Advancing Anti-Racist Transformation in Medical Education: An Interview

What does it mean to be anti-racist in medical education, and how can medical schools effect change that is both institutionally and individually transformative? To help answer these important questions, the American Association of Colleges of Osteopathic Medicine (AACOM) spoke with Dr. Linda Grace Solis, University of the Incarnate Word School of Osteopathic Medicine (UIWSOM) assistant professor of applied humanities and chair of AACOM’s Council on Diversity and Equity, and Dr. Rebecca Sanchez, UIWSOM assistant professor of microbiology, who are co-chairing UIWSOM’s Anti-Racist Transformation in Medical Education (ART in Med Ed) project. UIWSOM was one of the inaugural schools chosen, and the only osteopathic medical school selected, for ART in Med Ed, which is a three-year project funded by the Josiah Macy, Jr. Foundation to replicate the Icahn School of Medicine and Mount Sinai’s change-management strategy at 11 partner medical schools in the United States and Canada.

The answers below have been edited for brevity and clarity.

Q: How did you hear about this project and why did you know UIWSOM would be a good fit?

Dr. Solis: I first heard about the opportunity from a medical school listserv. It aligned with our diversity, equity, inclusion and justice efforts, so I decided to apply, even though the application date was only 10 days away! The project aligned so well with our school’s social justice mission that I decided, even with just 10 days, to take a shot and see what happened, and we were selected.

Q: What do you hope to achieve over the course of this project? Are there measurable goals?

Dr. Sanchez: This is a three-year program, so we're still in the process of identifying our goals and meeting with other schools in our cohort. We are in the early learning phase but we're asking ourselves what we want our school to look like at the end of this three-year program. We'd really love for the end goal to be having all our faculty be more aware of the materials they're presenting to learners and to be more diverse and more inclusive. We also want our learners to be aware of how their communication affects others. We both feel very passionate about UIWSOM being a place where everyone feels like they're heard, they're seen and they matter. Those are very big goals and that's what we're striving for in the end.

Dr. Solis: The Icahn School of Medicine model for ART in Med Ed is not a diversity, equity and inclusion model. It's a change model. It really emphasizes communication and having hard conversations where people feel heard, important and valued, just like Dr. Sanchez said. The goals are all up to us and what UIWSOM needs. Creating your own goals can be challenging but using the ART in Med Ed framework will help us get there.

Q: How is the work progressing so far? Have there been any early successes or challenges, either from COVID-19 or other factors?

Dr. Solis: We're very early in the process but one of the early successes is our ability to gather people. In our project cohort, there's 14 of us in what we call the guiding coalition. We've been able to gather in-person twice, which was wonderful, and we’ve started having those hard conversations. We have all levels of our campus represented—students, staff, faculty and administrators. Together, we are thinking through what we want our school to look like at the end of this transformation and that alone has been a really quick win for us.

Dr. Sanchez: It can be challenging to schedule meeting times that work with everyone’s schedules, especially across such a diverse cohort of faculty, staff and learners, but the more we've met, the more people have attended. At first, Dr. Solis and I were pretty nervous about finding others to do this work with us, but every time we meet, more and more people join. If you look at who's in our group and you think about their background—deans, assistant, associate and full professors and learners across different years—what's been interesting is that in such a short time, we’ve been able to have these hard conversations. We’ve brought up questions where there's that awkward silence in the room and everybody feels nervous to say anything, but then we've slowly grown trust in our group. Now, it takes less time for people to speak up and offer their input, especially learners. That's been one of the biggest successes for us.

Q: The ART in Med Ed project recognizes that addressing racism in medical education will require systemic change. What are some steps that colleges of osteopathic medicine can take to initiate transformational changes on their campuses?

Dr. Sanchez: The first thing you do, which we did in meeting one, is define terms. Language matters. It carries weight. People can't be afraid to use words like anti-racist, bigot or white supremacy. In our first meeting, we defined these terms and talked about them. You need to be able to comfortably use these words to face these issues, you can't hide from them. When these words and their meanings are out in the open, it can help get people on board to say, look, change must happen.

