There is evidence of ongoing anti-Black and anti-Indigenous racism in Canadian health care. In 2020, the Toronto Board of Health declared anti-Black racism a public health crisis, acknowledging that race-based health inequities disproportionately affect Black and racialized communities.
Anti-Indigenous racism remains present in Canadian health care, as demonstrated by appalling and tragic events like Joyce Echaquan experiencing in-hospital racism that contributed to her death — and persisting poor health outcomes for Indigenous people.
Some medical educators have urged medical schools to produce physicians who not only represent the communities they serve, but who are also trained to address racism and health inequity. This appeal for more equitable and inclusive medical education is an important part of educating a next generation of medical practitioners, and has been present for years. Yet, as we witness persisting inequities in health care and their harms, a sense of urgency remains.
Need for diverse physician workforce
Researchers highlight that a diverse physician workforce can help decrease health inequities, and that establishing such a workforce requires establishing a just and equitable system of medical training.
In the United States, researchers note that Black, Hispanic and Indigenous students continue to be underrepresented in medical schools, and this underrepresentation has not changed significantly since 2009. In Canada, data regarding diversity in medical education remains scarce.
Avoiding false sense of of progress
In today’s world, if an institution posts a statement declaring that it has become more inclusive while it still preserves discriminatory practices in the background, the false reassurance that the problem has been solved could shut down ongoing conversations around race.
The appearance of an inclusive academic environment could initially attract underrepresented applicants, but in fact give them a false sense of security until they experience discrimination. This, once made public, would lead to an institution not only being known as one that stifles diversity and inclusion, but also as one that is inauthentic.
Profound change in medical education will be visible only after years of sustained effort. Diversity is necessary at all levels in medicine, and attention must be given not just to recruiting a diverse workforce but to retaining and promoting a diverse group of faculty and leaders.
Towards comprehensive solutions
Potential solutions will need to be comprehensive and thoughtful and could include the following:
Institutions must examine themselves deeply and thoroughly. Leaders in medical education need to listen closely to students, faculty and the communities they serve to understand what is truly happening and what has happened in the past in their learning environments. Whatever is found needs to be acknowledged and dealt with so the institution can move forward and improve.
Institutions must actively avoid mismatch between their statements and their actions. Learning about social justice must be paired with the unlearning and undoing of past processes and biases. Adopting an anti-racist framework that includes accountability measures has the potential to help with this.
What meaningful change looks like
Institutions, if they are to achieve it, must have an idea of what meaningful, comprehensive change looks like. In an institution that is truly inclusive there will be:
- Inclusive and localized planning. When forging and implementing equity plans that reflect institutions’ visions, and take into account their legacies and pasts, listening to the lived experiences of current racialized faculty and students matters.
- Accountability. Actions by faculty or students that go against principles of exclusion can be reported and schools are prepared to take counteraction.
- Support for underrepresented students. Students from underrepresented groups will not think twice about applying or attending, as they are guaranteed support and mentorship. Those who are let in through the door must be supported, mentored and promoted for success.
- Curricular change. Students from underrepresented communities see their own communities represented in the cases and images presented in teaching.
- Representative leadership and faculty. Students from underrepresented communities will see themselves in their role models, faculty and leaders at every level.
Meaningful change cannot occur unless the efforts made toward equitable medical education go beyond window dressing. The good news is that authentic changes in structures and practices are possible and an inclusive medical education is an achievable goal.
Superficial efforts that only improve appearances, but actually overlook deeply entrenched systemic racism in medical schools, are only going to set us back.
Author Bio:Mala Joneja is Associate Professor, Division Chair for the Division of Rheumatology, Department of Medicine, at Queen’s University, Ontario