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Building Structural Empathy to Marshal Critical Education into Compassionate Practice: Evaluation of a Medical School Critical Race Theory Course

Published online by Cambridge University Press:  29 June 2021

Jennifer Tsai
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Abstract

Ideas of racial genetic determinism, though unsupported by scientific evidence and atavistic, are common and readily apparent in American medical education. These theories of biologic essentialism have documented negative effects in learners, including increased measures of racial prejudice.

Keywords

Critical Race TheoryMedical EducationBiologic EssentialismStructural RacismStructural Empathy
Type
Symposium Articles
Information
Journal of Law, Medicine & Ethics , Volume 49 , Issue 2: Race and Ethnicity in 21st Century Health Care , Summer 2021 , pp. 211 - 221
Copyright
© 2021 The Author(s)

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References

Sharma, M., Pinto, A. D., and Kumagai, A.K., “Teaching the Social Determinants of Health: A Path to Equity or a Road to Nowhere?” Academic Medicine 93, no. 1 (2018): 25-30.CrossRefGoogle ScholarPubMed
Cummins, S. and Macintyre, S., “Food Environments and Obesity — Neighbourhood or Nation?” International Journal of Epidemiology 35, no. 1 (2006): 100-104; D. R. Williams and P. B. Jackson, “Social Sources of Racial Disparities in Health,” Health Affairs 24, no. 2 (2005): 325-334.Google Scholar
Sharma et al., supra note 1; Simis, M. J., Madden, H., Cacciatore, M. A., and Yeo, S. K., “The Lure of Rationality: Why Does the Deficit Model Persist in Science Communication?” Public Understanding of Science 25, no. 4 (2016): 400-414; D. G. Solorzano and T. J. Yosso, “From Racial Stereotyping and Deficit Discourse Toward a Critical Race Theory in Teacher Educa-tion,” Multicultural Education 9, no. 1 (2001): 2.10.1177/0963662516629749CrossRefGoogle Scholar
Sharma et al., supra note 1.Google Scholar
Vyas, D. A., Eisenstein, L. G., and Jones, D. S., “Hidden in Plain Sight — Reconsidering the Use of Race Correction in Clinical Algorithms,” New England Journal of Medicine 383 (2020): 874-882; T. Duster, Backdoor to Eugenics, 2nd ed. (New York: Routledge; 2003); J. Tsai, J. Cerdeña, and Khazanchi R, et al., “There is No ‘African American Physiology’: The Fallacy of Racial Essentialism,” Journal of Internal Medicine 288, no. 3 (2020): 368-370; J. P. Cerdena, M.V. Plaisime, and J. Tsai, “From Race-Based to Race-Conscious Medicine: How Anti-Racist Uprisings Call us to Act,” Lancet 396, no. 10257 (2020): 1125-1128.Google Scholar
Ryn, M. van, Hardeman, R., and Phelan, S. M., et al., “Medical School Experiences Associated with Change in Implicit Racial Bias Among 3547 Students: A Medical Student CHANGES Study Report,” Journal of General Internal Medicine 30, no. 12 (2015): 1748-1756.CrossRefGoogle Scholar
Fuentes, A., Ackermann, R. R., and Athreya, S., et al., “AAPA Statement on Race and Racism,” American Journal of Physical Anthropology 169, no. 3 (2019): 400-402; L. Braun and B. Saunders, “Avoiding Racial Essentialism in Medical Science Curricula,” AMA Journal of Ethics 19, no. 6 (2017): 518-527.CrossRefGoogle ScholarPubMed
Andreychik, M. R. and Gill, M. J., “Do Natural Kind Beliefs about Social Groups Contribute to Prejudice? Distinguishing Bio-Somatic Essentialism from Bio-Behavioral Essentialism, and Both of These From Entitativity,” Group Processes & Intergroup Relations 18, no. 4 (2015): 454-474.CrossRefGoogle Scholar
