UB School of Medicine implements anti-racism as a core tenet of its curriculum

Thu February 24, 2022 7:00 PM

Curriculum changes affect all aspects of medical education, spurred by demands from Jacobs School student leaders

By University at Buffalo

A new medical program focused on anti-racism is being designed and implemented at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences.

Catalyzed in 2020 by the COVID-19 pandemic, as well as the murder of George Floyd and the ensuing global protests, the evolving new curriculum is the result of the profound awareness these events have imposed on those who study and practice medicine.

“I have never seen so much willingness to change,” observed Margarita Dubocovich, Ph.D., senior associate dean for diversity and inclusion, and one of the four co-chairs of the Diversity, Inclusion and Learning Environment Committee. “Now is the time. This is the opportunity.”

Although issues such as the social determinants of health have been part of the Jacobs School’s orientation and required coursework, it was a student-written document and petition submitted in June 2020 that launched the overall efforts. currently in progress.

student petition

“The student petition changed urgency,” recalled Linda Pessar, MD, former director of the Center for Medical Humanities and now professor emeritus of psychiatry. “He demanded that the medical school rapidly increase its attention to structural racism and social justice, to examine the ways the curriculum creates and perpetuates racism by failing to take into account the differences between people.”

Former Dean Michael E. Cain, MD, called for the requested changes to be expedited. Her successor, Allison Brashear, MD, vice president for health sciences and dean of the Jacobs School, who arrived at UB in December 2021, has stepped up her efforts.

“Medical education at Jacobs School is undergoing fundamental changes to address structural racism in medicine in an effort initially inspired by our students,” she said. “This fact speaks volumes about the depth of commitment our students bring to this work collectively as they work with faculty to achieve health equity in all aspects of patient care.”

Recommendations included providing racial and socioeconomic context behind long-standing health issues in African American communities and directly acknowledging the effects of systemic racism and the threat of police violence on people’s physical health. of color. They included teaching students how to be effective patient advocates and teaching about the history of anti-darkness, discrimination against LGBTQ+ people and other marginalized communities, and how these issues have affected the medicine and how it is taught.

The petition also aimed to increase faculty and staff diversity, a goal to which the university as a whole has committed through the establishment of President Satish K. Tripathi’s Race Advisory Council. Trustees recognize that such diversity is sorely lacking in medical school, but with this change comes new diversity requirements for search committees and a focus on holistic interviews.

It is well documented that greater diversity among instructors benefits all students and faculty, and that mentorship is essential, a premise taken for granted throughout the medical profession.

Additionally, the school has:

√ Anti-racism training recommended for teachers and lecturers.

√ Committed to protecting students and applicants who speak out against social injustice.

√ Establishment of a crisis/bias advisory response team.

√ Undertake a full case review

The patient cases to which students are exposed, both in the classroom and in the clinic, either with standardized patient volunteers or in the community with preceptors, are a key component of curricular change.

“We look at the full caseload in the curriculum,” said Jennifer Meka, Ph.D., associate dean for medical education and director of the Institute for Medical Education and Education Research at the JacobsSchool.

Professors reviewed and edited cases and discussed ways to encourage students to think about implicit bias and structural racism.

“It’s really a systemic look at the entire program,” said Alan J. Lesse, MD, senior associate dean for the medical program, who along with Meka co-chairs the program’s review subcommittee. .

An early and critical change was the decision in fall 2020 to subscribe to a database that specializes in dermatological manifestations of disease and features a broad spectrum of representation, including many people of color.

Traditionally, most cases involved patients who were white males between the ages of 40 and 55, with no mention of race or economic orientation.

“We are working on guidelines to revise cases to better reflect the diversity of the population our local students will be working with,” Meka said. “The goal is to develop the racial competence, cultural humility and advocacy skills necessary for the practice of medicine, to examine the intersectionality of race and its impact on health and well-being. We also work with our faculty facilitators to move beyond biomedical issues and to speak with patients about the social determinants of health, incorporating respect for other cultures.

More diverse “standardized” patients

The Clinical Practice of Medicine course, which students take during their first two years, is a key focus. It relies on community volunteers who are trained to act as “standardized” patients with specific medical symptoms, which are then diagnosed by medical students.

“Most standardized patients are white,” said Class of 2024 member Tatiana Amaye-Obu. never had a standardized non-white patient.”

Diversifying this pool of standardized patients will be difficult. “Minority communities are already wary of medicine,” Amaye-Obu said. “So to improve that, we have to go out into the community and really explain what we’re doing. That’s the whole point of making standardized patients: taking care of others in the future.

To that end, the school introduced the Neighborhood Health course in 2018 as a pilot elective course.

The course pairs medical students with congregational members from Hopewell Baptist Church in Buffalo. The objective of the course is for students to become familiar with the realities of medical disparities and how they affect individuals.

“The intent of the course was to explore the effect of racism on the black community and to engage with the African American community,” said David Milling, MD, senior associate dean for medical education, who has founded the course with Pessar and Henry-Louis Taylor Jr., Ph.D., professor of urban and regional planning in the School of Architecture and Planning and director of UB’s Center for Urban Studies. “It didn’t have much to do with us providing care, but more about listening to the community, finding out what the barriers are to providing care, and how can we be better doctors.”

The course has now expanded to include a clinical component, blending what students learn in the classroom with culturally sensitive interviews as they work with clinical preceptors in underserved communities.

Instructors throughout the school have integrated anti-racism into their courses, not only for those pursuing medical studies, but also for those pursuing undergraduate and graduate programs in the biomedical sciences.

Jennifer Surtees, Ph.D., associate professor of biochemistry, and David Dietz, Ph.D., chair of the department of pharmacology and toxicology, explicitly integrated anti-racism into their ethics course, introductory to research Science and Responsible Conduct ( BMS 514LEC). One of the objectives of the class engages students in addressing the attitude still prevalent among some scientists that “we don’t need to discuss this in science.”

Social Justice and Equity Administration Leadership Fellowships

Students urged school administrators to work to ease the burden on students of color who are impacted by structural racism while being key leaders in diversity and inclusion efforts.

These efforts resulted in the creation of the Social Justice and Equity Administration Leadership Fellowships launched last year by the Office of Inclusion and Cultural Enhancement. Funded initially by the Jacobs School Dean’s Office, the scholarships give graduate students in medical and biomedical sciences the opportunity to work on specific projects that address social, educational, or health care inequalities while providing $3,500 each in scholarships, as well as funding for travel expenses. .

Five scholarships were awarded in the first round and topics range from evaluating the course’s impact on neighborhood health and improving vaccine equity in communities of color, to developing a program on the history of racism and ways to improve the learning environment for members of the LGBTQ+ community.

And while the institution has clearly embraced these changes, Lesse noted, they all have yet to fit into the medical curriculum.

“The question is, we have four years right now to turn students into doctors,” Lesse said. “What do they need to learn when?” These changes will make them much more aware of their role as doctors in society.

This is especially true in the compulsory first-year Medicine and Society course, which emphasizes the role of the physician. The course has been redesigned with a greater focus on health inequalities.

James N. Jarvis, MD, clinical professor of pediatrics, who is of Akwesasne Mohawk ancestry and has worked on Native American and Alaska Native child health issues for more than 30 years, spoke to the class.

He told students, “You can’t just say to indigenous groups, ‘We’re here to help you, that’s what we think you should do.’ Instead, you need to spend time with them. Ask them what they think. Sit down with these communities. Be humble and listen.

These principles, which have become an integral part of the Jacobs School curriculum, will benefit not only individual students in training, but also, by extension, any communities where they eventually practice.

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