Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
Med Teach. 2022 Dec;44(12):1347-1353. doi: 10.1080/0142159X.2022.2094231. Epub 2022 Jul 10.
In 2020, medical schools across the U.S. were called to task by students who demanded a response to structural racism in medicine. Many medical schools made anti-racism declarations and pledged to promote more inclusive learning environments. Much of the focus was on changing the pre-clinical curriculum and less on the everyday interactions that occur in clinical settings. As medical educators, we have an obligation to reinforce statements of solidarity by role modeling behaviors that demonstrate anti-racism in clinical practice.
This article proposes a framework that provides practical steps for role modeling anti-racism in the clinical learning environment. These steps are drawn from a review of the literature on role modeling, constructs from Social Cognitive Learning Theory, and anti-racism praxis.
The resulting framework uses the acronym R.E.A.C.T to describe practical steps that include Reflecting on implicit biases, Educating ourselves on historical and current forms of structural racism, Assessing the use of race in clinical practice and asking how racism is impacting a clinical interaction, Calling out behaviors that perpetuate racism, and Treating everyone with dignity and respect.
The R.E.A.C.T framework is of value to medical educators because it provides practical steps on role modeling anti-racism in the clinical learning environment. The framework calls medical educators not to merely passively 'react,' but to be introspective, proactive, and intentional in their response to racism. Examples are provided on how each step can be actualized and adapted for different learning environments.
2020 年，美国各地的医学院都受到了学生的挑战，学生要求对医学领域的结构性种族主义做出回应。许多医学院发表了反种族主义宣言，并承诺营造更具包容性的学习环境。许多重点放在了改变临床前课程上，而对临床环境中发生的日常互动关注较少。作为医学教育工作者，我们有义务通过模范行为来强化团结的声明，这些行为在临床实践中表现出反种族主义。
本文提出了一个框架，为在临床学习环境中树立反种族主义榜样提供了切实可行的步骤。这些步骤来自对榜样行为、社会认知学习理论的构建以及反种族主义实践的文献综述。
由此产生的框架使用 R.E.A.C.T 这个缩写来描述切实可行的步骤，包括反思隐性偏见、教育自己了解历史和当前形式的结构性种族主义、评估种族在临床实践中的使用并询问种族主义如何影响临床互动、揭露助长种族主义的行为，以及以尊严和尊重对待每个人。
R.E.A.C.T 框架对医学教育工作者具有价值，因为它为在临床学习环境中树立反种族主义榜样提供了切实可行的步骤。该框架呼吁医学教育工作者不要被动地“反应”，而是要在回应种族主义时进行内省、主动和有针对性。提供了如何实现每个步骤的示例，并针对不同的学习环境进行了调整。