Plaks, J. E., Malahy, L. W., Sedlins, M., and Shoda, Y., “Folk Beliefs about Human Genetic Variation Predict Discrete Versus Continuous Racial Categorization and Evaluative Bias,” Social Psychological and Personality Science 3, no. 1 (2012): 31-39; S. K. Kang, J. E. Plaks, and J. D. Remedios, “Folk Beliefs About Genetic Variation Predict Avoidance of Biracial Individuals,” Frontiers in Psychology 6 (2015): 357; B. Bastian and N. Haslam, “Psychological Essentialism and Stereotype Endorsement,” Journal of Experimental Social Psychology 42, no. 2 (2006): 228-235; M. M. Chao, Y.-Y. Hong, and C.-Y. Chiu, “Essentializing Race: Its Implications on Racial Catego-rization,” Journal of Personality and Social Psychology 104, no. 4 (2013): 619; N. Haslam, B. Bastian, P. Bain, and Y. Kashima, “Psychological Essentialism, Implicit Theories, and Intergroup Relations,” Group Processes & Intergroup Relations 9, no. 1 (2006): 63-76; A. Roets and A. Van Hiel, “The Role of Need for Closure in Essentialist Entitativity Beliefs and Prejudice: An Epistemic Needs Approach to Racial Categorization,” British Journal of Social Psychology 50, no. 1 (2011): 52-73; K. Pauker, N. Ambady N, and E. P. Apfelbaum, “Race Salience and Essentialist Thinking in Racial Stereotype Development,” Child Development 81, no. 6 (2010): 1799-1813; U. Rangel and J. Keller, “Essentialism Goes Social: Belief in Social Determinism as a Component of Psychological Essentialism,” Journal of Personality and Social Psychology,” 100, no. 6 (2011): 1056.Google Scholar
Williams, M. J. and Eberhardt, J. L., “Biological Conceptions of Race and the Motivation to Cross Racial Boundaries,” Journal of Personality and Social Psychology 94, no. 6 (2008): 1033; A. Rattan, K. Savani, N. Naidu, and C. S. Dweck, “Can Everyone Become Highly Intelligent? Cultural Differences in and Societal Consequences of Beliefs About the Universal Potential for Intelligence,” Journal of Personality and Social Psychology 103, no. 5 (2012): 787; H. Brueckner, A. Morning, and A. Nelson, “The Expression of Biological Concepts of Race,” paper presented at Annual Meeting of the American Sociological Association, Philadelphia, PA (2005), available at <http://www.tessexperiments.org/sup/brueckner275_genet-ics.pdf> (last visited May 5, 2021).CrossRefGoogle ScholarPubMed
Vyas et al., supra note 5; Braun and Sanders, supra note 7; Braun, L., Breathing Race Into the Machine: The Surprising Career of the Spirometer from Plantation to Genetics (Min-neapolis: University of Minnesota Press, 2014); L. Braun, “Theorizing Race and Racism: Preliminary Reflections on the Medical Curriculum,” American Journal of Law & Medicine 43, no. 2&3 (2017): 239-256; J. Tsai, L. Ucik, N. Baldwin, C. Hasslinger, and P. George, “Race Matters? Examining and Rethinking Race Portrayal in Preclinical Medical Education,” Academic Medicine 91, no. 7 (2016): 916-920.Google Scholar
Braun and Sanders, supra note 7; Donovan, B. M., “Playing With Fire? The Impact of the Hidden Curriculum in School Genetics on Essentialist Conceptions of Race,” Journal of Research in Science Teaching 51, no. 4 (2014): 462-496; L. Lieberman, R. E. Hampton, A. Littlefield, and G. Hallead, “Race in Biology and Anthropology: A Study of College Texts and Professors,” Journal of Research in Science Teaching 29, no. 3 (1992): 301-321; J. C. Phelan, B. G. Link, and N. M. Feldman, “The Genomic Revolution and Beliefs about Essential Racial Differences: A Backdoor to Eugenics?” American Sociological Review 78, no. 2 (2013): 167-191.CrossRefGoogle Scholar
