Why It is More Important Than Ever to Reveal the Hidden Curriculum in Educating the Next Generation of Physicians By Dr. Higginbotham

By Eve J. Higginbotham, SM, MD

A recent article by a medical student from Brown University raises the question about the understanding of how future generations of physicians consider the influence that the social construct of "race" has on medicine.

In her article entitled "The Hidden Curriculum" Brown continues the conversation about the intersect between racism and medicine that one of our very own Penn medical students, Mark Attiah[1] noted in a previous article, highlighting the benefits of considering the benefits of an inclusive environment, "where everyone feels included in the larger dialogue." While one perspective appears to be in opposition of the other, both views are critically important in moving toward a more inclusive culture. Ms. Brown highlights a few of the events that have occurred in the last few years such as the tragic deaths of Trayvon Martin and Michael Brown. Her article preceded the recent tragic death of nine African Americans in a South Carolina AME Church, one of the most revered sanctuaries in our community, thus adding a painful punctuation to this chapter in American life. These events coupled with her observations in clinical medicine create a vortex of influence on her approach to patients as she concludes, "…if we refuse to deeply challenge how racism and implicit bias affect our clinical practice, we will continue to contribute to health inequalities."1 This is a poignant statement coming from a future physician, whose colleagues according to a recent MTV survey[2] of millennials largely consider themselves colorblind. Sixty-eight per cent of those surveyed indicate, "Focusing on race prevents society from becoming colorblind."  Yet, if society remains colorblind, it will remain in an unconscious incompetent state and unable to move toward the necessary level of unconscious competence, which Mark Attiah 2 hopes for among his peers and in fact all of us who occupy the House of Medicine. Among millennials responding to the MTV survey, 63% admitted to being raised in homes where racism was not discussed. Thus, unlike older generations which experienced the Jim Crow and Civil Rights eras of American history first hand, this younger generation may not have the full appreciation that this history has had on current policies, practices, and attitudes of providers and patients. Therefore, since the millennials have not had the necessary open conversations about racism and how it shapes our thinking on both conscious and unconscious levels, it is time to have those conversations now, before more lives are lost.

[1].  Attiah, M. The New Diversity in Medical Education, NEJM 2014; 371 (19); 1474-5

[2].  Bouie, Jamelle. "Why Do Millennial Not Understand Racism?" http://www.slate.com/articles/news_and_politics/politics/2014/05/millennials_racism_and_mtv_poll_young_people_are_confused_about_bias_prejudice.html, Accessed, July 2, 2015