• Jessica

Decolonising the medical curriculum

Updated: Aug 2

In recent years, students have been trying to ‘decolonise’ the traditional university curriculum in a range of subjects and this has gained momentum across faculties. The aim of decolonising the traditional curriculum is to provide a more inclusive education, one that looks beyond the traditional Eurocentric white male syllabus to include more women, black and minority ethnic figures. “Decolonising” refers to the aim to overturn power imbalances which arise from historic and institutional biases in race, class, gender and disability.


Here are some shocking and uncomfortable stats affecting black healthcare professionals and patients today (some were collected from Dr. Amile Inusa's instagram post):

  • While the ethnicity gap may be small (~1-2%) for nearly all grades and types of doctor, an even larger gap exists among consultants, with white consultants earning around an extra £4,644 per year compared with BME consultants. Understandably, this is very concerning and we must find out why this is. [1]

  • Black women are 5 times more likely than white women to die during childbirth. [2]

  • During the COVID-19 pandemic, Black males have been 4x more likely to die and Asian males 3x more than any other person. [3]

  • 95% of doctors who died during the first month of the COVID-19 pandemic were Black or Brown. [4]

  • BME groups are known to have higher prevalences of psychotic disorders and are over-represented in prisons and forensic psychiatric institutions [5]. Rates of psychotic disorder experienced by Black and Asian men are higher than among White men and rates of detention under the Mental Health Act among Black/Black British men are ~4x higher than White men. [6]⠀⠀

  • In comparison with white ethnic groups, black people have significantly higher rates of multiple myeloma and stomach cancer. Black men have higher rates of prostate cancer, as in the USA. Asian women have increased rates of cancers of the mouth. Black and Asian women with breast cancer have poorer survival. [7]

Unfortunately, there are several aspects of our medical education lacking the representation it needs, leading to downstream inequalities like this. I decided to make this blog post to collate the amazing resources that I found for us to support one another in decolonising the medical curriculum and institutional racism. It is also important to explore effective ways that we can change our educational/healthcare environment going forward and to educate ourselves/up-skill on how to identify conditions on black and brown skin and how they may manifest in these individuals.


These are some social media accounts that have educated and inspired me along the way:

  • @BrownSkinMatters - Instagram depicting different presentations of dermatological conditions on brown and black skin

  • @Blackhealthmatters.uk - An Instagram to educate the public about health statistics and presentations in black patients

  • Melanin Medics (@melaninmedics on Instagram and Twitter)

  • African Caribbean Medical Mentors (@acmedicalmentors on Instagram and @acmedicalmentor on Twitter)

  • Modern Day Medics (@MDmedics on Twitter)

  • All of the organisations above support and uplift aspiring and current black African/Caribbean medical students & doctors.They also run amazing events to help students get into medicine and for current students to develop professional skills, enhance your portfolio/CV and learn from doctors.

  • @amileya - Dr. Amile Inusa compiles some great posts and statistics about race and healthcare. She also discusses taboo topics in healthcare regarding race.

  • @DecolonizeGH (Twitter) - Provide an extensive reading list for decolonising the medical curriculum

I also recommend that every medical student reads the BMA (British Medical Association) Racial Harassment Charter so you are aware of what to do and how to report racial discrimination if it happens during your medical education and beyond (even if it is not directly happening to you).


Furthermore, Malone Mukwende, a St. George's medical student, has put together a fantastic handbook that presents clinical features on darker skin: Mind the Gap. Mind The Gap has sparked a worldwide discussion about the dangerous gaps in medical education that are ultimately leading to disproportionately poorer healthcare being delivered to black and brown patients. The book has been promoted in places such as the House of Lords, BMJ, Sky News, BBC, ITV, Washington Post, Medscape, CBC, Fox News, AjPlus + More!

You can keep up to date with more of Malone's ventures as well as the release of his book via his social media accounts: Instagram, Twitter, LinkedIn

Resources like this can shift the culture of medical education. Please see https://www.blackandbrownskin.co.uk/ to sign up for a notification when the book is released.


The GMC's statement on ethnically diverse medical school teaching materials can be found here - hopefully Mind the Gap will be integrated into our teaching!


So what can you do now?


Petitions you can sign (updated 01/08/20) - some have had responses but none have been debated yet and are still open to sign:

What you can read:

To end this blog post, I encourage you to keep discussing these uncomfortable facts (and these are not even all of them), whether you are of the same race or not. Run events, get involved in public health campaigns, do not be afraid to put forward new ideas or to question doctors/clinicians about their practice with certain patients. As future doctors, patient safety is our ultimate goal and the reality is: a whole group of patients are being failed by our healthcare services. We must truly be culturally competent and aware of the inequalities that exist in order to tackle them. Every time you learn about a condition (especially dermatological), do a quick google search on what it looks like on darker skin. Think about the barriers that the most vulnerable people in our community may face and acknowledge the systemic racism that place some of these barriers in their way. Feel free to use this blog post as a way to start navigating this information and 'decolonising' the way you think about medicine and healthcare. It is only when you start doing this, that you will be the best doctor you can be! You must have diverse knowledge to serve the diverse population.


References:


1. Ethnic pay gap among NHS Doctors by John Appleby, Nuffield Trust

2. MBRRACE-UK: Saving Lives, Improving Mothers' care

3. Disparities in the risk and outcomes of COVID-19, 2020

4. HSJ Deaths of NHS Staff from COVID-19 analysed

5. Denzel, A Dorina et al. “Ethnic variations regarding clinical profiles and symptom representation in prisoners with psychotic disorders.” BJPsych open vol. 4,1 (2018): 18-28

6. Mental Health Act Statistics, Annual Figures 2019

7. National Cancer Intelligence Network (NCIN) & Cancer Research: Cancer Incidence & Survival by Major Ethnic Group 2001-2006



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