An article in The New England Journal of Medicine (NEJM) recommends racially separate “caucusing” of students at medical schools.
“Used as part of a broader antiracism and antioppression curriculum, racial affinity group caucusing (RAGC) engages participants in critical introspection through the lens of their own racialized experience…” states the NEJM opinion piece. “RAGCs are facilitated sessions involving participants grouped according to self-identified racial or ethnic identity to support integration of antiracism curricula into clinical practice.”
The article, titled “Racial Affinity Group Caucusing in Medical Education—A Key Supplement to Antiracism Curricula,” was authored by academics and administrators at the University of California, San Francisco (UCSF) and the University of California, Berkeley.
A UCSF pilot RAGC program that supplements “antiracist curricula” and works to “eliminate health inequities,” is one model for medical schools to follow, state the authors.
‘Addressing Structural Racism’
The NEJM article states that medical education “has historically centered White learners” and is “founded on legacies of colonialism and racism.”
Students who are black, indigenous, or people of color (BIPOC) endure “personal experiences of racism that are nuanced” and therefore can find the existing medical education system “retraumatizing,” states the NEJM.
The authors reference the Critical Race Theory that minorities have been conditioned to defer to whites’ defensiveness about their racism as a reason to meet separately.
“Some BIPOC people have been socialized to care for the egos of White people, to express their emotions only in ways that are palatable to White audiences, and to tread lightly around ‘white fragility,’” state the authors. “In a space without White people, BIPOC participants can bring their whole selves, heal from racial trauma together, and identify strategies for addressing structural racism.”
‘A Tool to Control Us’
Minority students do not need racial “caucuses” to speak openly, says Marilyn Singleton, M.D., J.D., a black graduate of the UCSF School of Medicine.
“If students need someone to whom they can speak freely, they can confide in a friend,” said Singleton. “They should not be subjected to university-sponsored segregation. To promote racial harmony, we need more open discussion between different individuals, not subjecting white people to struggle sessions and having black or brown people bare their souls to strangers who just happen to be black or brown.”
Singleton says the mindset of the UCSF academics is more indicative of the elites than regular people.
“Society itself was evolving to Martin Luther King, Jr’s dream of judging people by the content of their character,” said Singleton. “It seems those in power like division and strife as a tool to control us. Except for outliers on both sides of the political spectrum, everyday people are getting along fine and do not racialize every word, thought, or action.”
Consequences of Segregation ‘Profound’
Separating students by race is counterproductive, says Stanley Goldfarb, M.D., a former University of Pennsylvania medical professor and chairman of Do No Harm.
“It is distressing that such a prestigious medical journal can believe that race segregation is acceptable,” Goldfarb told Health Care News. “This flies in the face of the experience of most Americans who work with and socialize with many different racial groups. Our society is healthier than our elites’ academic institutions would like us to believe.”
“The consequences of perpetuating racial segregation are profound and include further dividing an already divided nation,” said Goldfarb.
Addressing Poor Health Outcomes
There is no evidence to support the idea that health care disparities are due to discrimination, says Goldfarb.
“The principal reason for poor health outcomes is delayed interaction with the health care system, leading to delays in receiving proper care,” said Goldfarb. “Increased access is then the way to improve health care outcomes for minority patients,”
A long-range approach to improving minority health is to better prepare low-income students for successful lives, says Singleton.
“We have to start at the beginning by improving the schools (including after-school programs) in low-income neighborhoods to get children started on a path to success,” said Singleton. “The current focus on painting people of color as victims compounds the problem. People internalize the political rhetoric and lose hope in their future.”
Medical Journals Broken
The NEJM has elevated ideology above science, says Goldfarb.
“The New England Journal of Medicine has become politicized,” said Goldfarb. “The editors and the editorial board have decided that the political ideology of the left is the only proper approach to dealing with health care for minority populations.”
Goldfarb says that damages the journal’s credibility, and the way to fix it is for think tanks and research centers in academic medicine to “rigorously study the culture and the scholarship of medical care to identify the real engines of poor health care outcomes.”
A systemic problem with medical journals is centralized control, says Martin Kulldorff, a professor of medicine at the Harvard Medical School who spoke against the public health establishment during the pandemic and coauthored the Great Barrington Declaration.
“While extremely profitable for commercial publishers, the scientific publication system is broken,” said Kulldorff. “Controlled by entrenched scientists in each field, scientific journals delay and restrict new important research. The solution is a decentralized system of open-access, open-peer-review journals, where a research article is judged by its content rather than the journal in which it is published.”
Harry Painter (email@example.com) writes from Oklahoma.
Leanna Lewis, M.S.W., et al., “Racial Affinity Group Caucusing in Medical Education—A Key Supplement to Antiracism Curricula,” The New England Journal of Medicine, April 27, 2023: https://www.nejm.org/doi/full/10.1056/NEJMp2212866