Beyond the White Coat

Racism and Medical Education: Telling the Full Story

Episode Summary

The history of medicine is filled with amazing scientific discoveries and remarkable innovation, but the profession is also haunted by a history of structural oppression and exclusionary practices that act as barriers for people of color. This history influences the policies, practices, and procedures that govern how physicians are trained in the United States today. In this episode of “Beyond the White Coat,” AAMC President and CEO David J. Skorton, MD, speaks with AAMC Chief Diversity and Inclusion Officer David A. Acosta, MD, about the history of structural racism in U.S. medical education and how that history informs today’s learning environment.

Episode Notes

The history of medicine is filled with amazing scientific discoveries and remarkable innovation, but the profession is also haunted by a history of structural oppression and exclusionary practices that act as barriers for people of color. This history influences the policies, practices, and procedures that govern how physicians are trained in the United States today. In this episode of “Beyond the White Coat,” AAMC President and CEO David J. Skorton, MD, speaks with AAMC Chief Diversity and Inclusion Officer David A. Acosta, MD, about the history of structural racism in U.S. medical education and how that history informs today’s learning environment. 

Episode Guest:


You Might Also Be Interested In:

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  4. More from the “Beyond the White Coat” Podcast

Episode Transcription

Narrator:               A diverse country needs a racially and ethnically diverse physician workforce. And the path to diversity in the workforce starts with the students at our medical schools. 

But, according to the AAMC’s data, Black, Hispanic, and American Indian students remain underrepresented in medical schools, despite increasing efforts to create a diverse physician workforce.   

How did this issue begin, how has it evolved, and what can history teach us about racism in medical education today? 

In this episode of “Beyond the White Coat” we’re talking with Dr. David Acosta about how the history of racial segregation in the United States has affected efforts to build racial and ethnic diversity in medical schools. 

This is our conversation with Dr. Acosta on “Beyond the White Coat.”


SKORTON:               Welcome to the second episode in the second season of “Beyond the White Coat.” I'm David Skorton, president and CEO of the Association of American Medical Colleges. In today's episode, we'll explore the history of structural racism in U.S. medical education. And I'm here with Dr. David Acosta, chief diversity and inclusion officer of the AAMC, to talk about this very important topic. Dr. Acosta is a family medicine physician who joined the AAMC after a distinguished career at the University of Washington and at the University of California, Davis. Dr. Acosta provides strategic vision and leadership for the AAMC's diversity and inclusion activities across the medical education community and also leads the association's Diversity Policy and Programs unit. Thanks for being here and sharing your thoughts today, Dr. Acosta.


ACOSTA:                   Thank you, David. It's certainly an honor to be here today, and thanks for this opportunity as well.


SKORTON:                 Well, let's jump in. What is the point of examining the past? Why is it important for academic medicine to own our history of racism, specifically in medical education?


ACOSTA:                    Well, David, you know, I think we're informed quite a bit by our historical past. You know, clearly, medicine's past is filled with amazing scientific discoveries and remarkable innovations over decades — matter of fact, centuries. But medicine's past is also, unfortunately, filled with experimentation, structural oppression, and exclusionary practices. And I truly believe that understanding and being sensitized to that historical trauma that many of our population groups have suffered throughout the years really informs us in understanding present-day issues and the realities that we face. For example, I think about the mistrust that is still prevalent among racial and ethnic groups and other marginalized groups — and how they think our health system has failed them.

So, I think for us to repair the harm, knowing that history is a really critical first step for us, acknowledging the wrongdoings, apologizing for our past, and making every effort to not only repair the past but also to ensure that these harms will not be repeated as we move forward.


SKORTON:               Well, I sure agree with everything that you just said, and, you know, it's interesting, Dr Acosta, in my years at the Smithsonian Institution, I gained an even larger and more profound appreciation of history, really, just as you've described it. And so, speaking of history, let's talk a little bit about the Flexner Report. Now, the publication of the Flexner Report in 1910 had a profound impact on medical education in the United States. Staff members at the AAMC have called the impact of the Flexner Report on the training of African Americans, in particular, “immediate and enduring.” What was the Flexner Report, and what were the implications of its main ideas for African Americans?

