Taking the first steps to dismantle systemic inequities in academic medicine

Illustration by Jordan Carson

In the summer of 2020, the Faculty of Medicine & Dentistry launched a new task force aimed at tackling systemic institutional racism. The Anti-Racism Commitment to Change (ARCTC) group has since been hard at work, under the leadership of assistant dean of diversity Helly Goez, designing and implementing a solid plan of anti-racist action. “Recent events had opened windows of awareness that the consequences of racism could be so dangerous and lethal,” says Goez, “and unfortunate societal events inspired very bold conversations here in the faculty.” 

That summer in Minneapolis, Minn., 47-year-old Black man George Floyd died at the hands of white police officer Derek Chauvin. At the same time, all over the world, racialized people were dying from COVID-19 in disproportionate numbers due to massive inequities in social determinants of health. Compelled by these twin specters of systemic racism, a global grassroots movement took to the streets to voice their grief and anger. And many of the democratic world’s most powerful institutions embarked on the hard work of dismantling structures that upheld decades-long inequities. 

Building on a solid EDI foundation

Goez and her team at the Office of Equity, Diversity and Inclusion have been looking at “who we are, what we are doing well and what we can do better” in terms of diversity since 2017. The faculty was the first at the U of A to conduct an EDI survey, establishing benchmark measurements of how gender, racial and disability demographics compare to those of both the broader institution and the provincial population. 

While that original EDI survey and followup work are an important start, ARCTC—composed of 24 faculty, students and staff, many of whom represent racialized communities—is designed to focus specifically on racialization and anti-racism. Their “deep dive” through the lens of academic medicine, focused on service, education and research, is at the foundation of a solid plan of anti-racist action. “We did not want our work just to be a product that would sit on a shelf,” stresses Goez, “or a box we would check and then be done.” 

Still in its infancy, the group has already completed an intensive review of existing anti-racism practices and policies both at the University of Alberta and in other schools of medicine around the world, culminating in an anti-racism policy and a plan that features actionable goals in four broad areas: awareness, recognition, reporting and management.  

It all starts with awareness

The process of building awareness began in 2017 with that voluntary pilot census, says Goez, which showed that the faculty in general closely mirrors both the university’s demographics and the provincial population at large—with two exceptions. Both in the faculty and at the U of A, Indigenous representation as well as that of persons with disability are lower than in the population that we serve. 

Awareness enables us to address and remedy situations like this, says Goez. Seeing the low numbers of Indigenous learners, the faculty two years ago eliminated a quota that limited Indigenous enrolment in its medical school through the Indigenous Health Initiatives Program (IHIP). This move begins to answer the Truth and Reconciliation call to action No. 23, regarding the need for an increase in the number of Indigenous professionals in health care. But this is “really just a first step,” says Goez.

Ultimately, says Goez, awareness can become the foundation for a robustly anti-racist environment in the FoMD, which will open doors to a larger number of racialized learners and future health-care professionals. This contributes directly to the faculty’s social accountability mandate, leading eventually to both caregivers and patients feeling emotionally and psychologically safe to participate fully in the health system, help inform delivery of care and ultimately improve health outcomes of marginalized groups.

Teaching and recognition

Where do we go from awareness? “Many people say, ‘I understand there is racism. I want to help, but I don’t know how,’” says Goez. This is where education is key. Under the leadership of member and professor of nephrology Manjula Gowrishankar, the ARCTC group has designed an e-course that addresses the broader topic of racism from several perspectives, including the neurobiology of bias, professionalism, ethics, and the importance of allyship of bystanders and witnesses. 

While the anti-racism e-course is available for anyone in the faculty and the university who wants to take it, completion will be a mandatory part of onboarding for newly recruited faculty, and required for anyone applying for a leadership position. It will also be a useful coaching tool for those at the receiving end of complaints. 

Teaching those with gaps in understanding is crucial, but it’s at least as important to recognize those who model the values at the core of ARCTC’s work, says Goez. “There are members of the faculty who are doing great and important work in the area of anti-racism, and we have learned we need to better celebrate those people and their achievements.” 

A safe reporting path

A major actionable goal of the ARCTC group’s work was the creation of a discrete and reliable pathway to report racism, says Penny Smyth, associate dean of professionalism and a member of the ARCTC group. While processes are currently in place in the faculty for reporting accolades or concerns around professionalism, mistreatment and harassment, grassroots ARCTC members stressed that a lack of institutional trust might be keeping members from engaging in that reporting path. Another route was needed to begin to create a psychologically safe, anti-racist learning and working environment.

The ARCTC is addressing concerns about possible retaliatory behaviour, says Smyth. “Third-party reporting is especially important to offer here, so the person can talk to someone they trust and that party can bring their concerns forward on their behalf.” In addition, many members of the triage committee responsible for responding to complaints are from racialized groups themselves, and the entire committee is advised by key members of the ARCTC group. These triage officers, adds Goez, are specially trained to support those at the receiving end of both explicit racism and the ongoing, insidious burden of microaggressions—those casual comments or behaviours which are discriminatory and which are directed at marginalized people on a daily basis. 

Vision for the future

To build a truly anti-racist faculty, we must not only support those who have been subject to harmful behaviour but also educate those who have been perceived as being racist, says Goez. At the Office of Professionalism, says Smyth, “we’re working hard to build awareness, primarily among faculty, about what racism is and how it can affect people’s actions, behaviour and thoughts.” 

A key component in that support will be the option of peer coaching, in which faculty—the first cohort is currently receiving training through the Office of Lifelong Learning—will support peers who have been reported for racism concerns. Mutually agreed-upon coaching plans aim to aid in awareness and self-reflection for behaviour and habit changes.

The ARCTC task force is answering the call to build better awareness—among all members—of the harms of racism, make the faculty a safer place for racialized folks, and ultimately support the training of more health professionals who represent the diverse communities they serve. 

“We are committed to working tirelessly on all frontiers toward the promotion of wellness, well-being and the ability for all to thrive in the work, academic and learning environments,” says Goez. “We wear our intersectionalities and identities 24/7. We do not leave them at home when we come to work or school, or go to the doctor. And we all deserve to be free to feel proud of who we are.”