Medicine is not Immune to Racism: A Call for Us to Act According to Research at the Society of Behavioral Medicine's 42nd Annual Meeting & Scientific Sessions

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Not all medical students hold a clear understanding of “race-based medicine” and its role in medicine, new research suggests.

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54.8% of participants agreed that race should be considered a risk factor in diseases and 46.8% agreed race should be considered when diagnosing patients.

Study findings have implications for the future of medical education.

Not all medical students hold a clear understanding of “race-based medicine” and its role in medicine, new research suggests.

The research is being presented at the virtual conference of the Society of Behavioral Medicine’s (SBM’s) 42nd Annual Meeting & Scientific Sessions.

Researchers examined 438 medical students’ knowledge, attitudes, and experiences with “race-based medicine’” via an electronic, anonymous survey. They found 50.5% of participating students had heard of the term “race-based medicine,” with participants self-identifying as racial minorities more likely to than their White counterparts. Of the participants who heard of the term, only 42.5% understood the true meaning of “race-based medicine.”

As defined by Dorothy Roberts in 20081, “race-based medicine‘ refers to the use of racial or ethnic groups as a means of diagnosing and treating patients. Lead author, Morgan Jivens, OMS-IV writes, “In medical education, race tends to be portrayed as a biological factor, instead of a social construct. Race is self-identified and therefore cannot be biologically based. By using race as a biological factor in medicine, research, and education, we are continuing to create bias in medical systems.”

Participants described several examples of “race-based medicine” in their education. Specific examples frequently included references to hypertension medication and screening for sickle cell, sarcoidosis, lupus, and type 2 diabetes. Of concern, 54.8% of participants agreed that race should be considered a risk factor in diseases and 46.8% agreed race should be considered when diagnosing patients. Participants self-identifying as racial minorities were more likely to disagree with the use of race as a risk factor or for diagnosis as compared to White participants.

“I want professors and physicians to think about what they are teaching,” says researcher Morgan Jivens, OMS-IV. “In my personal experience, when I questioned a lecturer or physician on the basis of their statement about race, or how the statistical analysis takes into consideration race, they do not have the answers. For me, this shows as medical professionals we are not critically thinking about the information we are being taught or teaching. We need to know what we are teaching, where it came from, and if the research was done correctly when influencing future physicians. Medical school is the foundation from where we learn everything about patient care.”

This descriptive, cross-sectional survey study is the first of its kind to explore medical students’ understanding of “race-based medicine.” In the last year, numerous organizations released statements opposing “race-based medicine”, including the American Medical Association and the American Academy of Family Physicians. Other organizations and scientific journals, such as the Lancet, argued for anti-racist policies to work towards racial equity in patient care and research.

“As this kind of research is the first of its kind, this data will be a type of steppingstone for other researchers looking to increase awareness of not only racial biases found in medicine, but to garner an understanding of how the teaching of ‘race-based medicine’ to medical students can have a large impact,” says author Ifeoma Okafor, OMS-IV. She continues, “I feel that 2020, for some, was a year of introspection and reflection into many of our current practices all across the board, not excluding medicine. Now, we as a nation have had to have hard conversations especially within the medical community and are digging into the question why. Hopefully, this research opens up many more conversations about how race is taught in medical education.”

This study highlights the need to define and combat “race-based medicine” in medical education, medicine, and research. As noted by their faculty mentor, Elizabeth A. Beverly, PhD, “Had I not conducted this research study with these two amazing future physicians, Morgan Jivens and Ifeoma Okafor, I would not have learned perhaps the greatest lesson of my career to date. Change must start with me integrating anti-racist pedagogy in my teaching and research to combat racism in medicine. Then, collectively, as a society must denounce ‘race-based medicine’ and adopt a ‘race-conscious’ approach that defines race as a social and power construct that can be addressed through research on structural racism and medical care that provides support to overcome the barriers of structural racism.”

The research will be presented in an on-demand format at the virtual SBM Annual Meeting. The research team will be available for questions at 5:00 p.m. every evening during the designated on-demand time.

Research was supported by the Ohio University Heritage College of Osteopathic Medicine and the Osteopathic Heritage Foundation Ralph S. Licklider, D.O. Endowed Faculty Fellow in Behavioral Diabetes awarded to Elizabeth A. Beverly, PhD, corresponding author.

About Ohio University Heritage College of Osteopathic Medicine (OU-HCOM)

OU-HCOM: Created by the Ohio Legislature in 1975, OU-HCOM has built a national reputation as a model for primary care medical education. OU-HCOM carries a single mission: to improve healthcare in Ohio's rural and underserved areas. The school graduates the highest percentage of primary care doctors of any medical school in Ohio. The college is accredited by the American Osteopathic Association, is one of 37 osteopathic medical schools in the United States and is the only osteopathic program in Ohio. About 52% of the practicing graduates serve as primary care providers in general/family practice, general internal medicine or general pediatrics. Sixty percent of graduates practice in Ohio. OU-HCOM opened extension campuses in Dublin, Ohio in 2014 and Cleveland, Ohio in 2015, making OU-HCOM the largest medical school in the state with 240 students per class year. These additional campuses have established partnerships with two large healthcare systems, OhioHealth and the Cleveland Clinic.

About SBM

The Society of Behavioral Medicine (SBM) is a 2,400-member organization of scientific researchers, clinicians and educators. They study interactions among behavior, biology and the environment, and translate findings into interventions that improve the health and well-being of individuals, families and communities (http://www.sbm.org).

References

1.    Roberts DE. Is race-based medicine good for us?: African American approaches to race, biomedicine, and equality. J Law Med Ethics. 2008;36(3):537-545.

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Rebecca Borzon

Karoline Lane
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