A paper published in Academic Medicine focuses on how U.S. medical schools can address race and culture in medical education. The guidelines were co-authored by the George Washington University School (GW) of Medicine and Health Sciences’ Katherine Chretien, MD, associate dean for student affairs and professor of medicine, who worked with a cross-institutional team of faculty and students, including second-year GW MD student Rose Milando.
Through analysis of virtual patient cases created by nonprofit Aquifer, used by 95 percent of MD-granting U.S. medical schools, medical school faculty and students from around the country came up with six main themes describing common mistakes or pitfalls in the presentation of race and culture in the cases. They then developed an evidence-based guide for revision of Aquifer’s cases that can also be used by medical educators who seek to revise their teaching cases to reflect best practices.
“We wanted to make the cases better at teaching about race and culture because Aquifer had received feedback from students who said some of the cases were outdated and needed to present race and culture in a more thoughtful and contemporary way,” Chretien said.
In the first phase of the project, Chretien and co-author Steve Scott, MD, MPH, senior associate dean for educational affairs and accreditation at Texas Christian University and the University of North Texas Health Science Center, recruited students to conduct literature reviews on best practices for teaching about race and culture. Using that evidence, they created a guide for medical educators to use in teaching cases and to improve delivery of critical concepts surrounding race and culture.
For the second phase of the project, six new students were recruited to apply the guide to the Aquifer cases and make concrete editorial suggestions for changes. One of those students was GW’s Milando.
“I am in the [GW] Medical Education and Leadership Scholarly Concentration and my projects have been focused on evaluating the way our pre-clinical training addresses race and culture and how that could be improved,” Milando said. “When I saw the Aquifer opportunity, I realized I would have a chance to work on an evidence-based project on race and culture, which was in line with what I was already interested in.”
Milando and five of her medical school colleagues spent last summer examining hundreds of Aquifer’s virtual patient cases, flagging problematic areas, and offering suggested edits. The students then were able to present what they found during Aquifer’s annual meeting in fall 2018. Many of the changes have already been made to the cases. With one million case completions a year, these changes have the potential to impact thousands of medical students across the country.
Chretien said the cases were written years ago and not through the lens with which we view culture and race today. “They built excellent medical content with diverse cases and an eye toward incorporating cultural sensitivity,” she said. “But, as medical education has evolved in the last 10 years, we have different views on things. We’re shifting how we look at race and culture in medical education in general, particularly with an emphasis on social and structural determinants of health, and we wanted these cases to reflect that.”
This kind of work, Chretien added, reflects GW’s mission and the types of students who walk the medical school’s halls. “They’re interested in advocating for patients and improving health disparities,” she said.
Because of that interest, students have sought active solutions to continue to improve curriculum at the GW School of Medicine and Health Sciences when it comes to educating on race and culture.
A taskforce featuring about a dozen students and faculty members was formed, which came up with numerous ways to address race and culture in medical education within the school. In addition, with help from Chretien and Milando, the Aquifer checklist was used to inform new guidelines for faculty members.
“That’s a big push within our school,” Chretien added, “and I think it’s really commendable that GW is leading the way in this space.”
“Addressing Race, Culture, and Structural Inequality in Medical Education” is published in Academic Medicine.
