Pay it forward

Including social justice in the curriculum

Efforts to rework the medical school curriculum to address racism in health care have been underway at Stanford for several years. But they recently gained more urgency.

“After the killing of George Floyd and the other events of the summer of 2020, we realized we needed a deeper and more sustained commitment to making the necessary changes,” said Daniel Bernstein, MD, the associate dean for curriculum and scholarship.

Beyond addressing racial bias in patient care, the Stanford Medical School must also teach new doctors to consider social factors that impact patients, physician Daniel Bernstein said. Photo by Tom

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In the article "It’s not rocket science — it’s harder," learn about how Stanford Medicine is ramping up efforts to increase racial equity and end disparities in medicine.

Changing the curriculum in a meaningful way isn’t as easy as adding one or two more classes, however.

“Compared with when I went to medical school, the amount of knowledge we have to teach and the students have to learn is exponentially larger,” Bernstein said. “So how do we accomplish that while still remaining faithful to our commitment to teach social justice?”

The solution, Bernstein believes, is to incorporate discussions of health inequities and implicit bias into every aspect of teaching. A lesson about hypertension, for example, can include a discussion about the impact of poverty, lack of insurance or poor diet on disease prevalence.

It could also include the fact that, although non-Hispanic Black patients have the highest rates of cardiovascular disease in the country, they are less likely than white patients to receive appropriate therapeutic interventions.

“Some of these easy, clear targets can have enormous impact,” Bernstein said. “We teach students molecular biology, genetics, anatomy — sciences that underlie our practice of medicine. But 50% of the determinants of health are societal and are affected by the patient’s race or ethnicity, their income, and even their ZIP code. If a patient has asthma and lives near a refinery — breathing pollutants — how do we incorporate that knowledge into our patient care? We haven’t done an adequate job of teaching students that half of the puzzle.”

Conversely, students need to be empowered to correct others in a clinical setting when necessary.

“These are physicians during their formative years, first gaining knowledge as medical students, and then learning how to apply that knowledge in the clinic as residents,” said Bernstein. “We need to do better in both of these arenas.”

Krista Conger is a science writer in the Office of Communications. Email her at kristac@stanford.edu.

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