Donovan, B. M., “Framing the Genetics Curriculum for Social Justice: An Experimental Exploration of How the Biology Curriculum Influences Beliefs about Racial Difference,” Science Education 100, no. 3 (2016): 586-616; C. M. Condit et al., “Exploration of the Impact of Messages about Genes and Race on Lay Attitudes,” Clinical Genetics 66, no. 5 (2004): 402-408; J. T. Jost et al., “Political Conservatism as Motivated Social Cognition,” Psychological Bulletin 129, no. 3 (2003): 339; V. Yzerbyt, O. Corneille, and C. Estrada, “The Interplay of Subjective Essentialism and Entitativity in the Formation of Stereotypes,” Personality and Social Psychology Review 5, no. 2 (2001): 141-155; L. M. DeBruine, “Facial Resemblance Enhances Trust,” Proceedings of the Royal Society of London, Series B: Biological Sciences 269, no. 1498 (2002): 1307-1312; W. D. Hamilton, “The Genetical Evolution of Social Behaviour, II, Journal of Theoretical Biology 7, no. 1 (1964): 17-52; D. J. Kruger, “Evolution and Altruism: Combining Psychological Mediators with Naturally Selected Tendencies,” Evolution and Human Behavior 24, no. 2 (2003): 118-125; R. O’Gorman, D. S. Wilson, and R. R. Miller, “Altruistic Punishing and Helping Differ in Sensitivity to Relatedness, Friendship, and Future Interactions,” Evolution and Human Behavior 26, no. 5 (2005): 375-387.CrossRefGoogle Scholar
Metzl, J. M. and Hansen, H., “Structural Competency: Theorizing a New Medical Engagement with Stigma and Inequal-ity,” Social Science & Medicine 103 (2014): 126-133.CrossRefGoogle Scholar
Tsai, J. and Crawford-Roberts, A., “A Call for Critical Race Theory in Medical Education,” Academic Medicine 92, no. 8 (2017): 1072-1073.CrossRefGoogle Scholar
Bridges, K. M., Critical Race Theory: A Primer (St. Paul: West Academic, 2018).Google Scholar
Id.; Delgado, R. and Stefancic, J., Critical Race Theory: An Introduction (New York: NYU Press, 2017).Google Scholar
Bridges, supra note 16; Hatch, A. R., “Critical Race Theory,” The Blackwell Encyclopedia of Sociology (London: Wiley-Black-well, 2007); M. J. Matsuda, Words that Wound: Critical Race Theory, Assaultive Speech, and the First Amendment (Boul-der: Boulder, 1993); E. Lindo, B. Williams, and M-T Gonzalez, “Uncompromising Hunger for Justice: Resistance, Sacrifice, and LatCrit Theory,” Seattle Journal of Social Justice 16 (2017): 727.Google Scholar
Sharma, supra note 1; Kumagai, A. K. and Lypson, M. L., “Beyond Cultural Competence: Critical Consciousness, Social Justice, and Multicultural Education,” Academic Medicine 84, no. 6 (2009): 782-787; P. Verdonk, “When I Say… Reflexiv-ity,” Medical Education 49, no. 2 (2015): 147-148.CrossRefGoogle ScholarPubMed
Sharma, M., “Applying Feminist Theory to Medical Educa-tion,” The Lancet 393, no. 10171 (2019): 570-578; S. DasGupta, et al., “Medical Education for Social Justice: Paulo Freire Revisited,” Journal of Medical Humanities 27, no. 4 (2006): 245-251; D. Wear, “Professional Development of Medical Students: Problems and Promises,” Academic Medicine: Journal of the Association of American Medical Colleges 72, no. 12 (1997): 1056-1062; R. K. Tsevat, et al., “Bringing Home the Health Humanities: Narrative Humility, Structural Competency, and Engaged Pedagogy,” Academic Medicine 90, no. 11 (2015): 1462-1465.CrossRefGoogle Scholar