ACOSTA:                    Sure, David, that's a good question. Just for our listeners, you know, the Flexner Report examined the state of American medical education and led to reform in the training of physicians. And essentially, in 1909,     Abraham Flexner embarked on his visit of 155 medical schools in the United States and Canada. And essentially, he — when you looked at some of the Flexner Report itself, there was a particular chapter that was titled "The Medical Education of a Negro," and I wrote down some quotes that I think are really important. 'Cause it really does set the framework and the mindset that Flexner had as he started evaluating these seven historical Black medical colleges. And the first quote in this chapter stated the following: "The practice of the negro doctor will be limited to his own race, which, in its turn, will be cared for better by good negro physicians than poor white ones. So, the negro must also be educated not only for his sake but for ours. But he has, besides, the tremendous importance that belongs to a potential source and infection and contagion."

So, his model to reform medical education was really based on the premise that medical schools should, essentially, be integrated into a university, have a sufficient financial endowment, and also have a university hospital collectively with that. And at that time, essentially, it was a severe challenge for many of the schools, especially the historical Black medical schools. To meet even just the financial requirements alone were an impossible benchmark. And when you consider the organizational and educational requirements that Flexner was espousing, then most historical Black medical schools were doomed. And in fact, you know, there's another quote that he had in this particular chapter that said the following: "Make-believe in the matter of negro medical schools is, therefore, intolerable. Even good intentions helps but little to change their aspect."

And unfortunately, as a result, five of the seven historical Black medical schools closed, leaving only two, Meharry and Howard, to remain open.


SKORTON:                Well, that's very, very much an eye-opening and a mind-opening review, and many of us who know just a little tiny bit — just scratched the surface of the Flexner Report — may not have realized the very, very important segments that you quoted. Thank you, Dr. Acosta.

Let's talk about the kind of racism Dr. Acosta expressed, and the policies and practices and procedures of those institutions that we are really taught to trust. What kind of policies and what kind of practices and what kind of procedures create racist outcomes in today's medical education environment?


ACOSTA:                    So, David, let me reframe this just a little bit. So, you know, I would look at it in this way — you know, it's really the racist ideas that have been embedded in our policies and practices over time that have led to these exclusionary practices that we experience today, inequitable opportunities. And that's ultimately led to the poor outcomes that intentionally target and impact specific population groups but also preserve the status quo, as I have heard you say in many of your speeches prior to before. So, when I think about policies and, you know, what are some examples of those, I mean, we could probably have a very long podcast on this. But the reality is there are certain areas that kind of pop into my mind, and that is thinking about our admissions practices, including outreach, recruitment, and selection, and how we have admitted our learners. But also, even faculty hiring processes.

Also, in the area of just meritocracy of who gets awarded, who gets promoted, and who doesn't. Even we have a system that also focuses more on weeding out, screening out, publish-or-perish paradigm. And then, when I think about medical education, I think about how just the concept of race, in some circles, has been used, is still being considered biological and genetic, and not as a social construct, and still used in formulas, algorithms, and guidelines, even to aid in our diagnosis and treatment that are not evidence-based but are still present. When I think about admissions practices on its own side, all you need to really look at is the trends of our enrollment of medical students. You know, if I just take the African American enrollment, you know, up today, presently, they make up about 7% of the total medical school enrollment.

And then, when we looked at medical — the enrollment of Black students in medical schools over the last 40 years, we have found that it's only increased by 1.2%. Now, if I put that in numbers, we're talking, like, back in 1980, there were 999 African American students who enrolled in medical schools. Now, if you fast-forward today, it's only increased to over 1,500. And if you think about that and put that in the relevance, we have over 21,600 seats available for students, and today they only make up 1,500 of that, as well. And again, I think a lot of it, probably a best illustration of this, is just the anti-affirmative action laws that have been in place, and are still in place in 10 states, that have really prevented race-conscious admissions. And that's kind of a good example of, you know, where putting racial inequities have been in place in their policies and processes, you know, play out quite so.


