Academic medicine : journal of the Association of American Medical Colleges
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Racism and bias are American medicine's fatal flaw. They permeate clinical practice and biomedical research, and their influence on medical education is even more profound because it is through medical education that racism and bias are perpetuated across generations and throughout history. This insidious influence has persisted despite the stated values of the medical profession and well-intentioned efforts to lessen their impact. ⋯ They also reflect on personal and structural lessons learned during the course of designing and implementing this initiative. Eliminating racism and bias demands that medical educators embrace a change process that is lifelong, people-centered, incremental, and nonlinear. It requires the courage to constantly course correct while never losing sight of the ultimate goal: health care and medical education that are free of racism and bias.
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Structural racism is pervasive in U. S. society, and academic medicine is not immune to the effects of this disease. The social determinants of health have been implicated as the main drivers of health disparities and inequities in society, and racism has been well established as a social determinant of health. ⋯ This work will not be easy, and there will be great resistance to the type of change that is needed. It is time to ask whether the leaders of academic institutions have the will to act and to continue to push forward in the face of opposition. The author is skeptical-because of the scope of the work that needs to be done and because it feels as if society has been here many times before-and, yet, remains optimistic.
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The COVID-19 pandemic has highlighted the limitations of the current health care workforce. As health care workers across the globe have been overwhelmed by the crisis, oversight entities and training programs have sought to loosen regulations to support ongoing care. Notably, however, workforce challenges preceded the current crisis. ⋯ The authors recommend the following: (1) a comprehensive approach to guide health care workforce development, (2) streamlining transitions to the next level of practice, (3) reciprocity among state licensing boards or national licensure, (4) payment reform to support a strengthened health care workforce, and (5) efforts by employers to ensure the ongoing safety and competence of the bolstered workforce. These steps require urgent collaboration among stakeholders commensurate with the acuity of the pandemic. Implemented together, these actions could address not only the novel challenges presented by COVID-19 but also the underlying inadequacies of the health care workforce that must be remedied to create a healthier society.
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Faculty from different racial and ethnic backgrounds developed and piloted an antiracism curriculum initially designed to help medical students work more effectively with patients of color. Learning objectives included developing stronger therapeutic relationships, addressing the effects of structural racism in the lives of patients, and mitigating racism in the medical encounter. ⋯ Medical educators must address racism in medical education before seeking to direct students to address it in medical practice.