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Eva Larkai
Eva Larkai, a fourth-year medical student, leads the student body to demand change
A large UK medical school is leading the drive to eliminate what it calls ‘inherent racism’ in the way doctors in the UK are trained.
The University of Bristol Medical School says urgent action is needed to investigate why learning primarily focuses on how diseases affect white people above all other sections of the population.
It comes after students called for reform, saying holes in their training did not allow them to treat patients with ethnic minorities – potentially compromising patient safety.
Hundreds of other medical students in the UK have signed petitions calling for teaching that better reflects the diversity of the country.
The Medical School Council (led by the heads of UK medical schools) and the regulator, the General Medical Council, say they are putting plans in place to improve the situation.
Meanwhile, a recent draft report from Public Health England suggests that racism may play a part in the increased risk of death from coronavirus, which is being confronted by black, Asian and other minority communities and recommends that work continue to discriminate in the health service packages.
Life-as-death signs
A number of diseases manifest differently, depending on skin tone, but too little attention is paid to this in training, according to Dr. Joseph Hartland, who helps lead changes at the University of Bristol Medical School.
And he says the problem is one that all UK medical schools and the wider NHS share.
“Historical medical education was designed and written by middle-class white men, and so there is an inherent racism in medicine that means it exists to serve white patients above all others,” he said.
When patients are short of breath, students are often taught to look for a constellation of signs – including a blue tint on the lips or fingertips – to help judge how seriously ill someone is, but these signs may look darker otherwise. fel.
“Essentially, we teach students how to recognize a clinical sign of life or death for the most part in white people, and not recognizing these differences can be dangerous,” Dr. Hartland said.
He agreed that there were other words of making the diagnosis, but said teachers should ask why training almost always focuses on signs when they appear in white-skinned people.
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Some studies suggest that black people receive less pain relief than other patients
According to Dr. Hartland, the same problems apply to training on normal skin conditions such as eczema, with students often going through their entire medical school education without seeing examples of how these manifest in people who do not have white skin.
But, he says, the problem goes much deeper than skin conditions.
‘The colonization of the curriculum’
After receiving a letter from cities for reform of black, Asian and other ethnic minority students, the school sent a detailed document to all students, describing measures to colonize ‘the curriculum’.
These include:
- New textbooks demonstrate clinical signs in dark skin along with guidance that all clinical signs, where possible, are presented in both light and dark skin tones
- Investigate the fact that drug trials involve mainly white, male participants, and see how this can lead to incorrect and harmful prescribing for other patients
- Learn about the history of medicine, including the explosion of people of color in scientific research
- Training on discussing unconscious bias and helping students and staff to report and deal with racism with more confidence
- Establishing an anti-racism task force to promote an environment that is active against racism
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Black men involved in the Tuskegee study were not told about the full objectives of the study
Eva Larkai, who leads the black and minority ethnic medical student group at the school, said the changes would make doctors better – and ultimately help patients with better treatment.
She said: “If the new generation of doctors are not equipped to adequately care for the multi-ethnic population we see here in the UK and around the world, we are doing patients a favor.”
Experiments without permission
She cites the example of studies showing that black patients are often prescribed less pain relief than other people, despite the same conditions – and the same is true for children.
“Some of this is rooted in problematic ideologies of the past – the wrong idea that black people feel less pain.
“As students and staff, it is important that we understand and train this colonial history so that we can investigate and reflect on our unconscious bias,” Miss Larkai said.
One new area of the history of drugs that will be treated is the Tuskegee syphilis experiments – where the US government conducted experiments for almost 40 years on a group of black American men without their knowledge, to see what would happen if syphilis remained untreated.
Miss Larkai and Dr. Hartland say it is important for students to learn about the difficult past of medicines to prevent such atrocities from happening again.
Dr Kathreena Kurian was recently appointed co-chair of the Anti-Racism Task Force, in collaboration with Dr Joseph Hartland
The work to “de-colonize” the curriculum is part of ongoing action at the University of Bristol. The medical school is adding its own specific changes to help trainee doctors.
Dr Kathreena Kurian, who is helping with the changes, said: “Bristol really has a unique opportunity to shed some light on our issue with our large BME population, and as highlighted by recent high profile events in the city. “
Miss Larkai, who has campaigned for years on the issues and co-founder of the organization BME Medics, said she feels positive about the recent progress, and is proud of the students who have helped her over bring.
But she acknowledged that the work took an emotional and social toll. They added the reforms would require long-term funding and expertise.
Future doctors
The Council for Medical Schools has already started working with universities to diversify curricula and improve support for people dealing with racism.
Dr Clare Owen at the council, said: “It is important that the profession not only represents our diverse population, but it must also understand the unique health inequalities in our diverse communities.”
The General Medical Council – which sets the broad framework for medical training but not specific curriculum content – said it would work with medical schools to provide guidance that includes ethnically diverse attendance in their curricula.
The organization says it wants to be active “in driving change that is real and effective in supporting ethnic students, trainees, doctors and patients in black and minority in the UK.”