SKORTON:                 And of course, as you well know, Dr. Acosta, we're still not done fighting the issue of affirmative action, on many fronts. You know, the statistic you mentioned about African Americans in medical schools, matriculants increasing only about 1%, you know, 1980 was the year that I started my first faculty position, and in those days, the number of Black men matriculating to medical schools, they made up about 3.4%. And that hasn't changed at all in these 40 years. So really, these data are quite shocking, and I very much appreciate you bringing that forward. You know, you mentioned — 


ACOSTA:                    And, David, they're also reflected in even our faculty hiring, because, again, if we're not gonna bring in enough of the folks from a racial ethnic background, as well. I think about URiM faculty makeup, only about 9% of our total full-time faculty in our U.S. medical schools. And even if I, again, with the theme of African American, African American faculty only make up about 3.5%. I'm Latino, and as a Latino, we only make up 5.6%. And then, even more atrocious is, again, the American Indians only make up 0.1-0.6%. So that's pretty profound.


SKORTON:                 Yeah, it's very, very sobering, and you're talking about overall statistics in faculty. If you look at leadership, it's even more challenging.


ACOSTA:                   Exactly.


SKORTON:                Now, you know, you mentioned in passing a couple of minutes ago, some ideas — false ideas — that we have about race as a biological as opposed to social construct, and I wonder if you can share some of the data — some of the interesting data — on misconceptions even recent medical school students have about biological differences, say, between African Americans and Whites, and how that may affect their medical care.


ACOSTA:                   No, and in fact, I think it's a very, very hot topic today with our medical students, and really calling this out. And so, again, I'm inspired by what they're discovering, and also, the questioning of some of the practices that are very prevalent in medicine today. For example, when we talked about some of the different formulas and the algorithms used, we still take race into consideration when we figure out the glomerular filtration rate, you know, for renal functioning, these days. Where there's actually a converting factor that, if you are Black, essentially impacts, you know, the calculation of that particular formula. And the problem with that is that it sends the wrong message in the sense that you may not be paying attention to — by setting a different standard for African Americans with the renal function, that really may miss some of the complications due to hypertension, diabetes.

As we see that it is also these particular diseases are very prevalent in the African American population group, as well as Latinos as well, and Native Americans. But unfortunately, by manipulating some of the formulas, we may not be finding and explicitlytargeting enough of the African American population and getting them into care and treatment. As we also know that these three targeted population groups also have the highest rate of end stage renal disease and even needing renal transplantation, as an example. You know, and another example is just, again, measuring pulmonary function by spirometry, which still incorporates race into its formula, as well. That again, for the same reasons I just quoted with the renal function, really, again, also may misinterpret the findings that we find or think that we're finding with pulmonary function in the African American groups, as well.


SKORTON:                Wow, such a real, real critical [throat clearing interferes with audio] that you make. Thank you for that. Well, you know, I'd like to shift a little bit, Dr. Acosta, to talk about your personal experience [crosstalk] and now practicing in medicine. And we certainly, if you wish, can include examples if any of the practices you just mentioned actually affected you on the path. I know that you've spoken before about your family physician, your grandmother who was an herbalista, your brother, Lou, an emergency medicine physician, and how they've impacted your own career in medicine. If you would, tell us a little bit more about your journey, your motivations, barriers you encountered, or any other stories to help our listeners get to know David Acosta better, please.


ACOSTA:                    You're putting me on the spot, David, thank you. [Laughs] You know, what the question really — what really pops to mind are a couple of experiences that, again, I think we continue to learn from over time. And the first one that pops to my mind is that stereotype threat and the imposter syndrome is very much alive and still in my soul and still ingrained in my brain. And by stereotype threat, I mean the known stereotype that I as a Latino carry, that — essentially, that I have battled all my life, to try to disprove those particular stereotypes, by some of the things I say, my actions and — as well. But unfortunately, no matter how hard I try, depending on the context that it's in, I'm constantly reminded that — essentially, of people that society stereotypes, you know, about the Latino population.  I can still remember, way back, standardized tests and examinations have always been the monkey on my back, so to speak. And I remember baffling teachers, even in elementary school when I took the standardized testing there, that they were never really reflective of how I performed in school, and really was totally discordant with my own grades that I received.

