Despite the widespread backlash against “Diversity, Equity, and Inclusion” (DEI) measures in healthcare, true believers continue to introduce ideology into medical practice. No other takeaway is possible when one examines a course currently available in the “Anti-Racism Coalition” educational series at the George Washington University School of Medicine & Health Sciences (GW SMHS).
That course, “Moving Beyond Bystanding … to Disrupting Racism,” exists, according to its website, to “change racist culture, policies, and practices” in hospitals and other medical institutions.
“No matter what role you have,” the website promises, “this training will allow for you to recognize your responsibility in contributing to an antiracist institutional culture.”
The course’s intellectual framework is the so-called D.I.S.R.U.P.T. model, created by GW SMHS medical educator Maranda C. Ward, pediatrician Olanrewaju Falusi, and student collaborators. In a recent post on the medical-news site MedPage Today, Ward et al. describe D.I.S.R.U.P.T. as “a mnemonic that offers a set of personal and shared considerations for building anti-racist clinical care.”
Among the authors’ specific recommendations is that physicians’ rounds should end with a “bias check”: “Did we consider whether bias influenced this care plan?”
The authors also propose that “[p]atterns in patient satisfaction, readmission rates, or delays in follow-up can be analyzed by demographic group.”
According to Ward et al., the issue of racism in medicine is not merely a matter of a few bad actors. Rather, the authors see it as a systemic and structural issue requiring collective accountability. They note approvingly that training participants “grasped bias as a collective issue” and that “teams can create structured prompts to prevent bias and institutionalized racism.”
This is bad medicine. It focuses on ideology over substance, blaming every racial disparity on bigotry while ignoring genetics, comorbidities, behavior, lifestyle, and other well-documented factors.
Moreover, Ward et al. rely on widely debunked “implicit bias” ideology in the plugging (and, presumably, the designing) of their course, writing that “[r]esearch on implicit bias makes it clear that unconscious stereotypes shape physician behavior.”
The problem with this assertion is that there is no evidence that “implicit biases” explain racial disparities in health outcomes. Moreover, the tests used to evaluate these unconscious but ostensibly ubiquitous prejudices fail to meet widely accepted standards of reliability and validity.
As Do No Harm has previously noted, “a 2013 meta-analysis published in the Journal of Personality and Social Psychology found that Implicit Association Tests (IATs) were ‘poor predictors’ of real-world bias and discrimination.”
Yet these are the very tests on which Ward et al. base their “antiracist” ideology.
Other elements of Ward’s D.I.S.R.U.P.T. defense are just as problematic.
Over and over, the GW professor and her co-designers draw a parallel between antiracist practices and such evidence-based medical developments as hand hygiene.
But such a comparison strains credulity. Hand hygiene is based on testable theories of germ transmission and infection control. Antiracist medicine, by contrast, is based on anecdotes, political theory, and critical social justice.
So, apparently, is GW SMHS’s course. According to the aforementioned MedPage Today article, a two-part D.I.S.R.U.P.T. training “showed improvement in participants’ sense of motivation to respond to racism, responsibility to act, and belief in their ability to contribute to equity work.” These results were assessed via “pre/post-data.”
Yet “pre/post” testing is itself methodologically suspect, as a classic meta-analysis by Victor L. Willson and Richard R. Putnam demonstrates. Across 32 studies, Willson and Putnam found a modest but real average effect: taking a pre-test at all tended to elevate post-test scores, including attitude measures.
In other words, not only is D.I.S.R.U.P.T. based on bad science, but its efficacy on its own terms deserves to be called into question. That its creators haven’t thought to do so is further evidence that their motives are political rather than medical.
At present, physicians taking “Moving Beyond Bystanding … to Disrupting Racism” may receive Continuing Medical Education credits for doing so.
Doctors on the hunt for authentic CME should look elsewhere.
