The School of Medicine’s Anti-Racism Committee tackled curriculum reviews, faculty accountability around DEIJ topics, and other critical issues in its first year as a standing committee
Real change takes time. Tufts University School of Medicine has been living these words for several years on its journey—along with the other schools at Tufts—to become an anti-racist institution. This fall, the School of Medicine is marking an important milestone on that journey: The Anti-Racism Committee (ARC) just completed its first year of service to the medical school, contributing ideas and recommendations to several projects with the goal of furthering anti-bias training in medicine, public health, and biomedical sciences.
The ARC was inspired by the Anti-Racism Task Force that began in 2019 for the MD program within the Office of Educational Affairs. It became a standing committee in September 2021 under the leadership of chairman Damian Archer, assistant dean for multicultural affairs and clinical assistant professor at the School of Medicine. In contrast to a task force, which is convened for a temporary period of time, a standing committee exists in perpetuity as part of the school’s bylaws, on equal footing to the Admissions Committee and Curriculum Committee.
“The ARC’s work is centered around diversity, equity, inclusion, justice, and belonging. It is critically important to create a space of psychological safety, and that work takes intentionality and time,” said Archer. “We spent the first few months making sure everyone understood how to engage on the committee and saw each other as equals, because that allows for trust and full engagement by students, faculty, and staff.”
The committee has elected faculty representatives from various departments at the medical school and from academic partners, such as Maine Medical Center. There are also eight medical student representatives. The committee’s responsibilities to address anti-racism at all levels of the school are outlined in the charter. However, the work of the ARC is not to implement, but to look at policies, review data, and make recommendations using an anti-racist lens.
The committee began by trying to get a foundational understanding of past and current anti-racism work and efforts around diversity, equity, inclusion, and justice (DEIJ) at the school and university levels.
“In that beginning stage, it was understanding how the medical school functions, who reports to whom, and what the accountability structures were,” said Archer. “This was critically important, because one of the charges to the ARC was to create accountability mechanisms and develop recommendations that could be held against an outcome we could measure.”
A Focus on Medical Education
The ARC has seven subcommittees that range in focus from admissions to climate to faculty recruitment and retention. The seven subgroups regularly gather data and conduct analyses of their respective areas and make recommendations around gaps found or resources needed.
Laura Baecher-Lind, dean of education affairs and professor of obstetrics and gynecology at the School of Medicine, recently engaged the curriculum subcommittee for a project related to DEIJ awareness among all faculty with teaching responsibilities.
“There's increasing recognition about racism in medicine and the disparities in healthcare outcomes that are really ubiquitous. One of the strategies to mitigate them is to increase education in medical school about historical and current racism in medicine,” said Baecher-Lind. “We recognize the racism that's inherent in medicine and develop physicians who approach medicine without some of the biases that were taught historically.”
Baecher-Lind and her department have spent the last few years focused on improving the school’s curriculum to reflect an anti-racist medical education. In the summer of 2020, at the same time as the ARC was growing from a task force into a standing committee, the school began an enormous review of all medical curriculum with an anti-racist lens.
"The ARC’s work is centered around diversity, equity, inclusion, justice, and belonging. It is critically important to create a space of psychological safety, and that work takes intentionality and time."
A lot of recommendations came out of the review, and many changes were made as a result. One of those changes was to set up an auditing system to prevent bias from creeping back in. At Archer’s encouragement, Baecher-Lind brought her framework for a checklist to the curriculum subcommittee.
“The DEIJ checklist for faculty was born from the idea that we needed some tool or process that our educators could use to regularly screen their course materials—every slide, syllabus entry, case study, and quiz or exam question—with every iteration going forward, to ensure all components are anti-racist,” she said.
The checklist includes points such as ensuring adequate representation of different races in class materials; for instance, a slide deck about dermatological conditions should show an array of skin colors and not just white skin. Another point refers to addressing race in a patient’s case, which historically, was mentioned regardless of the reason for the patient’s medical visit.
“If race is included in a patient presentation, it should be done purposefully with the understanding that race is a social construct, not a biological construct, and any disparities may not be due to race itself but to inequities that can lead to different health outcomes,” Baecher-Lind explained.
The ARC offered her helpful advice and tweaks for strengthening the checklist and supporting materials before giving it their stamp of approval and helping to disseminate it. It was introduced in the spring of 2022, and starting this fall, all medical education is being delivered with the help of this checklist. The Curriculum Committee review process for all courses and clerkships also has been modified to ensure the principles within the checklist are reflected in the educational experience.
One member of the ARC’s curriculum subcommittee is Keith Nokes, the H. Jack Geiger, MD, Director in Health Justice and assistant professor of family medicine at the School of Medicine. Most of the time, Nokes works as a family physician and director of medical student education at the Greater Lawrence Family Health Center (GLFHC), and as faculty at the Lawrence Family Medicine Residency, a Tufts-affiliated residency.
Over the summer, he spear-headed a slightly different type of curriculum review for the ARC. With the help of student interns assigned through the Office of Educational Affairs, they took a deep dive into the curriculum to see how much time medical students spent learning about issues of racism and social determinants of health, and they examined when that learning took place over the course of four years.
“It's almost exclusively in the first two years, before medical students enter their clinical education,” Nokes observed. “But when they get into clinical spaces in the third and fourth years, there’s some cognitive dissonance for our students when they are exposed to so-called ‘real-world’ medicine under medical professionals who may not have had a similar type of medical education. We can do a lot of teaching, but it's much harder to change culture.”
Nokes said one of his big takeaways moving forward is how to reinforce this knowledge and understanding as students venture into clinical training spaces—and how to convert the culture of the larger profession.
“The School of Medicine was the first school at Tufts to have a standing committee dedicated to anti-racism,” said Archer. “I'm proud of that, but it has required a lot of investment of resources. Tufts as a university and as a medical school is a socially minded institution dedicated to meaningful, impactful change of the world.”