And that continued throughout my life, and almost, I had this mindset that I created and fixed in my mind that, you know, the standardized testing, no matter what level of education, was still going to be a threat to me and was never going to, essentially, really truly reflect on, you know, my abilities as well. And that really didn't change in medical school, and I'll share with you now and share publicly that I failed Step 1. And I failed Step 1 by about five points, I remember, between my second year and my third year. And as you know, passing Step 1 was really critical in those days — and still today, in going on to the clinical wards and continuing the work. And you're kind of held behind until you can pass that particular exam.

And I was doing very, very well in medical school and I had great grades, but again, the standardized test, and I missed it by five points. It was pretty devastating to me, at that point. But as stubborn as I was, I decided that I would retake the test in six weeks, try to prepare, just study a little bit harder, 'cause that was the problem is I probably wasn't studying hard enough and studying the right things. And I took the exam six weeks later, only to fail it one more time, and I missed it by one point. So, at that time, the imposter syndrome rose out of its — seeped into my brain and basically said, "Well, maybe you don't belong here.

"You're really not that smart; you only think that you are. And maybe do somebody a favor and give up your position for somebody else who's more well-deserving than you are." So again, I think those — you know, I trudged on and took it a third time and did pass, by overcoming some of my pride and overcoming some of the stubbornness I had in how to prepare best for this — and really, really learned, again, how to really overcome that particular monkey that was on my back for such a long time, knowing that standardized tests were gonna be, essentially my life. My brother Lou said to me, he says, "Well, congratulations on finally passing this test, but you only have 15,642 more tests to go," you know, as a physician. [Laughs]

You know, the other thing that I think about it, you know, I attended a predominantly White institution located in a very affluent community in southern California and really had no Latino role models or mentors. And I think that was the norm at we all had in my class. You know, I also remember, you know, experiencing racial bias and discrimination, my first day in my OB-GYN rotation, where I was mistaken for the housekeeper and was instructed to clean the delivery room when I reported to the L&D floor, as well. You know, in residency, I remember witnessing an unethical transfer of an unstable young 21-year-old migrant farmer get to our hospital from a private local hospital that violated EMTALA law. And I was the receiving ER physician, I was on that shift.

And I remember, as a chief resident, myself and the residency program director, I was asked to deal directly with that responsible medical staff that did that transfer, and to accompany him to this particular hospital and meet with the executive medical staff at that time. And I was really shocked, because they certainly didn't demonstrate any remorse for the decision that they made, and they really attempted to so-called “put us in our place,” because we were the county public hospital and we had an obligation to receive any patient that they were going to send to us. And that was so devastating to me, 'cause that really — that experience itself upset me so much that I handed in my resignation to my director the next day. Because I really no longer wanted to be affiliated with medicine or this particular club, so to speak.

But I had a wise director who said, "David, I need you to cool off for a couple of days, think this over, and let's reconvene again in a couple days, and let's talk about this more." And I think this leadership and how he handled the situation, and how we changed policy and processes, was really an incredible changing event for me. Because that experience itself really reinforced my drive to advocate for vulnerable communities and combat racist actions that we see in medicine. And I even saw it in volunteering in community-run free clinics and in student-run free clinics — you know, you get exposed to the countless number of patients seeking health care that cannot afford it. Even folks who do have insurance but, again, do not cover many of the things that had inflicted them.

And they come in with all these unnecessary complications that you see due to conditions and disease that could've been prevented. And I think stuff like that is a thing that really keeps that fire within you burning, to advocate for better health for all.


SKORTON:                Well, first of all, I so much appreciate the fact that you had the courage to share those things with us. It's astounding and it says a lot about you. And, of course, the irony of those retries you took on Step 1, and so on, the irony is that you ended up not only contributing to your own patients' welfare, not only contributing to the education of countless students and residents along the way, but now you're a national leader in many aspects. And I very much appreciate that you shared that, Dr. Acosta.


