Active learning intervention challenges race-based medicine

Despite ongoing efforts in the corporate world and academia to untangle and correct inaccurate notions about race and biology, strong currents of belief and practice continue to challenge what can appear to be a broader awareness.

For example, although race has no biological basis, medical school training curricula tend to misrepresent race and reinforce biologically-essential components of race as explanations for disease. As the social construct of race continues to be used to inform health care providers' treatment decisions, this race-based medicine exacerbates racial health disparities.

New research from University of Georgia psychologists presented college students with data about the historical construction of racial categories in the United States to challenge race-based medicine. Participants in the study reported less support for race-based medicine and greater confidence that race-based medicine contributes to racial health disparities.

The study was published in a special issue of the peer-reviewed journal Health Equity focused on the incorrect use of race and ethnicity in clinical algorithms in health care systems across the U.S. and internationally.

"The notion that there is some sort of essential component to race, some sort of underlying fact that makes race makes meaningful in a medical, biological context continues to be pervasive," said Allison Skinner-Dorkenoo assistant professor in the Franklin College of Arts and Sciences department of psychology and lead author on the study.

"We wanted to see whether educating study participants about the history of how and why the concept of race was constructed and giving them an example of how race-based medicine has harmed people could impact the way people were thinking about race, and perceptions of race-based medicine," she said.

The researchers used an active learning intervention and recorded participant discussions in groups of two. For comparison, an equal number of participants were questioned about race-based medicine without the intervention.

Participants assigned to the intervention condition read an article highlighting the history of the sociopolitical construction of race. They were then prompted to discuss how racial categories were created and changed over history, and—in light of all this—the appropriateness of race-based medicine. 

"We were able to compare people who get this information and go through the experience of actively engaging with it and making connections to those without additional information or discussion," Skinner-Dorkenoo said. "We want to know if these two groups think differently about race-based medicine. Our hypothesis was that the former group would develop a more accurate understanding of race that they could use to think critically about the appropriateness of raced-based medicine, extending that information to apply to other areas."

The participant sample included pre-medical and non-pre-med undergraduate students.

Skinner-Dorkenoo points out that the interventions are presented as background information and history, not to be directly persuasive but rather as general information on which to answer questions and have a discussion.

"We have a particularly large number of pre-med students within our pool, which was an advantage because we were actually able to determine whether that made a difference," she said. "And though it was very subtle, there was a small tendency for premed students to trust physicians’ raced-based medical recommendations more, and to have more of an essentialist view of race. But the thing that we were most interested in – does that interfere with the intervention – are they then less receptive to the intervention, we didn't see any evidence of that."

She said that if students can be given them this information early on in their training, they might have to the power to think and respond differently, to question conventional notions behind treatment determinations about a biological health condition. Foundational information to challenge situations they encounter during training would lead to different processing later on as medical professionals.

"The study is another demonstration of how fixed ideas about race are spread across many more aspects of our society than we might think, aspects that often get boiled down to diversity training and the need for more egalitarian attitudes," Skinner-Dorkenoo said. "This example goes far beyond that. It's a much more diffuse issue that we need to be thinking about in all the different ways in which the history of the way we have created categories of race and made societal decisions and built the structures of society all influence the inequalities we see today.

The full study, "Challenging Race-Based Medicine Through Historical Education About the Social Construction of Race," was published Nov. 30.

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