Equity in medical education

Black Canadians and their health needs and experiences are vastly underrepresented in medical and health sciences curricula.

With 3.5 per cent of Canada’s total population, excluding and misrepresenting this information is a problem—one that is affecting the health of Black populations across the country.

Led by Drs. OmiSoore Dryden here at Dalhousie, and Dr. Onye Nnorom from the University of Toronto, a community of Black scholars and practitioners is committed to changing this.

Established in 2019 by Drs. Dryden and Nnorom, the Black Health Education Collaborative (BHEC) is working to transform medical and health professional education with the goal of improving the health of Black communities across Canada. With representation from various institutions throughout the country, BHEC aims to dismantle anti-Black racism in healthcare while creating change within health education to equip professionals to provide accurate, culturally safe, and culturally informed care.

Dr. Dryden, who is the James R. Johnston Chair in Black Canadian Studies, and Dr. Nnorom, Assistant Professor at the Dalla Lana School of Public Health and the Temerty Faculty of Medicine at the University of Toronto, and then Black Health Theme Lead for the Temerty Faculty of Medicine, connected in early 2019 as the only two Black theme leads in Canadian medical schools.

“At that time, having the Johnston Chair in Black Canadian Studies housed in the Faculty of Medicine was a notable thing in medicine,” recalls Dr. Dryden. “When Dr. Nnorom and I had our first meeting we asked ourselves, ‘how are we going to intervene in medical schools around Black health? How are we going to support medical learners?’”

Knowing they needed to make a difference in education, the idea for the Black Health Primer was borne.

Supporting Black health

The first of its kind in Canada, the Primer took shape in the summer of 2019. Drs. Dryden and Nnorom were struggling to get faculties of medicine to engage in conversation about the idea when the pandemic hit, and the murder of Mr. George Floyd happened in Minnesota. Suddenly, conversation and support around Black lives and Black health became of interest and the two Black health leaders found themselves at many tables discussing the need for, what at the time they were calling Black medical education on Black health, systemic anti-Black racism and structural white supremacy.  

They sat down with their respective deans, Dr. David Anderson at Dalhousie, Dr. Trevor Young at the Temerty Faculty of Medicine, and Dr. Adalsteinn Brown at the Dalla Lana School of Public Health. In 2021, the three schools provided them with a million dollars in funding, allowing them to hire staff, engage in research, create committees, and hire writers and medical education pedagogical specialists. It was during these discussions that BHEC was formalized.

“We thought we should name it the Black Health Education Collaborative and really look across healthcare,” says Dr. Dryden. “And we began our early work with the Medical Council of Canada (MCC) to push to have Black learning objectives included for all medical learners.”

Four years later, the MCC is in the process of approving the Black Health Learning objectives, and the BHEC is preparing to launch the Black Health Primer, something Dr. Nnorom says is desperately needed.

“Even though Black people have been on this land for centuries, and anti-Black racism has been a driver of health inequities, physicians and other healthcare providers have had little or no training about Black communities in Canada,” she says. “Sadly, they have had little guidance on how to provide better quality, anti-racist care. Our modules provide this training for practitioners and trainees across the country.”

The Black Health Primer incorporates the research and scholarship that has been completed on Black health and anti-Black racism and consolidates it into a course for medical and health students, faculty, and educators. Available across Canada in English, with the French version available later this year, the Black Health Primer is a multi-module online resource that seeks to advance knowledge in and promote dialogue about the critical issue of anti-Black racism and its impact on health. Throughout the course, learners will gain knowledge to support the unlearning of anti-Black racism and learning racially just practices and competencies that improve the health of diverse Black communities.

“We wanted to make sure that we were focusing on Africentric and culturally affirming care to amplify competent anti-racist practice and make sure that we are working collectively to decrease the health disparities that exist in African Nova Scotian and Black communities,” says Dr. Dryden. “It's greater training around anti-racist healthcare, and that is about building professional capacity, and also about shifting healthcare systems.”

A race-conscious approach to learning

Health metrics show that Black, Afri-Indigenous, and Indigenous communities have the worst health outcomes in the country. This is directly connected to the continued impacts of colonialism and slavery. Unfortunately, prevailing healthcare practices, grounded in the misconception that Blackness constitutes a distinct race and implies inherent biological deficiencies, persistently contribute to heightened mortality rates, delayed diagnoses, denied treatment, and inferior health outcomes.

BHEC and the Black Health Primer hope to shift the narrative by moving to a race-conscious approach, which means understanding the social and structural determinants of health. This method of learning will allow for interventions into the reasons why Black health outcomes are so poor.

Progress at Dalhousie

Here at Dalhousie, a concerted effort has been made to respond to the healthcare needs of diverse communities in our region. In the last few years, with the addition of an admissions pathway for Black learners, an academic lead in Black Health, updated undergraduate curriculum with increased lectures on Black health, paired with the ongoing work of PLANS (Promoting Leadership in Health for African Nova Scotians), progress has been made.

But there is more to be done.

Dr. Dryden suggests Black health should be added to all levels of medical education and supports the work of Dr. Leah Jones, the Academic Director of Black Health, to increase the focus on African Nova Scotian and Black communities for Rural Week, which sees medical students travel to distributed learning sites throughout the Maritimes to spend a week observing rural physicians at work.

“Thanks to the dedication of Dr. Jones, great strides are being made in the Faculty of Medicine, but we need to make sure that students are prepared to work in African Nova Scotian and Black communities. As Dr. Jones’ has argued, they need those skills, and this is part of preparing them to land in rural spaces which is currently missing.”

Central in medical education

Dr. Dryden says that anyone involved in medical education, from medical students and residents to teachers and supervisors, and preceptors and tutorial leaders, should enroll in the primer.

“The Black Health Primer is the thing that needs to be central in medical education across the country. So just as they would do a block learning on neurology, or they do block learning on metabolism, they would complete a block on Black health.”

The number of Black health leaders in medical faculties nationwide is on the rise. Tasked with creating a curriculum focused on Black health, many of these leaders are physicians lacking formal training, expertise, or scholarship in this specific subject. Dr. Dryden is hopeful the Black Health Primer will alleviate this burden.

The Black Health Primer, available to individuals and institutions, launched March 21, 2024, on the BHEC website.