Leaders, faculty and students in
health professions education urge fundamental change in how we train doctors,
nurses and other health care providers
New York, NY—The Josiah Macy Jr. Foundation issued a report today detailing a series of sweeping recommendations aimed at addressing bias and eliminating discrimination in the nation’s medical, nursing and other health professions schools. Among the recommendations—developed by a group of more than 40 health professions education leaders, faculty and students—is the need for mandatory formal health disparities curricula and anti-racism training. Currently, doctors and nurses in training can complete their education without formally learning about how racism and bias harm people’s health and influence providers’ behaviors and choices in providing health care—decisions that perpetuate inequities in society.
The recommendations also call for reforming grading systems to ensure fair and equitable assessments of learners, and instituting a requirement that all health professions schools conduct a self-study of their institutional histories of discrimination, along with other recommendations aimed at creating positive culture and boosting diversity and authentic inclusion in their learning environments.
“Creating the doctors our nation needs will require an overhaul of our entire education system. It is not enough to simply address discrimination when we see it,” said Morehouse School of Medicine President and Dean Valerie Montgomery Rice, MD, FACOG, a member of the report planning committee who also serves on the board of the Macy Foundation. “We need to replace a system that was designed to be unfair with a system that protects, respects and values every person who works, learns or receives care in it.”
Harmful bias and discrimination in health care contribute to unequal care of patients. Black patients are less likely to be prescribed proper pain medication due in part to myths about biological differences between Black and white people—false beliefs held by medical students, residents and others. Black, American Indian and Alaska Native women are more likely to die from complications of pregnancy or childbirth. Among transgender and gender non-conforming people, 50% report having to teach their medical providers about transgender care. The imperative to address harmful bias and discrimination in health care has never been more urgent. As the world battles COVID-19, public health experts fear bias in treatment has contributed to the disproportionately high rate at which the novel coronavirus is killing African Americans and other patients of color.
“We know there is bias in health care, including racism. We know how to address it. Now it’s time to act,” said Yale University School of Nursing Dean Ann Kurth, PhD, RN, CNM, MPH, who served on the report planning committee. “Not only will patient care be better, all our health care professions will be better.”
It’s not just patients who suffer. Health care professionals and students also experience prejudice and discrimination in the learning environment: Studies show that students of color, women and those who are LGBTQ are more likely than other medical school classmates to experience mistreatment during their training.
Discrimination also shapes the way we assess our future health care workforce and limits opportunities for career advancement. While many schools have increased diversity in their classes, there have not been similar increases in diversity in honor societies, selective residency programs and medical specialties. While more women than ever before are enrolled in US medical schools, they remain underrepresented in leadership positions in medical schools and health care delivery organizations.
“As health care leaders and professionals, we have known for a long time that we must do better,” said Holly J. Humphrey, MD, MACP, President of the Josiah Macy Jr. Foundation. “Now is the time not only to acknowledge the racism and inequities in our health care system, but to act.”
The report outlines a series of action steps to ensure our nation’s health professions learning environments—from classrooms to clinical sites to virtual spaces—are diverse, equitable and inclusive of everyone in them, no matter who they are. The action steps span four overarching recommendations:
- Build an institutional culture of fairness and respect by making diversity, equity and inclusion top priorities.
- Develop, assess and improve systems to mitigate harmful biases and eliminate discrimination.
- Integrate equity into health professions curricula, explicitly aiming to mitigate the harmful effects of bias, exclusion, discrimination and all forms of oppression.
- Increase the numbers of health professions students, trainees, faculty and institutional administrators and leaders from historically marginalized and excluded populations.
these recommendations, the Macy Foundation hopes to catalyze change by creating
a sense of belonging for everyone within our health professions learning
environments,” said Humphrey. “Advancing an agenda of equity, diversity
and inclusion within the health professions is central to improving overall health
and well-being for all Americans.”
About the Josiah Macy Jr.
Since 1930, the Josiah Macy Jr. Foundation has worked to improve health care in the United States. Founded by Kate Macy Ladd in memory of her father, prominent businessman Josiah Macy Jr., the Foundation supports projects that broaden and improve health professional education. It is the only national foundation solely dedicated to this mission. Visit the Macy Foundation at macyfoundation.org and follow on Twitter at @macyfoundation.