ACOSTA:                    Thank you, David.


SKORTON:                 So, I want to talk a little bit about the AAMC. So, as we both know, the AAMC has a long-standing commitment to promoting diversity in medicine, but this wasn't always the case, even with our association. And share with the listeners: What was the AAMC's role in the history of segregation and medical education? And then, you know, move forward in time and tell us, what's the AAMC doing now to make progress in this absolutely critical area, please. Give us the history, give us the current status, if you would.


ACOSTA:                   Sure. And when I arrived at the AAMC, you know, this history I really didn't know, but it was there clearly to see in our resource center that keeps archives, you know, dating way back as far as we can go, about some of the things that have transpired at the AAMC. So, again, as we all know — listeners may not know this, but the AAMC was founded in 1876, and at that time, the membership was limited to predominantly White institutions. And these institutions also restricted medical school admissions to women, Jews, and other people of color, as well. Well, the history goes that, in 1949, the National Medical Association petitioned the AAMC to issue a policy statement that said, essentially, that medical schools be open to all, without discrimination related to ancestry or religion. And the AAMC's executive counsel response, at that time, was to maintain that it "never interfered with admission policies of any of its member colleges."

And so, they declined to take a stand against segregation at that time, and discrimination in medical schools. And it wasn't until 1968 that the AAMC — and this also included the AMA — joined to endorse the supposition that all medical schools should accept, as a goal, their expansion of their enrollments, and commit fully to ensuring that African Americans and all minority students had equal and meaningful access to medical schools. And again, in 1968, again, it was the result of the Civil Rights Act that was passed in 1964, and also, the Brown versus Education back in 1954, that really put the pressure on, I think, the AAMC, but also the AMA, as well, at the same time. So that was 1968, and in 1969, the AAMC established its first Office of Minority Affairs, but came under the student affairs division that was there at the time. And it really wasn't until 20 years later that the AAMC hired their first vice president, a physician, to lead diversity work.

And that was Dr. Herbert Nickens, a name that we all know, and he created the Division for Minority Health Education and Prevention, at that time. But then, fast-forward almost another 20 years, and it wasn't until 2007 that our past president, Dr. Darrell Kirch, publicly acknowledged this history. And that was after receiving a letter from an emeritus professor at Harvard University, to inform him of the past that the AAMC had. So, at that time, President Darrell Kirch expressed the association's deep regret, for the first time, for the decision of the past, and took responsibility for the association's inaction. So, as you say David, as I fast-forward to today as, you know, how have we — if I ask the question, “Well, how did we try to repair our past?”

You know, today, the AAMC, as you have mentioned, is very committed to equity, diversity, and inclusion. Not only do we have a chief diversity officer, but we also have three senior directors and 16 staff that focus on workforce development, they focus on the learning and workplace environment, on becoming anti-racist, diverse, and equitable and inclusive. We also have a portfolio that addresses population health, health equity, social determinants of health, and even racism. You know, we're interconnected, now, with all facets of medical schools, teaching hospitals, from student affairs to research to health care affairs, and assist in any way that we can along DEI matters that we can help with. And that includes also offering DEI education and training, where DEI matters.


SKORTON:                 Well, thanks, Dr. Acosta, that's a very interesting and sobering review of the history of our own association, and an upbeat review of where we are going. And please permit me to say, to everyone listening, that you yourself have been such a big, big part in moving us along in the direction we're going. You're quick to thank and comment on everybody else, but you've really been an extraordinarily effective leader, not only nationally but in this association, and I wanna thank you for that.


ACOSTA:                   Thank you, David, for those kind thoughts and words — appreciate that.


SKORTON:                 So, now I wanna drill down a little tiny bit more into where we are now, where we need to go. You've often used the term of systems-based change, and please share with us what kind of systems-based changes are necessary to help academic medicine dismantle racism, specifically in medical education? Tell us your thoughts on this, if you would.


