‘White male culture in medical school could perpetuate healthcare disparities’

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An often omnipresent culture of white male representation in medical schools could “lead even the most well-meaning students to perpetuate healthcare disparities in their future practices,” a recent perspective published in the New England Journal of Medicine argues.

LaShyra Nolen, BS, a first-year student at Harvard Medical School in Boston, runs through how such an environment affects medical education and, ultimately, the quality of care graduates might go on to provide in a piece entitled, “How medical education is missing the bull’s-eye.”

She highlights an example of how this culture can manifest itself, referencing a microbiology class that took a look at Lyme disease. Quoting her professor, she writes: “‘A hallmark of stage 1 Lyme disease is a bull’s-eye rash, erythema migrans, which typically appears three days after infection,’ the professor explained confidently.” Behind him, Nolen goes on, was an image of a prominent red bull’s-eye rash on white skin. “Shortly after the explanation, a classmate raised his hand and asked the professor, ‘How do you recognize this rash in patients with darker skin?’ The professor responded that it is more difficult to see the rash on melanated skin and moved on to the next slide.”

That got her thinking. She ponders such questions as: “Is the diagnosis of Lyme disease in black and brown patients delayed? Do these patients therefore present with more advanced symptoms, such as neurologic disorders and arthritis, than white patients?” She adds: “More research revealed that my hypotheses were correct.”

Furthermore, Nolen goes on to outline possible prescriptions that could be instituted in the early years of a medical degree in an effort to address iniquities. She calls for medical schools to obtain female-bodied mannequins “so that students can comfortably learn about the nuances of performing CPR [cardiopulmonary resuscitation] on patients with breasts.” She also writes that “medical educators should strive to include images of more than one skin type in their learning material.”

Summing up, Nolen provides a snapshot of possible real-world consequences of omnipresent white male representation in medical school. “If medical students and trainees are taught to recognize symptoms of disease in only white patients and learn to perform lifesaving maneuvers on only male-bodied mannequins, medical educators may be unwittingly contributing to health disparities instead of mitigating them,” she writes. “Most worrisome, the United States may be in danger of graduating large numbers of physicians who are unable to serve the needs of our ever-diversifying patient population.”

SOURCE: DOI:10.1056/NEJMp1915891

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