Duluth Campus
Task force 4 change
In response to the murder of George Floyd in May, Duluth students have been organizing under the name "Task Force 4 Change" in order to connect efforts in curriculum reform, admissions changes, writing letters to medical groups, and more.
The Duluth campus is no exception to the history of institutional racism in our nation's medical schools. Because of its unique mission that includes serving American Indian and Alaska Native people, many of Duluth students' efforts have been centralized on elevating the voices of Native medical students.
On July 23rd, 2020, students in the Task Force 4 Change sent a letter to Duluth campus Dean Termuhlen and the Duluth Campus Leadership Team to call attention to recent events as well as the long history of inaction to injustices faced by Native medical students and students of color.
Since sending this letter, Duluth Task Force 4 Change students have been organizing alongside the Med Ed Reform Student Coalition to coordinate our efforts.
On September 2nd, 2020, students of the Task Force 4 Change, Association of Native American Medical Students (ANAMS), and Med Ed Reform Student Coalition had a round table meeting with deans and administrators of both campuses to discuss issues of racial injustice and inequity specific to the Duluth campus. At this meeting, Duluth students emphasized the changes demanded in the original Med Ed Reform Student Coalition letter, and we also brought forth a list of Duluth-specific action items, which can be seen here.
14 Additional DUluth-Specific Action Items
- Incorporate, emphasize, and normalize non-white perspectives, experiences, and clinical presentations, especially those of Native Americans, within the core curriculum.
Analyze where diversity is lacking and/or adjunct to a white prototype within core curriculum.
We’d like to acknowledge that the Duluth campus recently obtained access to VisualDx. Rather than be limited to supplementation, VisualDx and similar resources should be utilized and referenced live in lectures if lecture materials themselves fail to provide examples of pathology on Black and Brown skin at a frequency that is, at minimum, reflective of the patient population.
Update curriculum to include historical context of racist medical practices and events to assist in the understanding of persistent health disparities and the relationship between the medical field and Black, Indigenous, and person of color (BIPOC) communities.
Example: In Hormone and Reproductive Medicine, curriculum should include discussion of disparities in maternal and infant mortality 1 and the occurrence of forced sterilization of Native women and other women of color 2, 3 as an important framework to the pathophysiology and treatment of disease.
Bioethics and research ethics education should include coverage of the Tuskegee trials. Any education on the Belmont Report and core ethical principles of research is incomplete without prefacing with the atrocities that warranted these ethical standards.
Research education should cover racial bias and minimizing practices in sample selection, analysis, and publication and be followed by discussion of the implications for evidence-based practice.
- Denounce and phase out race-based medicine
Many institutions, including the Minnesota Academy of Family Physicians (MAFP), have denounced the use of race-based medicine. As a scientific institution training future physicians, the Duluth campus has a responsibility to not only acknowledge the lack of science behind the use of race as a marker of disease (etc.), but to actively teach against the use of race-based medicine.
We ask that the Duluth Campus Leadership Team continue collaborating with the Twin Cities campus to phase out race-based medicine from our medical education.
Effective immediately, screen for and edit race-based content in exams.
Example: One author of this document recalls struggling to complete an exam during the Skin-Musculoskeletal course after the emotional impact of encountering a set of singly-authored standardized case studies, none of which included the race of the patient, except for in the case of a Black male patient. The answer choices included conditions that were entirely musculoskeletal and for which race/ethnicity had no clinical relevance. The implications are deeply disturbing and triggering to students of color who live this bias.
For further reading:
Scientific American - “What role should race play in medicine” by Jennifer Tsai
MAFP
- Invite speakers, panelists, and experts that represent diverse populations to lecture on the core curriculum.
In addition to inviting lecturers who are BIPOC, it is also valuable to invite lecturers who have served BIPOC communities. With the availability of experts and the flexibility provided by virtual learning, now is the time to prioritize extending invitations to BIPOC experts.
Reevaluate the qualifications of returning guest lecturers who are unable to demonstrate expertise in their field as it relates to serving a diverse patient population, providing equitable healthcare, and considering major public health crises in MN.
Example: During an 11/06/19 lecture on Lyme disease, a medical student inquired about the presentation of a pathognomonic rash on non-white patients and about the diagnostic procedures in these cases. The lecturer was unable to provide a knowledgeable answer and offered no follow-up.
- Recruit and hire more faculty and staff of color. Prioritize retention of current faculty and staff of color. Diversify Duluth campus leadership by recognizing and promoting faculty of color.
Prioritize candidates that are members of underrepresented populations, specifically those with a strong presence in Minnesota:
Native American, African American, African, Somali, Hmong, Karen, and Latinx
Prioritize recruitment of Native American faculty and staff that have a personal and/or professional connection to a Native community.
Inquire into the experiences of current faculty and staff of color at the Duluth campus and create a plan to ensure support and maximize retention. Review instances where faculty and staff of color have resigned from the Duluth campus to inform these efforts.
Actively support faculty and staff of color, reimburse them according to the added value they bring to the community, and elevate their voices.
Reflect on the demographics/characteristics of the Duluth administrative leadership and tenure faculty.
- Engage BIPOC members of our community - both within and outside of our medical school - in the redesign of the admissions process so that racist and white supremacist students are effectively screened out and prevented from matriculating.