ACOSTA:                    So, David, you know, I think about this probably in two distinct ways, but they're interconnected as well, and let me start with this one first. You know, I think after doing DEI work for over 25-30 years, you know, I've come to find that, you know, leadership does matter. You know, in looking at it, there's many studies that have shown, both in health care but also outside of health care, in the business and the education world as well, is that change really only happens when leaders are intentional, and they hold people accountable for change. And I truly believe that if we're to dismantle racism in medical education — now, again, thinking how long racism has been in place — that we need transformative leadership and system-based thinkers is what I believe we need, in order to disrupt this equilibrium they have or the status quo, as you would say, that really sustains these racial inequities in academia.

There is a preservation of this equilibrium, there, and I think it's really gonna take important leaders to have the courage, and also the insight, but also, being able to inspire others, you know, along the same route. A little bit more tangible, I would say, also, there's another important piece to this, in addition to leadership. You know, I think it's really critical for us, in medicine, and academic medicine, to really learn from our other colleagues in higher education and really think about changing our approach. Changing the approach more to an equity-minded approach, as leaders and medical educators. And this approach emphasizes the need to be evidence-based — which, again, in academic medicine, we certainly can relate to that, but — that is equity-advancing, race-conscious, system-based thinking, and hold our institutions accountable for our learner successes.

And let me expand on that just a little bit. When I say "evidence-based," that gets back to how we initially started this conversation, is that, you know, as leaders and as medical educators, you know, it is so important that we are proactive in understanding the social encircle context of structural oppression, experimentation, these exclusionary practices we've talked about, and how it's really impacted what we have done in higher education. Secondly, I think for equity-advancing, this is about — what equity-advancing really means, this is about rejecting this ingrained habit that we have of blaming inequities on the learners, on sociocultural and educational backgrounds. We really — equity-advancing leaders, you know, disavow this conceived notion that, you know, our students from racial and ethnic backgrounds are presumed incompetent.

And it really focuses more on the assets that these particular learners bring to the table, and really focuses on, you know, their lived experiences to really educate others, and not just focuses on their limitations. By race-conscious, I'm really talking about, “How do we take this deeper dive and look at how structural racism has truly been embedded and influences our decisions in higher education, especially in developing our policies and processes?” And by being equity-advancing, this means being intentional and addressing those entrenched biases, both conscious and unconscious, you know, those prevailing stereotypes, and any forms of discriminations that are in our policies and processes — and really pushes us to really ask ourselves the question, you know, "Are exclusionary practices happening here? Are there manifestations of structural racism that are operating here in our institution?"

So, this is really about being intentional, and to identify, critique, and deconstruct policies and practices that are felt to be race-neutral but that we know also sustain racial inequities. The next — when I say promoting systemic-based thinking, this is really about making these transformative changes that I mentioned, in the leadership that we need. It's really meant to disrupt the status quo and to shift our paradigm from sink-or-swim, publish-or-perish, screening people out, weeding people out, more to this investment paradigm. And this may even include, like we did with our curriculum in the Flexner model, you know, how do we reexamine and reenvision our meritocracy, which may be as archaic as our curriculum had been, you know, under the Flexner education rule.

And perhaps, you know, we may need to rethink about defining merits, and make it an updated and adjusting, to meet the needs of and promoting the vitality of our faculty that are present today, because our needs are so much different than they were years back. And then, lastly, it's about institutional accountability. You know, I really applaud the work being done by the Association of American Colleges and Universities, and their equity education initiative. Because they basically have this mantra in saying that, if we invest truly in our learners, that means that we have to be responsible for our effectiveness as an institution and the students' success. To the point they even say their mantra is: If one student fails, and especially in higher education, then we have failed.

And I think that's a mindset that we really need to really think about when we think about these system-based changes, and really reenvision, you know, how we do medical education. That, you know, after a student has gone through so much adversity, and essentially, has built up their resilience and they've gotten into medical school, you know, we need to value the assets that they bring to that table and not find ways to screen them out, but ways that where they can thrive even more. And I think that's why a lot of our HBCUs and our minority-serving institutes, you know, have done such a great job in preparing, you know, some of their learners, you know, for the work forward.


