‘Foundational knowledge’: School of Medicine reflects on anti-racist curriculum changes

Gabby Gilmer, a rising second-year medical student, said she believes racism is deeply ingrained in medicine, which is why an anti-racism curriculum is necessary for every future physician.

“We as physicians in training need to be trained to understand our patients, because right now our curriculum trains us to be racist — not directly, but with implicit biases,” Gilmer said. “Removing our blinders and forcing us to see this reality is one tiny baby step to improving.”

This belief is what prompted Gilmer — along with another 97 rising second-year medical students — to sign up for a voluntary book club this summer and read “Medical Apartheid” by Harriet Washington. This book focuses on medical experimentation and other cruelties against Black people by health care providers and how this history impacts medical care today.

The book club is a continuation of an anti-racism curriculum change introduced last year in Clinical Experiences — a required course for all medical students that runs from the beginning of spring semester of the first year through the fall semester of the second year. The anti-racism component was implemented for the first time in January 2020 with two mandatory lectures on health equity for all 147 medical students.

The course is taught by Andrew McCormick, an associate professor of pediatrics in the School of Medicine. McCormick developed this curriculum last fall alongside Dara Mendez, an assistant professor of epidemiology in the Graduate School of Public Health, and Jada Shirriel, the CEO of Healthy Start, a nonprofit focusing on improving maternal and child health.

This curriculum change was adopted months before a list of nearly 20 demands was drafted by medical students Casey Tompkins-Rhoades, Rachel Eleazu and Wheytnie Alexandre, as well as public health student Alexander Schuyler, in early June. The demands vary from scholarships for Black students to additional support staff to reforming school curriculum and policies.

Anantha Shekhar, the senior vice chancellor for health sciences and the school’s dean, agreed to some of the demands, including creating four scholarships, reevaluating the role of the School’s Honor Council and enforcing “serious consequences” for racist behavior.

Mendez said this curriculum adjustment is only one component of the broader changes students are pushing for.

“We have students who have demanded some really important things that should shift our culture, should shift our institution and what we’re doing in this class is a really small piece,” Mendez said. “Especially me as a Black faculty member, these are things we’ve been asking for a long time.”

McCormick said while this curriculum revision is an important first step, it is not nearly enough. He said he hopes to make the book club mandatory next year, as well.

“This is a starting conversation for a long, multiyear curriculum intervention,” McCormick said. “The ultimate goal is to have this be a springboard to larger curriculum changes to other courses in the School of Medicine and have it be not just a first-year intervention, but first-year, second-year, third- and fourth-year continuous dialogue.”

In the American health care system today, Black patients’ health outcomes are markedly worse than white patients. Black people tend to receive lower-quality health services, including for cancer, H.I.V. and cardiovascular disease, as well as prenatal and preventative care. They are also more likely to have unnecessary limb amputations and have more than double the infant mortality rate.

“Medical Apartheid” touches on many of these statistics and how they originated. The first half of the book, which students have discussed thus far, focuses on some historical wrongdoings, including those of James Marion Sims, who’s considered to be the father of modern gynecology, in which he conducted invasive experiments on enslaved Black women, often without anesthesia.

It also describes the Tuskegee syphilis experiment, a federally funded study where hundreds of Black men infected with syphilis were not given penicillin to cure the disease, so researchers could observe its natural course. Pitt’s Public Health building used to be named after Thomas Parran Jr., a former Pitt dean who presided over the Tuskegee and Guatemala syphilis experiments during his time as U.S. surgeon general. The building was renamed two years ago.

Gilmer said she was shocked upon learning this historical context, and is concerned about how many doctors before her never knew about this legacy of mistreatment.

“I was appalled by this history, and I was further appalled by the fact that I am halfway through my pre-clinical experience and I had never heard of any of these things,” Gilmer said. “Thinking of all the doctors who have gone through medical school and likely have never heard any of this — it’s imperative that everyone read it.”

Arnab Ray, a rising second-year medical student who is also in the book club, said participating has been an “eye-opening” experience because it helped him recognize how injustices against Black patients were perpetuated in medicine and how to recognize these biases within himself.

“The author mentions that surgeons didn’t show empathy to Black bodies used for demonstrations in the surgical theater which got passed on to students,” Ray said. “I’ve adopted a lot of views and attitudes about medicine from docs I respect, and with unconscious biases, sometimes you could inherit those values.”

Ray added that the current medical school curriculum doesn’t allow for self-introspection required to get rid of those biases, which is something he hopes will change.

“Just because medicine isn’t participating in what we would now completely condemn as horribly racist, it is more insidious in the forms it is creeping into medicine,” Ray said. “It should be mandatory because it directly plays into the oath we took at the beginning of medical school to learn how to be a supporter and advocate of every patient, no matter what kind of patient.”

McCormick said these biases need to be examined because they impact medical care for many members of the Pittsburgh community and beyond.

“This is foundational knowledge, just as much as learning anatomy and physiology,” McCormick said. “If we are physicians that care about the health of everyone in the community, we need to know how racism is impacting our ability to provide that care.”