Decolonising the curriculum: tackling systemic ‘life-threatening’ racism in medicine

Unconscious racial bias has led to adverse health and social outcomes in Black, Asian and other ethnic minority groups. [SHUTTERSTOCK]

Medical curriculums should be reformed if we want to eliminate systemic racial bias, according to students and teachers at the University of Bristol, who stressed that medical education should explore and reflect upon unconscious biases and how these may impact clinical judgement.

The university is one of the more prominent higher education institutions in the UK.

“The racism that exists in medicine and the lack of diversity in our medical education has impacts that can be felt across the healthcare sector; affecting medical students, doctors, and crucially, the healthcare experiences of Black, Asian and other ethnic minority patients (BME),” said Eva Larkai, a medical student at Bristol University and president at BME Medics,  a platform for students and medical professionals. 

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She told EURACTIV that unconscious racial bias has led to adverse health and social outcomes in BME groups.

For example, she highlighted that the presentation of important clinical signs and conditions differ across ethnic groups, but that this variation often does not appear in medical textbooks. 

“Almost every skin condition appears differently on darker skin tones, from more common conditions such as eczema to rashes associated with infectious or autoimmune diseases and skin cancers,” Larkai said.

This is something that Dr Joseph Hartland, a teacher at the University of Bristol medical school,  stressed can be a matter of life or death.

Dr Hartland, who also works to promote diversity in the department and the curriculum, offered the example of meningitis, a life-threatening condition in which the brain and spinal cord become inflamed and is most commonly diagnosed by a distinctive rash. 

However, a simple google search demonstrates that the overwhelming majority of examples are given on white skin, although this disease presents differently on black skin. 

“How quickly you treat and identify these kind of conditions can be a matter of life or death, because every minute counts,” he said, stressing that key symptoms can be missed in split-second decision making if doctors are not trained to spot symptoms in BME patients.

But this bias can also manifest in more insidious ways.

Hartland pointed to recent studies that have demonstrated that BME patients, including young children, often receive less pain medication on average than their white counterparts due to an unconscious bias concerning pain thresholds. 

Distrust and vaccine hesitancy

Hartland also highlighted the COVID-19 pandemic has exemplified the importance of tackling systemic racism in medicine, saying that a historical distrust for medical professionals in BME communities may lead to complications. 

“More broadly speaking, we have seen that BME communities are some of the most at risk of COVID-19, but they also tend to have the least trust in the medical profession,” he said, emphasising that incidences of abuse of trust, especially in medical trials, have created generations of wariness within BME communities. 

This runs the risk of a lower vaccine uptake in these communities once a COVID-19 vaccine is rolled out, an issue that should be taken into account in the push for vaccination,  he said. 

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Hartland and Larkai were also both quick to stress that this issue is not just confined to the UK, highlighting that doctors across the world are not being trained to adequately care for the multi-ethnic population. 

“This issue is not isolated to the UK, but relevant to medical institutions globally. If the medical education we are provided does not seek to address these issues, health inequalities will inevitably remain, or widen,” Larkai said. 

European Commission President Ursula von der Leyen has set out to tackle racism in the EU. In her first State of the Union address, von der Leyen announced a new EU anti-racism Action Plan that sets out a series of measures for the next five years.

Speaking in June, she stressed that “we relentlessly need to fight racism and discrimination: visible discrimination, of course. But also more subtle racism and discrimination – our unconscious biases.”

This is something that must start with education, Hartland stressed.

“We have to start incorporating this into the medical curriculum to properly prepare the next generation of doctors,” he said, adding that this must also be accompanied by a push for more representation of BME medical students in higher education.

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[Edited by Zoran Radosavljevic]

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The content of this publication represents the views of the author only and is his/her sole responsibility. The European Commission does not accept any responsibility for use that may be made of the information it contains.

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