Racism in medical education and the entanglement of contents and (con-)texts

Background: Institutional racism and racial disparities in healthcare have received greater focus in the public health sciences in recent decades. The role of medical education in this context has been researched in several studies, mostly in the US, but racism in medical education remains largely underresearched in Germany. The aim of this study is to show how racist knowledge and practices exist within German medical care and are systematically transmitted in German medical education, and how this may institutionally reproduce, legitimize, reinforce, and perpetuate disadvantages.

Methods: Based on consultations and preliminary interviews with civic stakeholders and experts, teaching and learning materials in German medical education were randomly sampled. These materials served as a starting point for participative reflection on racist knowledge and practices in German medical education. In the first step, the contents of teaching and learning materials were analyzed to identify terms, themes, or concepts that propagate racist ideas. Thereafter, we sought expert feedback on the analyzed content through one-on-one interviews and focus groups with physicians and medical students who self-identify as affected by racism.

Results: Our study reveals two main findings. First, racist knowledge and practices are systematically transmitted and reproduced at different levels of German medical education. Second, the entanglement of multiple institutional dimensions contributes significantly to the perpetuation and legitimization of racist knowledge and practices in German medical education.

Conclusion: In keeping with the state of research, the study was primarily exploratory in character and may serve as a starting point for future research on institutional racism in German healthcare and medical education. In addition to the findings that can be used to develop further research questions, initial recommendations for action by civil society, institutions, and policymakers may be derived from the interviews and focus group discussions.