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As the Black Lives Matter movement, racial tension and police brutality became frequent parts of the national dialogue in recent months, faculty at the Yale School of Medicine proposed a new framework to combat racism in medical education. 

The article Blackface in White Space: Using Admissions to Address Racism in Medical Education was written by psychiatry resident Nientara Anderson, assistant professor of emergency medicine Dowin Boatright and professor Anna Reisman. The essay calls upon the medical admissions community to use both novel and existing tools such as admissions essays, questionnaires and interviews to screen candidates for racist beliefs. The essay was published in the Journal of General Internal Medicine on July 28. 

“It has always struck me as incredibly unfair, and infuriating, that academic medical institutions would freely admit people with racist attitudes or who are grossly uninformed on matters of race, and then expect their BIPOC community members to do the labor of ‘reforming’ these individuals,” Anderson, the lead author of the essay, wrote in an email to the News. The authors write, “We propose a more direct way to address racism in medical training: stop admitting applicants with racist beliefs.” 

The authors list historical and modern-day examples of racism in medicine as the impetus for this project. Citing a 2016 study where approximately half of all white medical students and residents endorsed at least one false statement about biological race, such as the misconception that Black people have more collagen in their skin than white people, the authors of the essay underscore the prevalence of racism in medicine. 

Even in 2020, as issues of race are closer to the forefront of national consciousness, Reisman pointed to a blatant example in her profession: a medical student from the University of Minnesota defacing a George Floyd mural on Aug. 18.

“A medical student! A future doctor announcing to the world (and to his future patients) that he’s racist. How can any of his future patients who are Black feel assured that his racism won’t affect how he treats them?” wrote Reisman.

To address these challenges, the authors provide a list of specific steps that committees may take to admit racially conscious candidates. Among the first steps is the use of a short questionnaire to identify “significantly uninformed individuals” who are incapable of respectfully engaging with minority peers and patients. The authors also suggest the potential of surveys informed by social psychological principles to assess candidates’ explicit and implicit biases. 

Additionally, the essay’s authors highlight the importance of altering existing evaluative criteria like application essays and interview questions to more directly prompt candidates to consider race. For example, they suggest that essay questions require applicants to reflect on their own racial identity or respond to passages from prominent scholars on race and medicine such as Dorothy Roberts. 

The contributors also advocate for the use of multiple mini-interviews where applicants rotate among different rooms, responding to prompts that detail discriminatory practices: What would you do if a professor suggested that race is biological? If an attending told a patient not to take a racial slur as a personal affront? 

“Racism on the wards is so commonplace as to be expected as a matter of routine,” Anderson wrote in an email to the News. “Simply in my own experience, I have heard attending physicians telling others not to take the n-word ‘so personally.’ I’ve been told Black babies are ‘more hardy,’ and I’ve been told that Latinx people ‘exaggerate’ their pain … Racism is simply part of the fabric of institutional medicine in the United States.”  

The contributors enumerate other modifications that medical school admissions committees may implement. They state that interviews of candidates by BIPOC community members could be useful to more accurately evaluate applicant attitudes about minority patients. This approach provides a voice to underrepresented individuals and grants them more control over the future of their care. These interviews will also help to pinpoint applicants’ racial attitudes, create a more holistic view of each candidate and transform the medical profession into a more inclusive field.

The authors of the study hope that this essay will push the medical community to hold students and residents to a higher standard of racial awareness. 

“People can certainly learn and grow when it comes to anti-racism,” Anderson wrote. “But we assess for so many other qualities as part of the medical admissions process that it seems the only reason we would not assess racial attitudes or awareness is because we are afraid to confront and counteract the racism we routinely welcome into our ranks.” 

The authors are currently working in collaboration with several institutions to pilot and review the impact of some of the approaches outlined in their essay. 

In 2016, the Yale School of Medicine created the Internal Medicine Diversity Committee to retain and recruit minority students and faculty. 

Sydney Gray | sydney.gray@yale.edu

Correction, Oct. 1: A previous version of this article contained a misspelling of Nientara Anderson’s first name. It has been corrected.