Misrepresenting Race — The Role of Medical Schools in Propagating Physician Bias

Conceptions of race have evolved and become more nuanced over time. Most scholars in the biologic and social sciences converge on the view that racism shapes social experiences and has biologic consequences and that race is not a meaningful scientific construct in the absence of context.1-3 Race is not a biologic category based on innate differences that produce unequal health outcomes. Rather, it is a social category that reflects the impact of unequal social experiences on health. Yet medical education and practice have not evolved to reflect these advances in understanding of the relationships among race, racism, and health. More than a decade after the Institute of Medicine (IOM, now the National Academy of Medicine, or NAM) issued its report Unequal Treatment, racial/ethnic disparities in the quality of care persist, and in some cases have worsened.4 Such inequalities stem from structural racism, macrolevel bias intrinsic in the design and operations of health care institutions, and implicit bias among physicians.4,5 The majority of U.S. physicians have an implicit bias favoring White Americans over Black Americans, and a substantial number of medical students and trainees hold false beliefs about racial differences.6-9 These widespread problems are reflected in the fact that race is one of the most entrenched and polarizing topics in U.S. medical education. Efforts to advance health equity in medical education have ranged from implicit-bias training to supplementary curricula in structural competency, cultural humility, and antiracism.10-12 Researchers have highlighted the domains of misuse of race in medical school curricula and their potential role in propagating physician bias.13-15 In examining more than 880 lectures from 21 courses in one institution’s 18-month preclinical medical curriculum, we found five key domains in which educators misrepresent race in their discussions, interpretations of race-based data, and assessments of students’ mastery of racebased science. Indeed, in all the authors’ home institutions we found similar misrepresentations of race.15 Social medicine or equivalent courses discuss race in a nuanced manner, but misrepresentations arise in all other courses, including organsystem blocks and basic science classes. Consideration of these five domains in the preclinical curricula (Table 1) inform our recommendations for correcting content that may reinforce or instill race-based biases (Table 2).