Moving the Needle on Racial Justice in Medical Education: Updates After the 2021 ADFM Conference Session
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* Michelle Roett
* Damian K. L. Archer
* Archana Kudrimoti
* Sam Elwood

The COVID-19 pandemic exposed major health inequities, particularly for communities of color.1 Many family medicine departments continue to move the needle on racial justice in medical education to advance health equity. Recent examples include training modules on addressing racism in medicine, implicit bias, and racial affinity caucusing to learn about racial health inequities.1-4 The American Association of Medical Colleges (AAMC) published the Foundational Principles of Inclusion Excellence Toolkit to help with assessing climate in institutions or departments, provide tools to spark meaningful discussions with key stakeholders, and suggest priority areas for continuous improvement.5 The Association of Departments of Family Medicine (ADFM) Education Transformation Committee delivered a session “*Moving the Needle on Racial Justice in Medical Education*” in 2021 to provide examples of this ongoing work across the country. This session included representative departments making meaningful progress in changing institutional culture through undergraduate or graduate medical education or faculty development. We asked several of these panelists to provide an update on their ongoing efforts to highlight the leadership role family medicine plays in achieving inclusion excellence in medical education.

## A Commitment to Inclusion Excellence

Since 2018, the University of Kentucky College of Medicine’s institutional and departmental, diversity, equity, and inclusion (DEI) efforts were implemented through COMMITS (College of Medicine Map to Impact through a Transdisciplinary Strategy).6 This led to the appointment of a new Associate Dean of diversity and inclusion. Campus-wide advisory committees and programs, appointment of ambassadors, unconscious bias training, and diversity awareness month and newsletters continue to enhance the cultural climate. Residency program directors are being deliberate and intentional about recruitment and retention of underrepresented groups. This is accomplished by reporting recruitment methods in annual program evaluations. A new Health Equity curriculum was included in residency didactics. Recent curricular changes in medical student education allow students to reflect on how racism affects medical decision making and patients’ experiences in the medical system. During the clerkship, students are taught about racial health disparities and strategies to advocate for marginalized patient populations. As guided by our strategic plan, the Department of Family and Community Medicine established a Diversity, Equity and Inclusion committee which will assist in recruitment of staff/faculty from underrepresented groups. This committee plans to assess the culture of the department by administering annual surveys and increase awareness of campus-wide activities.

## Students Leading the Way

In 2020, Georgetown University Medical Center (GUMC) responded to an open letter signed by more than 500 medical students with 10 requests to improve the culture and climate for minoritized groups in the school of medicine.7 This resulted in standing committees, the Racial Justice Committee for Change and a graduate medical education Working Group for Racial Justice. GUMC assessed culture and climate, chose priority areas, and established subcommittees on well-being and experience, recruitment, retention and success of students and faculty underrepresented in medicine, campus and community engagement, and curricular reform. Each subcommittee set short- and long-term goals with key metrics of success. The results include analysis and feedback on curricular representations of race,8 new antiracism orientation, revised curricula to include more inclusive images, a new longitudinal thread in Health Equity and Advocacy, an anonymous curricular bias reporting tool, and a departmental project to produce DEI strategic plans. The department of family medicine actively participates in institutional efforts, leading several committees, the new orientation, and threads. The department formed a diversity, inclusion, and health equity committee to craft a strategic plan, selected a committee chair and a new director of diversity, equity, and inclusion to focus on priority areas.

## Teaching Antiracism

Tufts University School of Medicine (TUSM) set strategic goals to transform into an antiracist institution and achieve inclusive excellence, including an antiracism standing committee. Using the “four I’s of oppression” framework,9 the committee aims to dismantle racism ideologically, institutionally, interpersonally, and individually. The family medicine department has been actively involved in helping TUSM achieve its strategic goals by implementing a clerkship didactic session that applies the four I’s of oppression framework to addressing racism, bias, and microaggressions in the clinical environment. The meaningful impact of this clerkship’s didactic session is demonstrated by students’ feedback (over 400 students in 2 years), including the need for teaching to be authentic and aligned with antiracist and inclusive teaching principles such as equity, transparency, accountability, and transformation. The Tufts family medicine department has helped to move the TUSM community closer to achieving its strategic goals of transforming into an antiracist institution and achieving inclusive excellence in a measurable way. Working in concert with necessary institutional changes gives hope for broader impact on the TUSM community and permanent cultural change that a didactic session for students alone cannot do.

## Where to Start

As these examples showcase, it is essential for family medicine departments to support institutional efforts to achieve inclusive excellence.2 Understanding institutional culture and climate, barriers, and setting short-term and long-term priority areas may be critical initial steps. The Council of Academic Family Medicine organizations have taken this first step by setting goals for diversity in leadership and faculty.10,11 See what other institutions and family medicine departments are doing by viewing the ADFM Education Transformation Committee’s Social Justice Curricula repository: [https://drive.google.com/drive/folders/1LuSQWfn8kSFKUSBupmhtl9IJdCYVsTGK?usp=sharing](https://drive.google.com/drive/folders/1LuSQWfn8kSFKUSBupmhtl9IJdCYVsTGK?usp=sharing)

*   © 2022 Annals of Family Medicine, Inc.

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