The collaborators of this letter of action items include representatives of the classes of 2020 through 2023 who can confirm many instances of racist and discriminatory behavior committed by fellow classmates on the Duluth campus, including those voiced in our original letter. This was not an exhaustive list.
Racist applicants, regardless of their commitment to any aspect of the Duluth campus mission, must be viewed as a liability to the University of Minnesota and to the field of medicine.
Duluth admissions must commit to working alongside the Twin Cities admissions in reforming committee and process.
At least two positions on the Duluth admissions committee must be reserved for BIPOC representatives.
We demand that in the name of anti-racism, the Duluth campus reframes its priority from accepting students raised in rural communities instead to applicants who can strongly demonstrate intentional, longitudinal experiences in engaging with a community outside of their own.
Example: a student from an urban area with stated interest in rural and/or BIPOC-focused primary care who has experience working with a diverse community must be rated higher than a student from a rural community who cannot demonstrate experience with diverse communities.
- Arrange for third party review of admissions processes.
Of the BIPOC students matriculated into the class of 2023: 24% hold advanced degrees, 24% received training from ivy league institutions, ≥41% have made scholarly contributions to medicine, public health, and related fields in a professional capacity, and ≥24% identify as members of the LGBTQ community.
We offer no comment on the significance of this information. We observe the pre-matriculation qualifications and characteristics of the BIPOC students to be incongruous with those of our non-BIPOC peers and urge investigation into the equity of the admissions process.
- To become an institution that serves and engages its hosting community, commit to engaging the local communities of color, building relationships with community organizations, providing funding for in-house events, and creating local community engagement volunteer opportunities for students.
The Medical School should be well-known and have a positive reputation within the BIPOC communities of Duluth, and community members should feel like the school belongs to them and their futures, too. Although the Duluth campus caters to rural interests, the city of Duluth hosts our campus.
In addition to more community events and engagement, Duluth citizens of color should be consulted whenever possible. This should include consulting in the admissions process, in curriculum related to social determinants of health and health disparities, and other processes where community BIPOC voices are needed.
When people of color, including students, are consulted and utilized for their unique perspectives, they must be financially compensated for their time and expertise.
Consider providing retroactive financial compensation for students who have given their service, at the detriment of their wellbeing and educational standing.
- Reevaluate the current Community Advisors for the Duluth campus for representation of the community and create space for community members to engage in discussion with the medical school.
Establish a recurring Town Hall with Duluth administration (at minimum, 4 meetings per academic year) that invites “walk-in” participation from members of the community to engage in open discussion on the topics that they see fit.
- Do more to support and emphasize diversity within the mainstream medical school culture and environment.
Training providers in Native American healthcare also means recognizing and valuing the culture, values, traditions, and norms held by Native students.
Create opportunities for out-of-state Native students to return to their home communities and tribes for RMSP.
Many Native students have found it difficult to access the academic support services available on campus. Ensure that the Native students have access to academic support that is informed on Native sociocultural norms, learning styles, and a variety of academic backgrounds/experiences.
Provide adequate training to ensure that facilitators of small group discussion are mindful of the diversity of communication and of social norms. It is not uncommon for BIPOC students to be spoken over, disregarded, and discouraged by more vocal peers. Faculty should be prepared to recognize power differentials within a group and be comfortable supporting conversation that is equitable, which may include moderating where necessary.
Furthermore, the ability to engage in respectful and conscientious communication does not require culture-specific training and should be considered a core measure of professionalism.
- Review complaints about any current or future RMSP preceptors and commit to breaking ties to preceptors who have been reported for racist words or actions.
Task Force for Change can provide administration with the identity of some preceptors known to discriminate against patients on the basis of race, upon request.
- Take responsibility for governing the harm that occurs within the medical school community.
When harmful information is distributed within the medical school by students, staff, or faculty, the Medical School is responsible for the content. It is the responsibility of the sponsoring institution to mitigate the harm and enact corrective action.
Example: If a member of the community distributes a message of hate and division, as on 05/31/20, it is the responsibility of the medical school to mitigate harm done by listening to those impacted and distributing a message reinforcing unity.
Example: If a lecturer includes discriminatory and derogatory content in their lecture materials, as on 01/15/2020, it is the responsibility of the medical school to provide corrected education. It is of equal importance that there is recognition of the harm done.
- Establish an internal Restorative Justice Committee.
While the Duluth campus prides itself on our close-knit community, we also lack the essential quality of a group who demonstrates a value of equity which is to acknowledge and anticipate that hurtful events will occur within our community and to pre-establish pathways for repair.
Designate a point of contact to receive concerns and establish a plan of action.
Establish a committee to evaluate concerns in light of the standards and values of our community and determine the appropriate course for resolution with the goal of repairing harm and restoring a sense of equity and inclusion in the community.
- Provide the Duluth campus community, including alumni, with quarterly updates on progress related to dismantling our institutional racism and working towards equity in medicine.
Communicate regularly with Duluth students, faculty and staff on efforts and progress to increase transparency, accountability, and unity.
Ensure all new and ongoing Duluth efforts are reflected in the Med Ed Reform Student Coalition Action Items + Updates document to ensure optimal transparency and accountability.
- Be explicit about the Duluth campus’ commitment to Diversity, Equity, and Inclusion.
While offering our deepest appreciation of the importance of institutional recognition and support of seniority/tenure status and enforcement of academic freedom, we assert that the advancement of medical education towards equity is a matter of academic integrity.