Teaching critical race theory in medical school could improve patient outcomes

By Jules Murtha | Fact-checked by Barbara Bekiesz
Published May 20, 2022

Key Takeaways

  • Up to 40% of White medical trainees believe that Black people have “thicker skin” and are less sensitive to pain than White people, which can lead to less than optimal treatment of pain in Black patients.

  • Critical race theory (CRT) teaches students that race is a social construct ingrained in the fabric of societal institutions and structures, rather than a force perpetuated by individuals.

  • The implementation of CRT in medical schools could help trainee physicians break down racial stereotypes, and instead focus on the experiences and knowledge of patients of color to mitigate race-based health disparities.

When Columbia MPH student Nina Owen-Simon recalls what medical school taught her about race, she cites being taught that race was a risk factor for almost every disease. Black patients experience higher rates of asthma and obesity, for example.

What Owen-Simon doesn’t recall learning, however, is how race operates in the larger medical landscape, how it’s informed modern medicine, and how health systems perpetuate systemic racism.

That’s why, in an article published by publichealth.columbia.edu, she’s calling for the implementation of critical race theory (CRT) in medical school to better serve patients of color.[]

What is CRT?

If you’ve heard about the bans and restrictions placed on CRT in recent years, you may wonder what it is and why it’s causing so much political uproar.

According to Dennis C. Chin, vice president of Narrative, Arts, and Culture, Race Forward, CRT is “an academic field that simply demonstrates how racism is embedded in our laws and in our institutions.”

Chin provided this definition at a 2021 Prioritizing Equity discussion hosted by the American Medical Association.[]

“That is exactly what it is. It's a graduate-level course,” Chin said.

As race can be a predictor of individuals’ life outcomes, CRT seeks to demonstrate the effects it has on aspects such as wealth attainment and educational achievement—as well as health.

In a letter to the editor of Academic Medicine calling for the teaching of CRT to physicians-in-training, the writers defined CRT as a framework designed to challenge dominant ideologies in service of experiential knowledge to get a better look at how inequality persists.[]

Those who study CRT may then have the tools to identify, analyze, and transform systems that perpetuate the marginalization of people of color. For physicians-in-training, CRT could be the key to learning how to spot inequity as it exists in the medical field and elsewhere—and address it.

CRT and health equity

Achieving health equity hinges on the dismantlement of forces such as racial injustice, which unfortunately shows up in medical spaces regularly.

According to an article published by the Canadian Medical Association Journal, some physicians and clinical teachers hold the belief the belief that Blacks have an inherently higher pain tolerance than people of other racial backgrounds.[] As a result, Black patients are treated differently than patients of other races for the same ailments.[]

Racial disparities have also surfaced in morbidity and mortality rates due to COVID-19. Some racial groups have faced barriers in attaining access to COVID vaccines. To change racism's impact of racism within the healthcare system, physician intervention—not just recognition—is necessary.

According to Owen-Simon, implementing CRT in medical schools can help trainee physicians understand race as a social construct. It’s not something individuals are responsible for, but rather a structural force embedded within American institutions and systems—including healthcare.

Medical students who study CRT can then assess and dismantle harmful stereotypes surrounding different racial groups, and focus on the experiences and knowledge of patients in those groups.

Medical logic has historically sought to assign vulnerability to certain illnesses to specific racial groups, based on assumed “physiologic” proclivities in these populations.

The Tuskegee syphilis study was a case in point. Such reductionist approaches failed to account for social forces related to the differences observed.

CRT would enable trainee physicians and clinical leaders to look beyond such reductionist health models and see the factors contributing to race-based inequities, providing a clearer pathway to eliminating racial disparities in healthcare.

Owen-Simon believes CRT is as essential to public health as an understanding of common diseases.

"What understanding the pathophysiology of tumor development is to fighting cancer, critical race theory is to fighting racism," she wrote.

"We all want to treat patients equitably. Let’s train ourselves to do so. "

Nina Owen-Simon

What this means for you

Trainee physicians aren’t immune to racist ideologies that could harm their patients down the line. Mistaken beliefs, such as that Blacks are more pain tolerant than others, can lead to inappropriate treatment. To combat disparities that often arise as a result of systemic racism, medical schools can implement CRT. Trainees could then learn to dismantle racial stereotypes and avoid defaulting to race as the de facto explanation for observed inequities. Physicians who can go beyond recognition alone can take action to address racism as a barrier to equality.

Related: The critical issue putting doctors' careers and patients' lives at risk
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