Jean-Michel Leduc is an associate professor at Université de Montréal; Rhode Esther Joseph is a medical student at Université de Montréal; Karina Cristea is a research assistant at Université de Montréal; Isabelle Ferdinand is a clinical faculty lecturer at Université de Montréal; Édouard Kouassi is chair of the Quebec Black Medical Association; Édouard Staco is chair of the Socioeconomic Summit for the Development of Black Youth; Yves Alavo is a journalist and writer; Saleem Razack is the director of the Office of Social Accountability and Community Engagement at McGill University; Ahmed Maherzi is the director of the Office of Social Accountability at Université de Montréal
Black student underrepresentation is well described within medical schools and other health professions. Evidence from multiple contexts has shown that increasing diversity of the health care workforce improves patient care, including both access to and efficacy of care. From the learner perspective, diversity can improve healthcare training by enriching the learning environment, providing role models and, in some situations, promote better understanding of patient realities. For these reasons, healthcare education programs are deploying many efforts to increase diversity in their cohorts.
The underlying causes of Black student underrepresentation in health sciences are complex. Their roots lie upstream to admissions processes, intersecting with many other sociodemographic characteristics and variables. Given this complexity, analysis with a view to finding solutions is inherently perspectival in nature. If largely white faculty work at developing solutions to Black “underrepresentation”, proposed solutions risk failing to meet the needs of the populations they seek to serve or being colonizing. Therefore, co-construction of knowledge and solutions with community-based partners seems to be an essential approach. Co-construction is a concept that is used in many fields, including education and project management. It usually involves a participatory approach where partners from different backgrounds are working together toward common goals and go beyond consultation or concertation.
Using co-construction as a guiding principle, the two Montreal-based Faculties of medicine partnered with several health sciences programs (nursing, dentistry, pharmacy, optometry, public health) and two community-based organizations: Quebec Black Medical Association and Black Youth Socio-Economic Development Summit, to organize a virtual public consultation about Black student representation in health sciences. A working group was created to coordinate the event and ensure subsequent follow-up with action plans.
The forum took place on April 14, 2021, and about 100 representatives from universities and community-based organizations were invited and attended the event. The day was split into four activities:
1) A focus group platformed 8 participants, who shared their experience within the education and healthcare system, including experiences of anti-Black racism. The activity, called “reversed forum”, involved people from various healthcare fields (medicine, nursing, nutrition) and at different stages in their academic or professional journey (college students, graduate students, in-practice professionals), who gave brief yet concrete accounts of their experiences, hardships, and achievements. Thus, the day started with testimonies from Black students and health professionals who provided information not easily reflected by data and statistics.
2) A short presentation introduced available descriptive data on the representation of Black students in the two involved universities. The two main community-based partners of the event presented their organizations and the expectations they had for this event. Lastly, a case study from another Canadian institution (Community of Support, University of Toronto) was presented to inspire the attendees.
3) The main activity of the day was a series of breakout room discussions built on the “World Café” methodology, where groups of 10-12 people went through three related prompt questions: What should be kept, changed or implemented at the community, university and society level in order to improve Black student representation in health sciences? All discussions were captured by designated “writers” in each group and facilitated by a volunteer that was recommended by members of the organizing committee. During the lunch break, videos produced by a member of the working group, which showcased the contributions of little-known Black scientists and health professionals were presented to promote Black scientists in health sciences (https://www.youtube.com/c/nursestephietv).
4) A wrap-up session explored the main themes of the day that were presented by representatives of each small group; these were summarized by a designated person responsible to write a summary of the event.
Major themes discussed by participants throughout the World Café included:
- The importance of financial support for learners with financial challenges
- The need to refine or implement recruitment programs for health sciences while providing good orientation counselling upstream, including better knowledge and promotion of all health professions
- The importance of increasing the visibility and number of role models from the Black communities
- The need to review and update admission policies in universities
- The importance of fostering an inclusive and diverse learning environment
- The need to include more elements in health care curricula that are specific to Black Health
The Way Forward
The multi-institutional consultation on Black student representation in health sciences, while using co-construction as an underlying principle, identified areas for improvement at different levels (community, university, society) and has helped institutional decision-makers identify priority actions.
The first clear priority action was the importance of collecting sociodemographic data including self-declared race, ethnicity and socioeconomic status within institutions, as was recently mentioned in a call from the Black Medical Student Association of Canada. While preparing this forum, we realized how data were seldom available in our institutions to properly document the representation of Black communities in certain programs. These data are essential to inform admission policies and to make sure that initiatives translate in concrete results.
Data other than counting people are also important priorities. The lived experiences of Black students within admissions processes and within health sciences programs must also be collected; many racialized participants described potentially hostile processes and programs containing elements of systemic discrimination and racism within them. Indeed, the idea of appropriate representation must be accompanied with concrete measures to ensure that Black students evolve in an inclusive environment, devoid of racism. Black students encounter microaggressions in medical school and these must be properly documented so they can be acted upon.
Specific pathways for Black applicants have been implemented or are being implemented in many medical schools across Canada. However, to our knowledge, no such pathways exist for other healthcare professions. Upstream, pipeline programs can be improved by collaborating with community partners, to make sure that application processes and a variety of healthcare programs are presented and explained during activities. Also, many forum participants believed that, for some programs, the admission process should be revised to include metrics other than the R score or GPA to generate admission offers. Financial barriers were also a very common theme highlighting that specific financial support should be available for people who need it, either at the time of application or during their time in the program.
Our citizen forum was appreciated by all participants and constituted an important step to foster partnerships with community-based organizations. The ideas and data collected during the event will allow us to create and update specific action plans oriented toward improving the representation of Black students with the identified priorities. Community partners will be involved at each step to ensure that these plans and future actions are co-constructed.
The authors would like to thank all the people involved in the preparation and realization of the 2021 Citizen forum on Black Student Representation in the Health Sciences, as well as all participants of the event.
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