L. Hess is director, Strategy and Equity Education Programs, Icahn School of Medicine at Mount Sinai, New York, New York.
A.-G. Palermo is associate dean, Diversity and Inclusion in Biomedical Education, Icahn School of Medicine at Mount Sinai, New York, New York.
Acad Med. 2020 Dec;95(12S Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments):S44-S50. doi: 10.1097/ACM.0000000000003706.
Racism and bias are American medicine's fatal flaw. They permeate clinical practice and biomedical research, and their influence on medical education is even more profound because it is through medical education that racism and bias are perpetuated across generations and throughout history. This insidious influence has persisted despite the stated values of the medical profession and well-intentioned efforts to lessen their impact. The authors assert that racism and bias in the learning and work environment of medical school can be mitigated only through a formal change management process that leads to change that is institutionally transformational and individually transformative. The authors describe the sequence of events at one U.S. medical school, beginning in 2016, that led from student activism to an initiative that encompasses every functional sphere within medical education. They also reflect on personal and structural lessons learned during the course of designing and implementing this initiative. Eliminating racism and bias demands that medical educators embrace a change process that is lifelong, people-centered, incremental, and nonlinear. It requires the courage to constantly course correct while never losing sight of the ultimate goal: health care and medical education that are free of racism and bias.
种族主义和偏见是美国医学的致命缺陷。它们渗透到临床实践和生物医学研究中，对医学教育的影响更为深远，因为正是通过医学教育，种族主义和偏见才得以代代相传，贯穿历史。尽管医学专业有明确的价值观，也有减轻其影响的善意努力，但这种阴险的影响仍在持续。作者断言，只有通过一个正式的变革管理过程，才能减轻医学院学习和工作环境中的种族主义和偏见，这个过程会导致机构变革和个人变革。作者描述了美国一所医学院自 2016 年以来的一系列事件，这些事件从学生的激进主义开始，最终发展成为一项涵盖医学教育所有职能领域的倡议。他们还反思了在设计和实施这一倡议过程中所吸取的个人和结构经验教训。消除种族主义和偏见要求医学教育工作者接受一个终身的、以人为中心的、渐进的、非线性的变革过程。它需要不断纠正错误的勇气，同时始终牢记最终目标：没有种族主义和偏见的医疗保健和医学教育。
