Diversity Is Not Enough: Advancing a Framework for Antiracism in Medical Education

Abstract

Medical students, residents, and faculty have begun to examine and grapple with the legacy and persistence of structural racism in academic medicine in the United States. Until recently, the discourse and solutions have largely focused on augmenting diversity across the medical education continuum through increased numbers of learners from groups underrepresented in medicine (UIM). Despite deliberate measures implemented by medical schools, residency programs, academic institutions, and national organizations, meaningful growth in diversity has not been attained. To the contrary, the UIM representation among medical trainees has declined or remained below the representation in the general population. Inequities continue to be observed in multiple domains of medical education, including grading, admission to honor societies, and extracurricular obligations. These inequities, alongside learners’ experiences and calls for action, led the authors to conclude that augmenting diversity is necessary but insufficient to achieve equity in the learning environment. In this article, the authors advance a 4-step framework, built on established principles and practices of antiracism, to dismantle structural racism in medical education. They ground each step of the framework in the concepts and skills familiar to medical educators. By drawing parallels with clinical reasoning, medical error, continuous quality improvement, the growth mindset, and adaptive expertise, the authors show how learners, faculty, and academic leaders can implement the framework’s 4 steps—see, name, understand, and act—to shift the paradigm from a goal of diversity to a stance of antiracism in medical education.

A Qualitative Description of Resident Physicians’ Understanding of Child Maltreatment: Impacts, Recognition, and Response

“…Resident education should be sure to involve discussion of CPS contributions toward the disproportionate number of children who are in foster care and from equity-deserving communities. This cannot be achieved without residents being trained on anti-racism, including anti-Indigenous and anti-Black racism, and should be approached in partnership with people from affected communities [ 75 , 76 ].…”

Does Mistreatment and Perceived Stress Impact Career Choice for LGBTQ+ US Medical Students?: An Analysis of AAMC Data

“…Another way to address differences in experiences of heterosexual students compared with their sexual minority peers is expanding and adapting preexisting frameworks proposed for advancing antiracist initiatives in medical school toward initiatives for LGBTQ+ students. For example, there is the 4-step framework proposed by Solomon et al 24 of See, Name, Understand, Act, in which we can see from the results of this study that there are differences in medical school experience for LGBTQ+ students, we name that this is a result of years of bias and homophobia in society, but we must continue to do the work to understand and act.…”

Perspectives on Anti-Black Racism and Mitigation Strategies Among Faculty Experts at Academic Medical Centers

“…[20][21][22] This gap in the literature is particularly important in light of increased institutional awareness of the need to support diversity, equity, and inclusion (DEI) efforts. [23][24][25][26][27][28][29] Additionally, while studies of implicit and explicit bias training exist, we are not aware of any comprehensive interventions or curricula for faculty that target the many facets and effects of anti-Black racism in AM. [30][31][32][33] Furthermore, little has been published on how leaders in the field of anti-Black racism envision an antiracist intervention for AM.…”