Curriculum Reform Guidelines, Books, & Videos

In the wake of medical organizations and institutions wanting to incorporate curricular reform surrounding implicit bias, race in medicine, and race-based medicine, below are a list of guidelines for bias-free/anti-racism curriculums along with book/video suggestions that can be used by medical students from pre-clinical to clinical education and beyond (i.e. residency).

Columbia University’s Guidelines for Promoting a Bias-Free Curriculum

More details available at hyperlink. Summary provided below:

Be inclusive in representations of healthy/normal
- Problem: Not acknowledging that what is deemed “healthy” may not apply universally. For example, healthy gums may be described as “coral pink,” but healthy gums of persons of color may be pigmented.
- Solution: Add additional images of different normal pigmentations across all ethnicities
Be inclusive in representations of pathology
- Problem: Not considering that the clinical presentation of a disease may vary across populations. For example, hyperbilirubinemia is described as jaundiced skin, however, in darker-skinned persons, this clinical finding may be difficult to appreciate
- Solution: Discuss other clinical clues that can used (such as palms and sclera for jaundice). Note: Peau d’orange, which is used to describe dimpled appearance of cutaneous lymphatic edema is an example of a clinical finding that could be universally appreciated
Avoid stereotypes in representations of pathology
- Problem: Using the same case examples in order to illustrate that certain populations are at risk for certain diseases. For example, young patients or MSM are typically used as primary case examples for sexually transmitted diseases.
- Solution: Use a diverse set of case examples to illustrate both the typical populations at risk for certain disease (guided by evidence-based knowledge of population prevalence) while avoiding the impression that ONLY those populations are at risk.
Acknowledge limitations of research
- Problem: There are many studies that disproportionately enroll men or people of Caucasian descent
- Solution: Must disclose if research studies have an underrepresentation of study subject by gender identity, sex, race, and socioeconomic status or other meaningful variable. In addition, examine published data with the knowledge that generalizability is limited and discuss effect or implications of data not representing diverse populations
Explore differences in health outcomes and responses to treatment
- Problem: Relying on genetic or intrinsic differences to explain observed health disparities
- Solution: Must have discussions surrounding what may be driving healthcare disparities, which includes fostering an understanding of how race, socio-economic status, unconscious bias, and other factors impact healthcare – i.e. structural determinants of health
Consider informal attitudes and behavior
- Be aware how informal attitudes and behavior in the educational setting powerfully affect the student experience

University of Washington’s Anti-Racism Curriculum in Public Health

Hagopian A, West KM, Ornelas IJ, Hart AN, Hagedorn J, Spigner C. Adopting an Anti-Racism Public Health Curriculum Competency: The University of Washington Experience. Public Health Rep. 2018;133(4):507‐513. doi:10.1177/0033354918774791

https://journals.sagepub.com/doi/full/10.1177/0033354918774791?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed

Below are guidelines published by the University of Washington’s School of Public Health:

Require accredited courses that addresses racism, public health, police violence, and Black Lives Matter
Develop and document a common language and understanding to create a safe environment to openly discuss race and systems of oppression
Describe the historical context of racial oppression
Explain how racism influences the social determinants of health
Analyze interactions between structural racism and other systems of oppression
Describe the effects of developing insight and deepened awareness of racism and oppression
Recognize students’ roles as agents to address and fight against oppression in their own classroom and programs
Analyze ways in which internalized racism acts as a barrier to health equity
Consider roles in addressing and dismantling racism as public health practitioners
Integrate skills to demonstrate increased capacity to work across diverse cultures, perspectives, and backgrounds
Integrate a racism analysis into student and professional experiences

Below are action items adopted from the University of Washington School of Public Health. Full list can be found in their publication. Items have been removed or edited to better align with changes for pre-clinical and clinical education.

Involve all members of the community in anti-racist workshops
- All current and incoming administrators, faculty, and staff will participate in anti-racist workshops
- Organizations to consider enlisting include The Privilege Institute (https://www.theprivilegeinstitute.com) or Justice Informed (https://www.justiceinformed.com)
Incorporate anti-racist principles in various domains
- Course descriptions
- Student course evaluations
Infuse content on undoing racism in all of our courses:
- Add a question on anti-racism content to course proposal forms
  - Active-learning, student-driven curriculum tends to be more open to this content
- Teach an annual faculty workshop on how to infuse anti-racism content into courses
- Explore ideas such as “anti-racism pathways” or other academic tracks for students
- Adopt core competencies related to anti-racism in the curriculum
- Create a standard syllabus paragraph outlining commitment to anti-racism
Create messaging that establishes a schoolwide shared anti-racism vocabulary:
- Revise mission statement to include anti-racism commitment
- Add an admission essay question that goes beyond asking about diversity challenges:
  - “How will you improve the anti-racism climate in our school?”
Seek opportunities to infuse our work with communities with anti-racism principles:
- Seek more active engagement with explicitly anti-racist community organizations
- Encourage students to seek capstone and thesis opportunities with organizations that advance the status of communities of color and help those students engage with those efforts in responsible ways

Affirming Black Lives in School: Teachers, Administrators, and Students

This google doc lists several resources including books, movies, and videos mainly targeted for grade school, high school, and college students, but using their template, here is a list of medically relevant books and videos.

Books: Use any of the books below as part of onboarding for students, faculty, and staff. In-depth discussions across several months should be incorporated into schedules. Interdisciplinary staff and faculty with expertise in racial justice should be present and moderate the discussions in order to provide historical context. If appropriate, yearly assessments should include questions regarding the reading selection below.

Between the World and Me: Ta-Nehisi Coates

White Fragility: Why It's So Hard for White People to Talk About Racism: Robin DiAngelo

The New Jim Crow: Mass Incarceration in the Age of Colorblindness: Michelle Alexander

How to Be an Antiracist: Ibram X. Kendi

Tears We Cannot Stop: A Sermon to White America: Michael Eric Dyson

The Fire Next Time: James Baldwin

Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present: Harriet A. Washington