Perspectives on Anti-Black Racism at Academic Medical Centers

Intervention for anti-Black racism in academic medicine is urgently needed and will require leadership buy-in and financial commitments from institutions to be developed and implemented effectively according to a recent study published in JAMA Network Open by UPMC and University of Pittsburgh researchers. 

Due to systemic racism, Black faculty and trainees remain underrepresented in academic medicine. While many hospital systems have implemented diversity and inclusion efforts, those efforts have yet to eliminate the unique challenges faced by Black faculty in academic medicine. Though older studies have examined the experiences of underrepresented in medicine (URM) faculty, few have focused on anti-Black racism specifically or considered more contemporary experiences.

Researchers conducted this study using semi-structured interviews with experts to better understand the experiences of anti-Black racism among academic medical faculty and determine what strategies are needed to address those experiences.

Researchers recruited participants from academic medical centers from across the U.S. who are experts in understanding and dismantling anti-Black racism through their lived experience or through professional experience in diversity, equity, and inclusion (DEI) efforts. A total of 16 participants completed the study through an online meeting platform. Interviews were completed between October 2020 and March 2021. 

Barriers Faced by Black Faculty and Trainees and Potential Solutions

Lack of Representation

Several participants described how limited representation within medicine can cause Black students, trainees, and faculty to feel as if they are not allowed to struggle because of the way weakness could be attributed to inferiority based on race. 

“You’re going to be one of a small percentage of Black students in your class. So that initially just sets you up as the other, and often creates a target on the students to feel pressure to stand out, to be better, to be always on top of things, and to not have any mistakes or fail, for fear that they would be singled out even more than they already are. It’s just being the other” (Participant 5). 

Recruitment, Retention, and Promotion of Black Faculty

Participants identified that Black faculty recruitment, retention, and promotion challenges contribute significantly to lack of representation. This includes medical school acceptance policies, different treatment in recruiting versus in practice, and heavily relying on Black faculty to spearhead DEI efforts. Though many participants felt that DEI work is critical, it is believed that the push must come from the top.

Microaggressions and Overt Racism

Interviewees described how Black students, trainees, and faculty are expected to function at a high level while contending with both overt racism and microaggressions. 

“The smaller like microaggressions that we see on a daily basis, those hit almost just as hard right because of the multiple daily insults. It is sad though, that we’ve come to a point where they get ignored on an interprofessional level because it sometimes becomes a little bit exhausting to always be the one to call it out” (Participant 8). 

Recommendations to Dismantle Anti-Black Racism 

Learning Objectives Should Be Comprehensive

Participants emphasized the importance of ensuring faculty have a solid foundation on the history of anti-Black racism and how policies within their institutions lead to disparities. Additionally, practicing anti-racism skills should be treated the same way as learning other parts of clinical medicine. 

“We need to practice with cases and with direct observation — watching people do it the right way and giving them feedback about how it went” (Participant 6).

Intervention Should be Mandatory for All Faculty, With the Exception of Black Faculty

In the same way sexual harassment training is mandatory, anti-racism training should also be mandatory, according to many participants. Participants also highlighted that leadership must be invested and make it known that participation is expected. 

“It is really hard to get faculty members to commit, or learners or anyone to commit when the leaders themselves haven’t done the work” (Participant 8).

Participants had differing opinions about whether Black students and faculty should participate. Some interviewees thought Black faculty could benefit, while others thought it could be more emotionally traumatizing than helpful.

Intervention Should Draw from Outside Expertise

Some participants suggested using the expertise of those both inside and outside academia. 

“It needs to be experiential; it needs to be more than an hour — I would suggest that it’d be more than one session. And that it be run by a diverse group two to three people at minimum, different sex, racial ethnic backgrounds, experiences, because that’s the kind of dynamic teaching that I think has the best chance” (Participant 7).

Structural Change is Needed

Proposed structural changes included promotion of Black faculty to leadership positions, comprehensive review of institutional policies, and accountability for individuals who perpetuate anti-Black racism.

Participants additionally emphasized that the work of developing, implementing, and facilitating an intervention requires monetary resources and time compensation. 

“What you value is what you put your money behind. Any large change requires a capital investment, an investment in people,” (Participant 13).

Discussion and Implications

This study reviews multiple challenges faced by Black faculty and trainees and shows how little progress has been made in the last decade to address the challenges. 

While this study sets a foundation for developing an intervention, next steps for research could include recommendations from experts in other fields, community organizations, and leaders in medicine. 

The detrimental effects of anti-Black racism in academic medicine have been well-documented for more than a decade. Academic medicine has a moral imperative to develop interventions that dismantle anti-Black racism and to uplift Black members of the medical community. 

Reference

Konuthula D, de Abril Cameron F, Jonassaint N, et al. Perspectives on Anti-Black Racism and Mitigation Strategies Among Faculty Experts at Academic Medical Centers. JAMA Netw Open. 2022;5(4):e228534. doi:10.1001/jamanetworkopen.2022.8534

Authors

Dedeepya Konuthula, MD
Resident, PGY-4, Department of Pediatrics and Division of General Internal Medicine

Flor de Abril Gonzalez, MPH
Data Analyst, University of Pittsburgh Center for Research on Health Care Data Center

Naudia Jonassaint, MD, MHS
Vice Chair for Diversity and Inclusion, Department of Medicine
Professor of Medicine, Division of Gastroenterology, Hepatology and Nutrition 

Eloho Ufomata, MD
Assistant Professor of Medicine, Division of General Internal Medicine
University of Pittsburgh School of Medicine Diversity Advisory Council

Orquidia A. Torres, MD, MS
Assistant Professor of Pediatrics, Department of Pediatrics
Director of Medical Student and Resident Education, Division of Adolescent and Young Adult Medicine

Utibe R. Essien, MD, MPH
Assistant Professor of Medicine, Division of General Internal Medicine
Core Investigator, Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System

Megan E. Hamm, PhD
Assistant Professor of Medicine, Division of General Internal Medicine
Director of Qualitative, Evaluation, and Stakeholder Engagement Research Services 

Jessica S. Merlin, MD, PhD, MBA
Associate Professor of Medicine, Division of General Internal Medicine
Director, General Internal Medicine Research Fellowship
Associate Program Director for Research, Internal Medicine Residency

Maya Indira Ragavan, MD, MPH, MS
Assistant Professor of Pediatrics, Division of General Academic Pediatrics