.mdcalc.com/mdrd-gfr-equation. Accessed 27 Jul 2020.

  15. ASCVD Risk Estimator +. http://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/. Accessed 27 Jul 2020.

  16. Race. Genome.gov. https://www.genome.gov/genetics-glossary/Race. Accessed 17 Jan 2021.

  17. Du Bois WEB. The souls of black folk. Dover; 1994.

  18. Gossett TF. Race: the history of an idea in America. New ed. Oxford University Press; 1997.

  19. Goodman AH, Heath D, Lindee MS, eds. Genetic nature/culture: anthropology and science beyond the two-culture divide. University of California Press; 2003.

  20. Livingstone FB. Anthropological implications of sickle cell gene distribution in West Africa 1. Am Anthropol. 1958;60(3):533–62. https://doi.org/10.1525/aa.1958.60.3.02a00110.

    Article  Google Scholar 

  21. AAPA statement on race & racism. https://physanth.org/about/position-statements/aapa-statement-race-and-racism-2019/. Accessed 5 Jun 2021.

  22. Tishkoff SA, Kidd KK. Implications of biogeography of human populations for “race” and medicine. Nat Genet. 2004;36(S11):S21–7. https://doi.org/10.1038/ng1438.

    Article  Google Scholar 

  23. Omi M, Winant H. Racial formation in the United States: from the 1960s to the 1990s. 2nd ed. Routledge; 1994.

  24. AAMC releases framework to address and eliminate racism. AAMC. https://www.aamc.org/news-insights/aamc-releases-framework-address-and-eliminate-racism. Accessed 17 Jan 2021.

  25. Amutah C, Greenidge K, Mante A, et al. Misrepresenting race — the role of medical schools in propagating physician bias. Malina D, ed. N Engl J Med. 2021;384(9):872–878. https://doi.org/10.1056/NEJMms2025768.

  26. Tsai Jennifer et al. Race matters? Examining and rethinking race portrayal in preclinical medical education. Acad Med. 2016;91(7):916–20. https://doi.org/10.1097/ACM.0000000000001232.

  27. Goodman AH. Why genes don’t count (for racial differences in health). Am J Public Health. 2000;90(11):1699–702. https://doi.org/10.2105/ajph.90.11.1699.

    Article  Google Scholar 

  28. Hogarth RA. The myth of innate racial differences between white and black people’s bodies: lessons from the 1793 yellow fever epidemic in Philadelphia. Pennsylvania Am J Public Health. 2019;109(10):1339–41. https://doi.org/10.2105/AJPH.2019.305245.

    Article  Google Scholar 

  29. Petersen EE. Racial/ethnic disparities in pregnancy-related deaths — United States, 2007–2016. MMWR Morb Mortal Wkly Rep. 2019;68. https://doi.org/10.15585/mmwr.mm6835a3.

  30. Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci USA. 2016;113(16):4296–301. https://doi.org/10.1073/pnas.1516047113.

    Article  Google Scholar 

  31. National Academies of Sciences E, Division H and M, Practice B on PH and PH, et al. The root causes of health inequity. National Academies Press (US); 2017. https://www.ncbi.nlm.nih.gov/books/NBK425845/. Accessed 29 Jul 2020.

  32. Rothstein R. The color of law: a forgotten history of how our government segregated America. First edition. Liveright Publishing Corporation, a division of W. W. Norton & Company; 2017.

  33. Wildeman C, Wang EA. Mass incarceration, public health, and widening inequality in the USA. Lancet. 2017;389(10077):1464–74. https://doi.org/10.1016/S0140-6736(17)30259-3.

    Article  Google Scholar 

  34. Alang S, McAlpine D, McCreedy E, Hardeman R. Police brutality and black health: setting the agenda for public health scholars. Am J Public Health. 2017;107(5):662–5. https://doi.org/10.2105/AJPH.2017.30369.

    Article  Google Scholar 

  35. Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88. https://doi.org/10.1177/1049732305276687.

    Article  Google Scholar 

  36. Foundational Phase. Georgetown University School of Medicine. https://som.georgetown.edu/curriculum/foundationalphase/. Accessed 5 Jun 2021.

  37. Air of Injustice: African Americans and Power Plant Pollution. Clean Air Task Force. https://www.catf.us/resource/air-of-injustice-african-americans-and-power-plant-pollution/. Accessed 31 Jul 2020.

  38. Tsai J. What role should race play in medicine? Scientific American. https://blogs.scientificamerican.com/voices/what-role-should-race-play-in-medicine/. Published 12 Sep 2018. Accessed 2 Sept 2020.

  39. Brody GH, Chen YF, Murry VM, et al. Perceived discrimination and the adjustment of African American youths: a five-year longitudinal analysis with contextual moderation effects. Child Dev. 2006;77(5):1170–89. https://doi.org/10.1111/j.1467-8624.2006.00927.x.