Dr. Solis: Absolutely. I agree. Here in the states, we're brought up to only talk about polite things, especially in the workplace, especially in front of students. But if you only talk about what’s safe, you won't ever identify what needs to change, much less actually make that change happen. Osteopathic medical schools can approach this through the mind, body, spirit connection. Honestly, mind, body, spirit is what we're talking about. We want everyone on our campus to be able to bring their whole selves. To be able to bring whatever physical body they're in, no matter what they look like. To bring their intellect and their diverse experiences. We want to change hearts and minds and sometimes you have to change hearts first. All of this is coming back around to using your words and defining your words and not being afraid to speak up.

Q: AACOM is committed, and COM deans have unanimously pledged, to address systemic inequity and integrate health equity issues into the medical school curriculum. What lessons have you learned from this project that can help osteopathic medical schools collectively improve diversity in medical education?

Dr. Solis: First and foremost, we have to collectively see that there is a problem. Lack of diversity is a problem and has been a problem for a century now. We need to listen to people who don't look like us and who have had different experiences. We need to remember that just because someone else's experience doesn't mirror our own, that doesn’t make them wrong. That sounds so simplistic but it’s the way our brains work. We take our world view and assume that how we believe is how others believe. We need to be more intentional about diversifying not just our matriculating classes but our faculty, staff and administration. I think that's something we can offer to other osteopathic medical schools.

Dr. Sanchez: What we've learned is that it takes everyone, and you can't expect the people who are most impacted to initiate the change. For instance, we can't expect our students of color to start these hard conversations. It has been important to realize that we must be a voice too. We can't just sit back and watch. We all must notice and work to improve issues, whether that’s better presenting classroom material or using better language in conversations.

Q: UIWSOM is the only osteopathic medical school selected for this project. How has that shaped your experience, and has it influenced the cohort as a whole?

Dr. Solis: As I mentioned earlier, we have the mind, body, spirit ethos that is part of osteopathic medicine’s philosophy. Here at UIWSOM, our parent school’s mission specifically talks about social justice, and that has also been incorporated into the medical school’s mission and our vision. So, it's not just Dr. Sanchez and me saying, hey we need to do this. It is our mission. It is what we are called to do, to bring social and racial justice and equity and inclusion to our campuses. You know, it's kind of funny in the big cohort meetings with the leads from all the other medical schools because they'll say in the chat, osteopathic medical school, what's that? But I think the longer we work in this cohort, the more opportunity we'll have to introduce mind, body, spirit as a foundation for what we're doing, and I look forward to those conversations.

Dr. Sanchez: I'll be honest, when I set out to help Dr. Solis apply for this project, I never envisioned myself as a co-chair. I'm always just willing to help. So, while I was excited about having the opportunity, I feel very humbled that we were picked, especially because we're so new. I thought this would be an opportunity for a bigger school with more faculty, so it's been very humbling and at the same time I feel like it's really on our shoulders to do this right, or to at least to put the best effort in. Like I tell my students, be 100 percent present and 100 percent on board. We need to do that too, and even if we fail in some areas, at least we can say we did our due diligence and we tried. This project comes with a lot of leadership responsibility, and it's made this whole experience more serious in a way, because we are the only ones representing the osteopathic perspective.

Q: How do you think the ART in Med Ed project will impact UIWSOM’s broader diversity, equity and inclusion efforts?

Dr. Sanchez: Above all, we hope to improve it. We hope to identify concrete areas where we can do better and motivate others to join us in this work. We really want to make UIWSOM more equitable and more inclusive. There have been areas that we've identified already, and these are long conversations, it's a slow process, but over these next three years, we're going to have more and more conversations. I think we'll get quicker about having them and about making decisions and through this, we hope that we're going to attract more students of color to the physician workforce. UIWSOM is already very diverse, but I think we'll expand diversity even more because of this program. We would also love to grow this project and have others become a part of it who can help us identify areas we might not see.

Dr. Solis: Absolutely. I think that takes us back to really listening well. I hope that one of the outcomes is that everyone on our campus understands what listening well means and understands cultural humility—not laying your own culture over everyone else and not thinking that your culture is the only way or the best way of doing things. I also hope that we see fewer potentially harmful and insulting images and words being used in the classroom, and that we will be able to bring diversity to images, so that students are learning what conditions look like on darker skin. Let’s help faculty learn how to listen so that if a student raises concerns, you know how to listen without getting defensive, how to listen without pushing back and how to learn from that person. We can all learn something from everyone.