Solorzano, supra note 3; Delgado, supra note 17.Google Scholar
Lindo, supra note 18.Google Scholar
Ford, C. L. and Airhihenbuwa, C.O., “Critical Race Theory, Race Equity, and Public Health: Toward Antiracism Praxis,” American Journal of Public Health 100, no. S1 (2010): S30-S35; B. D. Hodges, “When I Say… Critical Theory,” Medical Education 48, no. 11 (2014): 1043-1044.CrossRefGoogle Scholar
Tsai, supra note 15; Hooks, B., Teaching Critical Thinking: Practical Wisdom (New York: Routledge; 2010).Google Scholar
Metzl, supra note 14; Westerhaus, M. et al., “The Necessity of Social Medicine in Medical Education,” Academic Medicine 90, no. 5 (2015): 565-568.CrossRefGoogle ScholarPubMed
L. Braun, “Theorizing Race and Racism: Preliminary Reflections on the Medical Curriculum,” supra note 11; Toste-son, D. C., “New Pathways in General Medical Education,” New England Journal of Medicine 322, no. 4 (1990): 234-238.CrossRefGoogle Scholar
Freire, P., Pedagogy of the Oppressed (New York: Bloomsbury Publishing USA, 2018).Google Scholar
Kiraly, D., A Social Constructivist Approach to Translator Education: Empowerment from Theory to Practice (New York; Routledge, 2014); F. C. Lunenburg, “Critical Thinking and Constructivism Techniques for Improving Student Achieve-ment,” paper presented at National Forum of Teacher Education Journal (2011); H. W. Hackman, “Five Essential Components for Social Justice Education,” Equity & Excellence in Education 38, no. 2 (2005): 103-109.Google Scholar
Vyas, supra note 5.Google Scholar
Boatright-Horowitz, S. L. and Soeung, S., “Teaching White Privilege to White Students Can Mean Saying Good-Bye to Positive Student Evaluations,” American Psychologist 64, no. 6 (2009): 574–575, available at <https://doi.org/10.1037/a0016593> (last visited May 5, 2021).CrossRefGoogle ScholarPubMed
Hackman, supra note 28; Willingham, D. T., “Critical Thinking: Why is it So Hard to Teach?” Arts Education Policy Review 109, no. 4 (2008): 21-32.CrossRefGoogle Scholar
Freire, supra note 27; Kumagai, A. K. et al., “Dialogues on the Threshold: Dialogical Learning for Humanism and Justice,” Academic Medicine 93, no. 12 (2018): 1778-1783.CrossRefGoogle ScholarPubMed
Astin, A. W., “Student Involvement: A Developmental Theory for Higher Education,” Journal of College Student Personnel 25, no. 4 (1984): 297-308; C. Bovill, A. Cook‐Sather, and P. Felten, “Students as Co‐Creators of Teaching Approaches, Course Design, and Curricula: Implications for Academic Developers,” International Journal for Academic Development 16, no. 2 (2011): 133-145.Google Scholar
Metzl, supra note 14.Google Scholar
Ford and Airhihenbuwa, supra note 23; Brayboy, B. M. J., “Toward A Tribal Critical Race Theory in Education,” The Urban Review 37, no. 5 (2005): 425-446.CrossRefGoogle Scholar
Israel, B. A., Schulz, A. J., and Parker, E. A., et al., “Critical Issues in Developing and Following CBPR Principles,” Com-munity-Based Participatory Research for Health: Advancing Social and Health Equity 3 (2017): 32-35.Google Scholar
Diversi, M. and Finley, S., “Poverty Pimps in the Academy: A Dialogue About Subjectivity, Reflexivity, and Power in Decolonizing Production of Knowledge,” Cultural Studies? Critical Methodologies 10, no. 1 (2010): 14-17.CrossRefGoogle Scholar
Nelson, A., Body and Soul: The Black Panther Party and the Fight Against Medical Discrimination (St. Paul: University of Minnesota Press; 2011).CrossRefGoogle Scholar
