Systemic racism is entrenched in all aspects of our society, including our educational and healthcare systems. Our duties as physicians and medical educators include both a recognition of this fact and a commitment to promoting anti-racism in the ways we teach, conduct research and provide care. At the DFM Departmental Assembly on December 4, 2020, Dr. Denice Lewis, the DFM’s Postgraduate Curriculum and Academic Day Director, presented “A proposed post-graduate anti-racism curriculum.” This project is a culmination of work with an external consultant and feedback from our current residents and postgraduate leaders. The presentation outlined several recommendations for an anti-racism curriculum for family medicine teachers. Dr. Lewis described an effective anti-racist curriculum as one which should:
- be woven throughout the length of training, with an end goal of incorporating anti-racist beliefs into the learner’s worldview and practice of family medicine;
- begin with a primer on the concept of race, and not shy away from naming and exploration the concepts of whiteness and white supremacy;
- recognize that language used in the discussion of race and racism is inherently political and will change over time or contexts;
- discuss the concept of intersectionality;
- focus on systemic racism versus individual racism;
- present the concepts of race and systemic racism in a Canadian context; and,
- provide an opportunity for reflective learning.
Using existing CFPC priority topics as a guide, Dr. Lewis proposed that the DFM could establish a new priority topic, Racism as a social determinant of health, with seven primary competencies:
- Identify patient priorities, expectations, and preferences (patient-centred clinical method).*
- Take the necessary time to establish trust and find common ground with your patient (patient-centred clinical method).*
- Consider cultural norms of different population groups while being careful to avoid generalizing and assuming that all group members share the same beliefs or circumstances.
- Recognize your potential personal prejudices, assumptions, and generalizations about race and racism.
- Recognize the systemic and individual effects of historical and ongoing government policies towards BIPOC populations and the impact these have on their health status.
- Recognize the connection between poor health and racism as a social determinant of health, and actively advocate for patients’ access to services.
- Recognize that illnesses/conditions may occur at different rates and may present differently in different populations (e.g., eczema may appear different across the spectrum of skin colours).
*Competencies 1 and 2 are already explicitly integrated into the existing curriculum in the patient centred approach to practicing family medicine.
Recommendations on how to deliver an effective anti-racist curriculum included in-unit and academic day teaching sessions, workshops, simulation, and faculty development sessions. Further details on proposed sessions can be found in the presentation slides.
What are some tips on how to prepare anti-racist and unbiased family medicine teaching sessions?
Dr. Lewis described some tips to consider when either preparing or reviewing teaching materials. Ask yourself the following questions:
- Do you have a default racial background in your cases? Why?
- Is the racial background in your case clinically relevant?
- Does including the racial background in your case perpetuate stereotypes?
If the racial background in your case is relevant, then include it and specify why it is relevant at some point during your teaching session. If the racial background of your case is not relevant then consider how to be more inclusive. Not specifying a racial background in your case is okay too, however, this sometimes leads to the assumption of the default racial identity.
- Does the disease or condition present differently in different racial backgrounds?
- Are there different outcomes between racial groups? Why?
Racial groups may differ in terms of how a pathology may occur or present, be treated and progress. Present the evidence-based ways that these differences may occur in racial groups.
The Department of Family Medicine is incredibly grateful to Dr. Lewis for her work on this important topic. Any feedback from our members on how we can promote anti-racism and inclusion is welcome. Do you have any questions, suggestions or resources to share with your colleagues at the Department of Family Medicine? Please contact firstname.lastname@example.org.