Teaching Critical Race Theory in Medical School
To say that I learned nothing about race in medical school would be false. I learned that race was a risk factor for nearly every disease. I learned that you calculate kidney function differently for Black patients. I learned that if a board exam question mentions a patient’s race, it is probably to clue you in to the right answer. These things were taught to me as scientific facts. Fact: Black children have higher rates of asthma. Fact: Black people have higher rates of obesity. As I rotated through the wards, I saw differentials in the health outcomes and treatment of people of color. These also seemed to be treated as fact. However, compared to the comprehensive understanding of the pathophysiology and treatment of physical disease I had gained, I had little training on the sources and solutions for these ailments. While I could treat hypertension, how was I supposed to understand and address the multitude of issues from poverty to insecure housing that were having such a significant effect on my patients’ health?
Medical education’s attempt at addressing issues of disparity in health has been the development of social determinants of health curricula. At my school, we had a course called “Doctoring” in which we learned about determinants of health, implicit biases and the idea of health equity. But I do not remember ever hearing the word “racism” or “racist” nor was I taught about how the medical field actively takes part in maintaining racist structures. In the absence of this systemic framing, health disparity curricula place the blame on the population reinforcing the racist system by pathologizing marginalized communities. A focus on bias without a larger context can make it seem as though the only issue is interpersonal and ignores larger power differentials and structural prejudice. Though well-meaning, these curricula serve to perpetuate the system but under a veneer of “culturally competent” young physicians.
What we really need in medical training to address race, is Critical Race Theory. At its core, Critical Race Theory (CRT) is the understanding that race is a social construct and that racism is not a relic of the past nor an act by individual perpetrators, but a central feature of society embedded within systems and institutions. CRT curricula in medicine would seek to expose how racism has informed medicine and how medicine has perpetuated racism. Framing health disparities in this larger context would teach physicians to critically evaluate and reject education, research, and practice that frame race as a biologic variable or as essential, instead of focusing on how the system has caused differential health outcomes between races. Ultimately, it would result in a new breed of young physicians. These physicians are not “culturally competent” but “structurally competent”, with a nuanced understanding of intersectionality and the complex interplay of systemic injustice and health. These physicians are equipped not only to better take care of their individual patients but to make the medical field an agent of change.
One difficulty in instituting CRT curricula in medical schools is time. Medical students’ schedules and minds are full of learning the vast amount of biomedical knowledge that they need to be able to treat their future patients. It may seem to students and instructors that this added work is too much and not relevant to medicine. Another concern is that the medical faculty who teach medical students may not have training in this area. Even the physicians who study health disparities may not be equipped to teach CRT. However, the medical field must come to the understanding that being able to recognize and address racism is as central to treating patients as understanding how atherosclerotic plaque forms. It must recognize its own racism and how it has created and continues to support racist systems and ideas. We must acknowledge that in this we are not the experts and that perhaps it is high time the medical community looks outside of its hospitals and laboratories and draws on the expertise of others to educate itself. Clearly, our focus on precision medicine and ever more high-tech procedures, has not been the solution.
The Covid-19 epidemic has brought this issue into unavoidable light. Over the past year and a half, we have watched the virus devastate vulnerable communities, most often communities of color. While initially, we may have been helpless in the face of foe no one understood, as we developed weapons in the form of vaccines and better treatments, we continue to see these weapons inequitably deployed. We have also seen, over the past few years, rising acknowledgment of these issues and activism, including among physicians. We must continue and grow this movement. As part of this, we must equip medical trainees with the knowledge and skills to combat systemic injustice in the same way we train them to combat disease. What understanding the pathophysiology of tumor development is to fighting cancer, Critical Race Theory is to fighting racism. We all want to treat patients equitably. Let’s train ourselves to do so.
Nina Owen-Simon is an MPH student in the Department of Health Policy Management and a resident in the Department of Surgery Education.