There is evidence of continued anti-Black and anti-Indigenous racism in health care in Canada. In 2020, the Toronto Board of Health declared anti-black racism a public health crisisrecognizing that race-based health inequalities disproportionately affect Black and racialized communities.
Anti-Indigenous racism remains present in health care in Canada, as evidenced by appalling and tragic events like that of Joyce Echaquan the racism in the hospital that contributed to his death — and the persistence of poor health outcomes for Indigenous peoples.
Read more: As an Indigenous physician, I see the legacy of residential schools and the ongoing racism in health care today
Some medical educators have urged medical schools train physicians who not only represent the communities they serve, but who are also trained to address racism and health inequities. This call for more equitable and inclusive medical education is an important part of training a next generation of practicing physicians and has been present for years. Yet, as we witness persistent inequalities in health care and their harms, a sense of urgency remains.
Need for a diverse medical workforce
The researchers point out that a diverse medical workforce can help reduce health inequities, and that building such a workforce requires establish a fair and equitable system of medical education.
In the United States, researchers note that Black, Hispanic and Indigenous students continue to be underrepresented in medical schoolsand this under-representation has not changed significantly since 2009. In Canada, data on diversity in medical education remains sparse.
Avoid false feelings of progress
In today’s world, if an institution issues a statement stating that it has become more inclusive while still maintaining discriminatory practices in the background, the false assurance that the problem has been resolved could end ongoing conversations about race.
The emergence of an inclusive university environment might initially attract underrepresented applicants, but actually give them a false sense of security until they experience discrimination. This, when made public, would lead to an institution not only being known as an institution that stifles diversity and inclusion, but also as an inauthentic institution.
A profound change in medical education will only be visible after years of sustained effort. Diversity is needed at all levels of medicine, and care must be taken not only to recruit a diverse workforce, but also to retain and promote a diverse group of faculty and leaders.
Towards global solutions
Potential solutions should be comprehensive and thoughtful and could include the following:
Institutions need to examine themselves deeply and minutely. Leaders in medical education need to listen carefully to students, faculty, and the communities they serve to understand what is actually happening and what has happened in the past in their learning environments. Whatever is found must be recognized and addressed so that the institution can move forward and improve.
Institutions should actively avoid discrepancies between their statements and their actions. Learning about social justice must go hand in hand with unlearning and eliminating past processes and biases. Adopt an anti-racism framework that includes accountability measures has the potential to contribute to this.
Read more: 4 ways white people can be responsible for fighting anti-black racism in universities
What Meaningful Change Looks Like
Institutions, if they want to achieve this, need to have some idea of what meaningful and holistic change looks like. In a truly inclusive institution, there will be:
Inclusive and localized planning. When developing and implementing equity plans that reflect institutional visions and consider their heritage and past, it is important to listen to the lived experiences of currently racialized faculty and students.
Responsibility. Actions by faculty or students that go against the principles of exclusion can be reported and schools are prepared to take countermeasures.
Support for underrepresented students. Students from underrepresented groups will not hesitate to apply or participate, as they are guaranteed support and mentorship. Those who are admitted 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, teachers, and leaders at all levels.
Meaningful change can only happen if efforts for equitable medical education go beyond window dressing. The good news is that genuine changes in structures and practices are possible and inclusive medical education is an achievable goal.
Superficial efforts that only improve appearances, but actually overlook the deep-rooted systemic racism in medical school, will only set us back.