Sharma, Pinto, and Kumagai, supra note 1.Google Scholar
Smith, W. R., Betancourt, J. R., and Wynia, M. K., et al., “Rec-ommendations for Teaching About Racial and Ethnic Disparities in Health and Health Care,” Annals of Internal Medicine 147, no. 9 (2007): 654-665.CrossRefGoogle Scholar
Strauss, A. and Corbin, J., “Grounded Theory Methodology,” Handbook of Qualitative Research 17 (1994): 273-285.Google Scholar
Freire, supra note 27.Google Scholar
Vyas, Eisenstein, and Jones, supra note 5; Cerdena, Plaisime, and Tsai, supra note 5.Google Scholar
Fuentes, Ackermann, and Athreya, et al., supra note 7; Braun and Saunders, supra note 7; Tsai, Ucik, Baldwin, Hasslinger, and George, supra note 11; Shim, J. K., Heart-Sick: The Politics of Risk, Inequality, and Heart Disease (New York: NYU Press, 2014).Google Scholar
Donovan, supra note 12.Google Scholar
Sharma, Pinto, and Kumagai, supra note 1.Google Scholar
Ubel, P. A., Jepson, C., and Silver-Isenstadt, A., “Don’t Ask, Don’t Tell: A Change in Medical Student Attitudes after Obstetrics/gynecology Clerkships Toward Seeking Consent for Pelvic Examinations on an Anesthetized Patient,” American Journal of Obstetrics and Gynecology 188, no. 2 (2003): 575-579; N. Masson and H. Lester, “The Attitudes of Medical Students Towards Homeless People: Does Medical School Make a Difference?” Medical Education 37, no. 10 (2003): 869-872.CrossRefGoogle Scholar
Simis et al., supra note 3; Solorzano and T. J. Yosso, supra note 3; Martin, T. “The Color of Kidneys,” American Journal of Kidney Disiese 58, no. 5 (2011): xxvii-xxviii; N. Ehlers and L. R. Hinkson, Subprime Health: Debt and Race in US Medicine (St. Paul: University of Minnesota Press, 2017).Google ScholarPubMed
See the articles referenced in note 13; Condit, C. M. et al., “The Role of ‘Genetics’ in Popular Understandings of Race in the United States,” Public Understanding of Science 13, no. 3 (2004): 249-272; J. T. Jost and M. R. Banaji, “The Role of Stereotyping in System-Justification and the Production of False Consciousness,” British Journal of Social Psychology 33, no. 1 (1994): 1-27.Google ScholarPubMed
Sharma, Pinto, and Kumagai, supra note 1.Google Scholar
Bridges, supra note 16; Ford, C. L., “Public Health Critical Race Praxis: An Introduction, An Intervention, and Three Points for Consideration,” Wisconsin Law Review 3 (2016): 477-491; L. Graham et al., “Critical Race Theory as Theoretical Framework and Analysis Tool for Population Health Research,” Critical Public Health 21, no. 1 (2011): 81-93; A. J. Lee et al., “The Value of Teaching Critical Race Theory in Prison Spaces: Centering Students’ Voices in Pedagogy,” Humanities 9, no. 2 (2020): 41; L. Ortiz and J. Jani, “Critical Race Theory: A Transformational Model for Teaching Diversity,” Journal of Social Work Education 46, no. 2 (2010): 175-193; D. G. Solorzano, “Images and Words that Wound: Critical Race Theory, Racial Stereotyping, and Teacher Education,” Teacher Education Quarterly 24, no. 3 (1997): 5-19.Google Scholar
Metzl and Hansen, supra note 14.Google Scholar
Stone, D. A., “Causal Stories and the Formation of Policy Agen-das,” Political Science Quarterly 104, no. 2 (1989): 281-300.CrossRefGoogle Scholar
Betancourt, J. R. and King, R. K., “Unequal Treatment: The Institute of Medicine Report and its Public Health Implica-tions,” Public Health Reports 118, no. 4 (2003): 287.CrossRefGoogle Scholar