SKORTON:                 Well, I just love your paradigm of investing instead of weeding — just a very important way to look at it. Well, Dr. Acosta, this has been fascinating. I'd like to wrap up by putting you on the spot and asking, if you could say one thing, one single thing to future physicians about their role in making these necessary changes in academic medicine, what would you say? Any words of wisdom or calls to action to share would be greatly appreciated. Dr. Acosta?


ACOSTA:                    David, you've known me long enough that it's hard for me to say one thing. [Laughs] So, let me give you a composite, if that's okay. Let me tell you what comes to mind, and it just reminds me because I recently have had the pleasure of addressing some student groups, and this is what I told them. You know, I think we all have a role and responsibility to really address racial inequities. This is not about people of color only addressing it, but we all have an important role and responsibility, and really learning how to become anti-racist, because we don't know how to be anti-racist. And just because I'm a person of color doesn't also necessarily mean that I know how to do that. You know, it's, again, as you have talked about before, you know, this is about acknowledging what we know, but more importantly, what we don't know.

And again, filling in those gaps. And as a physician, that's what we always do, and when you think about that, that essentially, we fill in the gaps because of the vulnerable positions that we're put in, every day, when we see our patients and we're not quite sure what's going on. But we study up, we fill that gap, for the health and sake of that patient. Also, is that we can't do this alone, you know, it does — it's gonna require collaboration and making partnerships that we have never made before or gone out of our way to do. And especially with our communities that we serve, you know, we have to listen to their history, especially, you know, the communities that we're anchor institutions in, because they can teach us a lot. And they probably know about some of the solutions that we could consider, but we have just never taken the time out to ask them.

But I think from the blueprint that you laid out, too, I think the other important thing that is that we need to partner, without a doubt, with public health. You know, our students have got it right, they say that, you know, racism is a public health issue, and I have to agree. And for that reason, I think partnering up with our public health, you know, and our communities, is really important for why we have to give — we have to be vocal, and we have to support our public and invest in their future, as you said in the blueprint for COVID-19. You know, I think we have an obligation, also, to be health advocates, but also to model what health advocacy and health activism is in medicine, to inform the changes that we need to necessarily eliminate racism in medicine. You know, and I truly think this starts with us.

And then I'll just finish up. There's a quote I ran across the other day that just really spoke to me and some of the things that we talked about today, that I'll mention in just a second. And that is, you know, when we ask ourselves, as physicians, as medical educators, as health systems leadership, you know, if we ask ourselves, if we're gonna truly make an impact, you know, we should collectively reflect on this particular quote, be influenced by it, and evaluate it, by this following quote that Mahatma Gandhi said. And he said: "The true measure of any society can be found in how it treats its most vulnerable members." You know, we know that the COVID-19 pandemic brutally reminded us how we measure up to this and how far we need to go. So, I would just maybe even change that quote and say, you know, the true measure of medicine and health care can be found in how we’ll end up treating our most vulnerable members.

And I think I'll end it there, David.


SKORTON:              Well, Dr. Acosta, I wanna thank you for joining me today on “Beyond the White Coat.” It's clear that we, as individuals, as an association, as the whole sector of academic medicine, and as members of society, we really need to do our own work, individually and collectively, to make academic medicine diverse, equitable, inclusive, and anti-racist. Part of that work involves owning our history and carving out new ways to promote anti-racism in medical education. And Dr. Acosta, I've gotta say that, as much of a pleasure as it's been to interview you today and to work with you, I also know that I will be passing the mic to you to host one of the upcoming episodes in Season Two, and wanna thank you for everything you did today, for everything you're doing, period, and for what you will do as an upcoming host of “Beyond the White Coat.” Thank you, Dr. Acosta.


ACOSTA:                    Well, thank you, David, again, for the opportunity. I always enjoy our conversations together, so thank you for doing this, as well.


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