    Article  Google Scholar 

  40. New AMA policies recognize race as a social, not biological, construct. American Medical Association. https://www.ama-assn.org/press-center/press-releases/new-ama-policies-recognize-race-social-not-biological-construct. Accessed 17 Jan 2021.

  41. Morning A, Brückner H, Nelson A. Socially desirable reporting and the expression of biological concepts or race. Du Bois Rev. 2019;16(2):439–55. https://doi.org/10.1017/S1742058X1900019.

    Article  Google Scholar 

  42. Racial Justice Committee for Change. Georgetown University Medical Center. https://gumc.georgetown.edu/racial-justice-committee-for-change/. Accessed 5 Jun 2021.

  43. 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.

    Article  Google Scholar 

  44. Mosley MP, Tasfia N, Serna K, Camacho-Rivera M, Frye V. Thinking with two brains: student perspectives on the presentation of race in pre-clinical medical education. Med Educ. 2021;55(5):595–603. https://doi.org/10.1111/medu.14443.

    Article  Google Scholar 

  45. Braun L, Saunders B. Avoiding racial essentialism in medical science curricula. AMA J Ethics. 2017;19(6):518–27. https://doi.org/10.1001/journalofethics.2017.19.6.peer1-1706.

    Article  Google Scholar 

  46. Acosta D, Ackerman-Barger K. Breaking the silence: time to talk about race and racism. Acad Med. 2017;92(3):285–8. https://doi.org/10.1097/ACM.0000000000001416.

    Article  Google Scholar 

  47. Afolabi T, Borowsky HM, Cordero DM, et al. Student-led efforts to advance anti-racist medical education. Acad Med. 2021;96(6):802–7. https://doi.org/10.1097/ACM.0000000000004043.

    Article  Google Scholar 

  48. Focus Area 3: Learning Environment | UCSF School of Medicine. https://medschool.ucsf.edu/differences-matter/action-groups/focus-area-3. Accessed 5 Jun 2021.

  49. The Upstate Bias Checklist. Amy E. Caruso Brown. https://aecarusobrown.com/the-upstate-bias-checklist/. Published 8 Mar 2021. Accessed 1 Oct 2021.

  50. Petersen EE, Davis NL, Goodman D, et al. Racial/ethnic disparities in pregnancy-related deaths — United States, 2007–2016. MMWR Morb Mortal Wkly Rep. 2019;68(35):762–5. https://doi.org/10.15585/mmwr.mm6835a3.

    Article  Google Scholar 

  51. Inclusive & Bias-Free Curriculum Checklist. https://www.feinberg.northwestern.edu/md-education/learning-environment/checklist.html. Accessed 17 Jan 2021.

  52. Tsai J, Crawford-Roberts A. A call for critical race theory in medical education. Acad Med. 2017;92(8):1072–3. https://doi.org/10.1097/ACM.0000000000001810.

    Article  Google Scholar 

  53. Metzl JM, Hansen H. Structural competency: theorizing a new medical engagement with stigma and inequality. Soc Sci Med. 2014;103:126–33. https://doi.org/10.1016/j.socscimed.2013.06.032.

    Article  Google Scholar 

Download references

Acknowledgements

May-Lorie Saint Laurent and Dean Carrie Chen at Georgetown University School of Medicine are acknowledged.

Author information

Authors and Affiliations

  1. Georgetown University School of Medicine, Washington, D.C, USA

    Zara Ibrahim, Claire Brown, Brendan Crow & Hailey Roumimper

  2. Family Medicine Academic Department, Georgetown University School of Medicine, Washington, D.C, USA

    Sarah Kureshi

Authors
  1. Zara Ibrahim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Claire Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brendan Crow
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hailey Roumimper
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sarah Kureshi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Zara Ibrahim, Claire Brown, Brendan Crow, Hailey Roumimper, and Sarah Kureshi. The first draft of the manuscript was written by Zara Ibrahim, Claire Brown, Brendan Crow, Hailey Roumimper, and Sarah Kureshi, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sarah Kureshi.

Ethics declarations

Ethics Approval

Project was approved by the Georgetown IRB. IRB Protocol # STUDY00000793: Race in Medical Education.

Consent to Participate

Respondents gave informed consent in accordance with GUSOM’s IRB policies.

Consent for Publication

Yes.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ibrahim, Z., Brown, C., Crow, B. et al. The Propagation of Race and Racial Differences as Biological in Preclinical Education. Med.Sci.Educ. 32, 209–219 (2022). https://doi.org/10.1007/s40670-021-01457-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40670-021-01457-x

Keywords

Search

Navigation