"Intersections of social systems, race, and health in America: A historical perspective": A novel elective for medical students to increase anti-racism advocacy

Problem: There are increasing calls for medical education curricula to effectively teach about the social determinants of health by explicitly naming racism as a driver of health equity and inspiring student action to address health inequities.

Approach: Using a novel application of the generative co-design approach, in 2020 Perelman School of Medicine students and faculty implemented a student-led, interdisciplinary elective course for preclerkship medical students. The co-design process allowed for an iterative and conversation-based experience emphasizing how social systems and racist policies shape health care access and outcomes. Active student participation was integral to developing discussion questions to elicit how students' positions in power structures can uphold inequities. Community members and nonprofit leaders taught about the current realities of discrimination and how students could best advocate for patients in the future. Enrolled students (n = 17) and a control group of non-enrolled classmates (n = 37) completed the Anti-Racism Behavioral Inventory (ARBI) pre- and post-course to compare changes in anti-racist behaviors.

Outcomes: Participants demonstrated a significant increase in ARBI scores (mean = 4.29 (7.30); t(16) = 2.42; P = .01), while students from the control group did not (mean = 1.43 (6.98); t(36) = 1.25; P = .11). The "individual advocacy" subdomain of the ARBI largely drove the change in ARBI scores, suggestive of increased anti-racism behavior in the enrolled cohort. Students provided feedback offering praise for course elements and suggestions for improvement.

Next steps: Early findings suggest that this course, created with a co-design approach, generated new experiences for medical students, increased their understanding of systemic racism, and increased individual anti-racist advocacy. Future work, with larger class sizes and longitudinal measurement of behavior change, should further investigate the transformative effects of applying co-design strategies to medical education courses about race and health.