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见窗窥蛛:将批判种族理论应用于医学教育,弥补生物医学模型和健康决定因素课程的不足。

Seeing the Window, Finding the Spider: Applying Critical Race Theory to Medical Education to Make Up Where Biomedical Models and Social Determinants of Health Curricula Fall Short.

机构信息

Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States.

Office of Healthcare Equity, University of Washington School of Medicine, Seattle, WA, United States.

出版信息

Front Public Health. 2021 Jul 9;9:653643. doi: 10.3389/fpubh.2021.653643. eCollection 2021.

Abstract

A professional and moral medical education should equip trainees with the knowledge and skills necessary to effectively advance health equity. In this Perspective, we argue that critical theoretical frameworks should be taught to physicians so they can interrogate structural sources of racial inequities and achieve this goal. We begin by elucidating the shortcomings in the pedagogic approaches contemporary Biomedical and Social Determinants of Health (SDOH) curricula use in their discussion of health disparities. In particular, current medical pedagogy lacks self-reflexivity; encodes social identities like race and gender as essential risk factors; neglects to examine root causes of health inequity; and fails to teach learners how to challenge injustice. In contrast, we argue that Critical Race Theory (CRT) is a theoretical framework uniquely adept at addressing these concerns. It offers needed interdisciplinary perspectives that teach learners how to abolish biological racism; leverage historical contexts of oppression to inform interventions; center the scholarship of the marginalized; and understand the institutional mechanisms and ubiquity of racism. In sum, CRT does what biomedical and SDOH curricula cannot: rigorously teach physician trainees how to combat health inequity. In this essay, we demonstrate how the theoretical paradigms operationalized in discussions of health injustice affect the ability of learners to confront health inequity. We expound on CRT tenets, discuss their application to medical pedagogy, and provide an in-depth case study to ground our major argument that . We introduce MedCRT: a CRT-based framework for medical education, and advocate for its implementation into physician training.

摘要

专业的医学教育应该使医学生掌握必要的知识和技能,以有效地促进健康公平。在这篇观点文章中,我们认为,应该向医生传授批判性理论框架,使他们能够质疑种族不平等的结构性根源,并实现这一目标。我们首先阐明了当代生物医学和社会决定因素健康(SDOH)课程在讨论健康差距时所采用的教学方法的不足之处。特别是,当前的医学教学缺乏自我反思;将种族和性别等社会身份编码为重要的风险因素;忽视了对健康不平等根源的考察;并且未能教导学习者如何挑战不公正。相比之下,我们认为批判种族理论(CRT)是一个独特的理论框架,能够很好地解决这些问题。它提供了必要的跨学科视角,教导学习者如何消除生物种族主义;利用压迫的历史背景为干预措施提供信息;以边缘化的学者为中心;并理解制度机制和种族主义的普遍性。总之,CRT 能够做到生物医学和 SDOH 课程无法做到的事情:严格地教导医学生如何消除健康不平等。在这篇文章中,我们展示了讨论健康不公正时所采用的理论范式如何影响学习者应对健康不平等的能力。我们阐述了 CRT 的原则,讨论了它们在医学教学中的应用,并提供了一个深入的案例研究,以支持我们的主要论点,即 。我们引入了 MedCRT:一个基于 CRT 的医学教育框架,并主张将其纳入医生培训。

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