Research Voices from the Field is a new feature that showcases cutting-edge research that breaks barriers and bridges equity gaps in medicine. Each edition spotlights a research article and includes insights directly from the authors—revealing their motivations, the significance of their findings, and why the research matters for healthcare professionals everywhere.
In this first edition, Saleem Razack, Paediatric Intensivist, BC Children’s & REDI Senior Faculty Advisor, reflects on why he co-authored “Cutting Close to the Bone: Student Trauma, Free Speech, and Institutional Responsibility in Medical Education” and how it can be relevant to those in medicine, healthcare, and beyond.
Saleem Razack, Paediatric Intensivist, BC Children’s & REDI Senior Faculty Advisor, reflects on why he co-authored “Cutting Close to the Bone: Student Trauma, Free Speech, and Institutional Responsibility in Medical Education” and how it can be relevant to those in medicine, healthcare, and beyond.
I have been involved in issues related to equity, anti-racism, and inclusion in medical education for many years. Up to the point of my involvement in this article, my focus had primarily been on issues such as representation in medicine (Who is present? Who gets to undertake a medical education?) and the inclusiveness of the learning environment (Who experiences microaggressions? What constitutes an inclusive learning environment?). In this article, I began to turn more attention to the processes of teaching and the content being taught—what we might term the “formal curriculum.” This article started me on a journey that leads me to conclude that we, as medical educators, need to undertake a major effort to question the very knowledge systems of medicine for their inherent biases. There is also a strong need for the promotion of concepts such as white supremacy and racial inferiority, which I have written about in subsequent publications. While this article focuses on learners from underrepresented backgrounds, it could just as easily extend to patients and health outcomes.
Authors: Arno K Kumagai 1, Brittani Jackson, Saleem Razack
Abstract:
Learning the societal roles and responsibilities of the physician may involve difficult, contentious conversations about topics such as race, gender, sexual orientation, and class, as well as violence, inequities, sexual assault, and child abuse. If not done well, these discussions may be deeply traumatizing to learners for whom these subjects “cut close to the bone.” Equally traumatizing is exposure to injustice and mistreatment, as well as to the sights, sounds, and smells of suffering and pain in the clinical years. This potential for iatrogenic educational trauma remains unaddressed, and medical educators must take responsibility for attending to it. Possible solutions include trigger warnings or statements given to students before an educational activity that may cause personal discomfort. The authors of this Perspective assert, however, both that this concept does not distinguish between psychological trauma and discomfort and that well-intentioned trigger warnings target the wrong goal-the avoidance of distress. Exposure to discomfort not only is unavoidable in the practice of medicine but may be crucial to personal and professional moral development. The authors argue that a more appropriate solution is to create safe spaces for dialogues about difficult topics and jarring experiences. This approach places even the notion of free speech under a critical lens-it is not an end in itself but a means to create a professional ethic dedicated to treating all individuals with excellence and justice. Ultimately, this approach aspires to create an inclusive curriculum sensitive to the realities of teaching and learning in increasingly diverse societies.