Active engagement is what medical training and institutions need to dig their way out of systemic racism, a group argued.
“Such engagement entails rooting out problematic behaviors and norms, challenging discriminatory policies, and dismantling racist power structures and institutions,” Hisham Yousif, MD, of Mount Sinai Hospital in New York City, and colleagues wrote in a New England Journal of Medicine “Perspective” article.
The three main places to start are adequate representation, increased power and influence, and the transfer of institutional wealth and resources, they suggested.
Some of the “low-hanging fruit” is boosting the minority trainee pipeline through active presence at historically Black medical schools and even undergraduate institutions where there’s a lot of Black talent, Yousif told MedPage Today.
“I trained at Johns Hopkins Hospital, and the city is low-60% Black but I was one of the few Black people in my training program,” he said, and that’s similar across the most prestigious programs: “Those places which are arguably some of the most excellent places to train or be faculty aren’t doing great. You’re locking Black talent out of places of excellence.”
Other not-so-difficult solutions include shifting to panel interviews to reduce bias in hiring, implicit bias training for faculty and trainees, and requiring that committees maintain a certain level of minority representation, Yousif suggested. “This should have been done years ago.”
More complex, but still key, is financial commitment, the group argued, outlining some strategies:
- Create strategic funds to hire Black faculty and equip them with startup packages for career acceleration
- Offer loan-repayment programs to ease the disproportionate financial burden on Black faculty members
- Protect Black faculty from or compensate them for participation in coalitions and groups to foster diversity
Training programs have a responsibility to create a welcoming environment “by addressing racism in all its forms, from insidious microaggressions to overt acts of racism,” his group wrote.
Ironically, Yousif’s own institution was recently called out for “digital blackface”: using Zoom filters to change trainers’ faces and voices to simulate diverse patients rather than hiring minority patient actors to fill those roles.
While Yousif declined to comment specifically on Mount Sinai’s apparent misstep, he said that greater actual diversity can head off insensitive actions in general. “It is important to have folks who have different lived experiences and understand how something is perceived — whether a virtual face may look like blackface and be offensive,” he said. “A Black person is probably more acutely aware of that history than a typical white person.”
Institutions could also be held accountable by accreditation bodies to publicly report disaggregated data on recruitment, retention, tenure, promotion, and salary levels for Black trainees and faculty in comparison with their white peers, Yousif’s group suggested.
“An internal diagnostic — that’s not challenging to do,” Yousif told MedPage Today. “The work needs to be done.”
Physicians can also take their own internal diagnostics, looking at the places where they work and their home life, he said. “Think about how exclusive our personal circles really are and how that deprives people from expanding their worldview. And think about how that translates to the professional setting.”