We recognize that systemic racism and inequity pervades education and our institutions from early childhood to higher education and continuing professional development. We fundamentally believe that a diverse and inclusive learning environment is critical but insufficient to ensure we achieve our mission of advancing human health and eliminating the persistent health disparities and inequities that plague our city, country and world. We know that we are in a highly privileged position to contribute to necessary change in our institution and to health professions education broadly. To this end, we make the following commitments, some of which we have been working on quietly but diligently for some time:
- We will educate ourselves as we attempt to educate others
- We will require diversity and bias training for all searches and admissions processes including student, resident, fellow, faculty, and staff positions in education.
- We have partnered with the Office of Diversity, Equity and Inclusion (DEI) to provide all UME course, clerkship, and coaching faculty with training on systemic racism and white supremacy culture and how this impacts both education and health. A link to that draft training is here.
- We will continue to educate ourselves as individuals and as an education team on issues of structural racism, best practices in education, and effective leadership to ensure we can maximally contribute to change.
- We will investigate and address biases, discrimination, racism and white supremacy culture in all aspects of our educational work.
- We will implement best practices in holistic review. We recognize that MCAT, NBME subject exam, and USMLE scores, like all standardized tests, suffer from the consequences of systemic racism and other forms of bias and therefore must always be considered as only one aspect of a true holistic review process. Admissions has already commissioned an internal review to ensure we are using evidence-based (where available) and emerging best practices in student selection.
- We will significantly expand education in social and structural determinants of health at both the UME and GME level. We commit to training on inequity and how it contributes to both harm and privilege in health and society.
- We will base our UME curriculum on a trauma-informed approach to history taking, physical examination, and clinical care. We will expand this training to GME and faculty as we learn from what we are designing for UME.
- We will investigate our UME curriculum and its artifacts for evidence of structural racism and other biases. We will be developing a team of individuals to review these items for that purpose. We will expand this process as we learn how to do it effectively.
- We will address racism and bias in our learning environment. To this end, we have charged a task force of UME and GME leaders, students, residents, and DEI experts to recommend best practices in reporting, faculty and learner development, and management of mistreatment and bias. We are implementing a coaching program and a peer advocacy program for UME to better support our learners on all issues but especially related to the hidden curriculum and bias. We will ensure all peer advocates and coaches have the training needed to ensure they are able to support our minoritized students who face disproportionate burdens during their education.
- We will implement best practices in assessment and actively identify and address racism and structural bias in the assessments we use. We recognize that all assessments have biases and are incomplete. We recognize that medicine has overvalued knowledge and under recognized the structural racism inherent in standardized tests. We recognize that medicine has undervalued the importance of other competencies critical to excellence in clinical care including communication, professionalism, and lifelong learning. We will define what we value as an institution and reflect these values in a program of assessment and in our representation of excellence in the Medical Student Performance Evaluations (Dean’s Letter). This will build on the work of the Commission on Equity in Clinical Grading (CECG) final recommendations, which have or are in the process of being implemented. Additionally, we have suspended election into Alpha Omega Alpha based on the CECG and a subsequent AOA Task Force recommendations.
- We will expand our relationships with our community partners. In addition to BJC, we have advanced our partnership with the Integrated Health Network and have made formal financial and educational partnerships with Affinia and CareSTL, thereby supporting their critical work. Our Community Engagement team is building a curriculum for our students that trains them in effective partnership with community and is collaborating with a variety of community partners to create sustainable relationships that will allow our students to contribute longitudinally to addressing the needs of St Louis and our region. We do this for the betterment of our city and to ensure we train a workforce capable of meeting the needs of all patients.
- We will hold ourselves accountable, admit when we make mistakes, learn from it and continually improve. We also invite our community partners to hold us accountable.
- We have charged the Program Evaluation and Continuous Quality Improvement team with measuring our achievement of the above.
- COMSE, our curriculum oversight body, the Graduate Medical Education Operations Committee, and Academic Affairs will receive regular reports on our progress and ensure we hold ourselves accountable.
- We offer to present these results to the Integrated Health Network (who has created a forum for us and our other partners to do so) and other community partners.
- We will disseminate what we learn so others can benefit from it
- The Medical Education Research Unit has been building a strategic plan for health professions scholarship. As part of this plan, they have identified diversity, equity and inclusion research as a key priority area. To this end, Jan Hanson, Donna Jeffe and Eve Colson have recently received a GEA grant to further assess issues of racial bias in grading building on work that will soon be published by the Macy Foundation and in an Academic Medicine Supplement describing the work of the Commission on Equity in Clinical Grading.
We recognize that these are only first steps and unlikely to be sufficient to ensure equity in our educational practices. We will continually learn from what we are doing and from our colleagues and strive to be better every day. To these things we commit.
Eva Aagaard, MD
Senior Associate Dean for Education
On Behalf of the Office of Education