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IDEAS

Why doesn’t medical school prioritize social justice?

If academic medical institutions are serious about equity, work in the community should be celebrated as much as research papers are.

Harvard Medical School in Boston.
Harvard Medical School in Boston.Blake Nissen for the Boston Globe

Last spring, I found myself in a crowded lecture hall at the University of Chicago. The South Side of the city had become my temporary home during my year of service with AmeriCorps before I started medical school. That day I had the pleasure of attending a lecture by Bryan Stevenson — lawyer, activist, founder of the Equal Justice Initiative, and one of my greatest inspirations.

At the end of his talk a student asked him, “How can we promote social justice within our profession?”

His answer was simple: “We have to get more proximal to our communities.” He went on to explain the importance of putting community needs at the center of solutions for societal problems.

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Stephenson’s words were like music to my ears. As a Black woman born in Compton, Calif., and raised by a single parent, community means everything to me. My community propelled me to achieve and inspired my decision to become a physician. My mission was to heal my community and advocate for the health and livelihood of its members.

Today, I am a medical student and my mission remains the same, but it seems that every day the work necessary to heal my community grows more expansive. I’ve been disheartened by the disproportionate impact the great exacerbator, COVID-19, has had on Black communities, amplifying America’s most deadly chronic disease: racism. And equally frustrated by the brutal killings of Black people by police — Breonna Taylor, George Floyd, Ahmaud Arbery, Tony McDade, among others.

In response to this devastating reality, academic medical institutions across the nation have expressed their new commitment to antiracism. While these statements are steps in the right direction, it is important to recognize that these words carry little weight if they’re not coupled with actionable steps that prioritize the healing of Black communities.

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If academic medicine — which encompasses not just medical schools but also the teaching hospitals where students train — seeks to “get proximal” to our communities, as Stevenson advises, we are in great need of an ideological shift. We need to prioritize praxis — the translation of social justice theory into action — as much as publications.

Though some institutions have made social justice central to their mission, research publications and grants continue to be the most valuable form of currency in academic medicine. This means the number of publications that aspiring doctors produce is a major factor in their admission to medical school, their competitiveness for residency programs, and their opportunities for career advancement and promotion.

This paradigm can be problematic, however, when not everyone’s research is valued the same. A 2019 study found that white researchers were nearly twice as likely to have their research funded by National Institutes of Health (NIH) R01 grants — among the best-funded NIH awards and a key to academic promotion — compared to Black researchers. The choice of topic was a big reason: White researchers’ proposals primarily focused on microscopic-level science while those of Black researchers focused on population and community health.

These statistics should be a wake-up call for academic medicine. We must ask ourselves why our institutions have traditionally valued the pipette more than praxis. Why is research promoting health equity seen as “soft” compared to “hard” science like bench work? All types of research — experimental, epidemiological, and clinical — are imperative for the development of best practices and novel treatments that promote the healing of our patients. But we must also consider how our institutions can do a better job at translating research publications into tangible benefits for our community. And I worry the “publish or perish” culture might discourage students and faculty from pursuing projects that more directly improve the conditions of our communities, out of fear their projects will be undervalued.

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I first considered this idea one day after talking to one of my mentors, who explained to me the intricacies of promotion in academic medicine. Together we looked at curriculum vitae guidelines, and I watched as my mentor swiftly scrolled down the PDF document past sections that read “patient education” and “community service” before stopping at the “peer-reviewed research” section. “Now this is going to be the most important part of your CV,” the person said. This puzzled me, because the topics so quickly overlooked were those I considered most beneficial to our community.

After our conversation, I reflected on how the “publish or perish” mentality is pervasive at every level of medical training. Some pre-medical students I mentor have discontinued community service projects after being told by pre-medical advisors, “you’re doing a lot of service, but where’s your research?” Similarly, my colleagues in medical school have reconsidered their roles as pipeline program coordinators — teaching and mentoring students traditionally excluded from careers in STEM — out of fear their leadership wouldn’t be viewed as prestigious by residency programs.

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The conversation with my mentor also reminded me of the underrepresentation of Black faculty in institutional leadership and a likely reason they are leaving academic medicine. Black faculty are frequently requested by their institutions to serve on task forces, mentor students of color, and champion community programs, but their efforts are often underfunded and undervalued when it comes time for their promotions.

If academic medicine truly seeks an antiracist future, we need less paper pushing for the sake of publishing, and more investment in research and community engagement projects that directly promote the healing of Black communities. One such example is the Freedom Community Clinic in Oakland, Calif., a grassroots initiative pioneered by a medical student at the University of California, San Francisco. It offers free health screenings among other services to the Black community. Another example is the Family Van, a mobile clinic started by Dean Nancy Oriol at Harvard Medical School. It offers free preventive health and wellness services to underserved communities in Boston. This shift would also mean supporting pipeline programs and creating a culture that values these important contributions at every level of medical education.

The work of antiracism must go beyond carefully crafted statements, figures, and data. It’s time to step outside the ivory tower and into the streets of our communities, because they need us and they also have a whole lot to teach us.

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LaShyra “Lash” Nolen is a writer, activist, and student at Harvard Medical School. Her commentaries on health equity, racism, and medical education have been featured in the New England Journal of Medicine, HuffPost, WBUR, Teen Vogue, and STAT. Follow her on Twitter @LashNolen.