Letter from the Editor - Teaching & Learning in Medicine’s Anti-Racism Strategy

Dear Readers,

A confluence of events in the U.S., including the COVID-19 pandemic and the deaths of George Floyd, Breonna Taylor, and Ahmaud Arbery among many others have exposed the deeply rooted connection between social, economic, and environmental justice, individual well-being, and community and population health. Over centuries, institutional structures and policies influenced by racial prejudice have produced socioeconomic inequality and historical trauma that underlie the health disparities suffered by Black Americans. We know these as the social determinants of health for which we must account to improve care outcomes. The June 1^st 2020 AAMC Statement on Police Brutality and Racism in America and Their Impact on Health notes that “…the people of America’s medical schools and teaching hospitals bear the responsibility to ameliorate factors that negatively affect the health of our patients and communities: poverty, education, access to transportation, healthy food, and health care.”

Institutionalized racism does not affect patients alone. Medical trainees, faculty, and staff from minoritized racial groups daily experience bias—explicit and implicit—and must navigate academic systems and power structures that, at best, were not designed to include them. The result includes disparities in educational experiences, performance outcomes, and career advancement that mirror racism’s impact on health and well-being. Recognizing the scientific enterprise’s complicity in perpetuating racism, the American Association for the Advancement of Science (AAAS) has recently called researchers in Science, Technology, Engineering, Math, and Medicine fields to “to pause, listen, and reflect on how—as an organization, as members of the scientific community, and as members of our broader communities—we can and must be a powerful force for change.”

Those of us who have discovered our own complicity in racially biased systems have found ourselves asking, “What can I do to help?” Anti-racism experts tell us that to move beyond rhetoric and take action toward dismantling racially biased systems, we must read, listen to, and amplify the voices that historically have been silenced. Toward this end, Teaching & Learning in Medicine has established a working Anti-Racism Strategy, a response to the AAAS call that includes medical education researchers situated in the Social and Behavioral Sciences. The purpose of this strategy is to identify and address systems at work in TLM’s structure and function that contribute to race-related disparities in medical education scholarship. The goal of this strategy is to dedicate space for individuals from racially minoritized groups in medicine to contribute their voices to knowledge-building conversations about the selection, development, and sustainment of health professionals.

TLM’s anti-racism strategy has the following aims:

Read – TLM will increase access to quality scholarship that informs efforts to increase diversity and inclusion in medical education research and practice by:

• Soliciting scholarly investigations and critical conceptual analyses that uncover systemic factors perpetuating racial inequity in medical education opportunity, experience, and outcomes.

• Ensuring that TLM has editors and staff reviewers with the requisite knowledge and expertise to effectively evaluate, cultivate, and manage submissions that deal with systemic racism in medical education.

• Periodically releasing TLM publications on diversity and inclusion to open access so that they will be freely accessible to all. Recent selected publications may be found along with other open access articles supporting the fight against racism at https://taylorandfrancis.com/socialjustice/.

• Exploring over the longer-term opportunities with our publisher to establish open access agreements with Historically Black Colleges and Universities and other institutions whose missions include educating and caring for people from minoritized racial groups.

Listen – TLM will provide a space for the voices of people from racial groups minoritized in medicine and their allies to be heard by:

• Soliciting scholarly evaluations of anti-racist interventions that provide helpful guidance to institutions seeking transformation.

• Seeking commentaries from trainees and faculty from racial groups minoritized in medicine exploring the blind spots with respect to race in TLM publications. The first commentary of this nature (E. Maduakolam, T. Kelley, B. Madden, & A. Cianciolo – “Beyond Diversity: Envisioning Inclusion in Medical Education Research and Practice”) is included in this issue.

• Organizing and participating in editors’ panels at academic conferences to foster community discussion on improving diversity and inclusion in medical education scholarship. The first of these will take place at this year’s virtual Generalists in Medical Education Conference (V. Brennan, A. Cianciolo, S. Crandall, P. de Jong, L. Hurtubise, H. Stoddard, D. Way – “Why and How Scholarly Publishing Should Become Anti-racist: An Interactive Session Facilitated by Editors of Medical Education Journals.”).

• Incorporating the input of scholars from racial groups minoritized in medicine into the evaluation and refinement of this anti-racism strategy.

• Seeking guidance on strategy refinement from international editors with strong anti-racism track records.

Amplify – TLM will actively cultivate the voices of people from racial groups minoritized in medicine education research and practice by:

• Increasing the representation of scholars from racial groups minoritized in medicine on TLM’s editorial board who will evaluate and cultivate scholarship across the full-spectrum of medical education topics in their area of expertise.

• Committing to the professional development of scholars from racial groups minoritized in medicine through mentorship and outreach, including a newly established TLM Editorial Internship Program.

Beginning with TLM, the outcomes we aim to achieve with this strategy include:

1. Increased participation of people from racially minoritized groups in published medical education scholarship;

2. Increased membership of people from racially minoritized groups on medical education journal editorial boards;

3. Improved theoretical and conceptual understanding of medical education phenomena stemming from greater accountability to diversity in research questions and design;

4. More inclusive medical education practice, informed by improved theoretical and conceptual understanding; and, ultimately

5. Enhanced career advancement of people from racially minoritized groups with respect to scholarly productivity, promotion and tenure, and academic leadership.

In implementing this strategy TLM will continue to fulfill its mission to “foster the development of capable, well-rounded, and continuous learners prepared to practice in a complex, high-stakes, and ever-changing clinical environment by providing the theoretical foundations and practical analysis needed for effective educational decision making.” However, we are moving forward determined to enact this mission conscientiously and consistently including all scholars and learners to achieve not only effective, but just educational decision making. Although this statement is focused on race, we recognize racism as an urgent problem among a wider set of ills limiting diversity and inclusion in medical education research and practice. We hope our Anti-Racism Strategy will encourage efforts to raise the voices of all people who have been marginalized in the advancement of medical education scholarship.

This Anti-Racism Strategy has the full support of TLM’s editorial board, as well as our publisher, Taylor & Francis. We are sharing this strategy knowing that it will need refinement over time and with the full expectation that we are making ourselves accountable to our readers, our contributors, and the international medical education community. We gratefully acknowledge the contributions of Dr. Quinn Capers IV and Dr. Antonio Bush to drafting this statement and thinking through associated implementation strategies. We encourage additional feedback and input on our approach, which can be provided via email ([email protected]) or Twitter (@TLMedEd). We look forward to collaborating with you in making real, positive change on this important issue.

Anna T. Cianciolo, PhD, Editor in Chief
On behalf of:
The Teaching and Learning in Medicine Editorial Board