Racism and sexism in the trajectory of black female medical students: an integrative review

Martins, Mirian Teresa de Sá Leitão; Taquette, Stella Regina

doi:10.1590/interface.230343

Brasil

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Review • Interface (Botucatu) 28 • 2024 • https://doi.org/10.1590/interface.230514 linkcopy

Racism and sexism in the trajectory of black female medical students: an integrative review

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Black female medical students are a minority and face various obstacles during their training because they are black women. The study aimed to synthesize the knowledge produced in empirical studies on the racial and gender discrimination suffered by black female medical students. We carried out an integrative review using the PubMed and VHL databases. Fifty studies were analyzed in depth and classified into three thematic categories: 1- Systemic-structural and structuring racial prejudice. 2- Racism as one of the factors of inequity in medical education. 3- Genderized racism experienced by black students. It was concluded that in medical schools, a social space with low ethnic/racial diversity and crossed by structural racism, female black students are negatively discriminated by the intersection of race, gender and social class dynamics.

Keywords Inequality; Medicine; Racism; Sexism; Students

Authors, Year of publication, country of study and method	Thematic category	Objectives	Sampling	Main findings / conclusions
Fitzousa E, et al.¹⁰, 2019, USA,Qualitative Study.	I; III	Understand what students think about the workforce in training.	15 students	The portraits of the graduates reflect the institution’s racial and gender bias.
Kalifa A, et al.¹¹, 2022, Canada, Qualitative Study	I	Explore how medical schools approach racism.	8 students; 4 deans; 7 staff and 11 professors.	Structural racism persists in the institution and there is no action to combat it.
Morrison N, et al.¹², 2019, England, Qualitative Study	I	Exploring the experiences of black students with low academic performance.	24 students Focus Group	Due to racism, black students face barriers at university.
Burgess DJ, et al.¹³, 2016, USA, Quantitative Study.	I; II	Identify the promotion of activities that favor interracial interactions.	2394 students	The institution held courses to reduce racial prejudice.
Escalante E, et al.¹⁴, 2022, USA, Quantitative Study.	I	Addressing racial disparity to combat racism in care practices.	85 students	An anti-racism initiative was implemented in the residency program.
Dyrbye L, et al.¹⁵, 2019, USA, Quantitative Study	I	To assess the association between burnout and racial prejudice among residents.	3392 students	“Burnout is associated with racial prejudice and interferes with medical care.
Sanky C, et al.¹⁶, 2022, USA, Quantitative	I	Evaluating knowledge about black protagonism.	166 students	There is racism in health and little knowledge about anti-racist protagonism.
Phelan SM, et al.¹⁷, 2019, USA, Quantitative Study	I	To identify the racial prejudice of students when they enroll in clinical internships.	3756 students	The racism expressed by students is associated with their decision not to do internships in poor communities.
Kristoffersson E, et al.¹⁸, 2022, Sweden, Qualitative Study	I; III	Indicate how medical schools can combat discrimination.	15 students	There have been insufficient anti-racist policies and actions to deal with discrimination.
Ona FF, et al.¹⁹, 2020, USA, Qualitative Study	I; II	Developing and implementing an anti-racist curriculum at the medical school.	22 students	Starting with a “pilot” project for anti-racist education, curricular reforms and institutional changes were proposed.
Perdomo J, et al.²⁰, 2019, USA, Quantitative Study	I	Discuss and address the impact of structural racism on health.	66 students	The Proposal implemented provided tools to reduce institutional racism and prejudice.
Van Ryn M, et al.²¹, 2015, USA, Quantitative Study	I	Examining racial prejudice among medical students.	3547 students	Racist attitudes are built up in childhood and are difficult to change.
Tsai J, et al.²², 2016, USA, Quantitative Study	I	To discuss the teaching of the concept of race in medical education.	350 lectures	The slides showed that race was presented as a determinant of health risk.
Burke SE, et al.²³, 2017, USA, Quantitative Study	I	To examine the effects of racism of white medical students in the clinical internship.	2922 students	It is necessary to address racial prejudice due to racist occurrences in medical education and health.
Kristoffersson E, et al.²⁴, 2021, Sweden, Qualitative Study	I; II	To analyze whether black and Latina students in the medical clinic feel excluded.	18 students	Students feel excluded and teachers must provide theoretical concepts for understanding discrimination.
Davis DLF, et al.²⁵, 2021, USA, Quantitative Study	I	Addressing racial diversity in medical schools.	615 students	Through the “DMO” program, concepts about racial diversity were introduced.
Davis D, et al.²⁶, 2013, USA, Quantitative Study	I	Examining the MCAT scores of white, Black and Latinx medical school students.	45800 examinations	The MCAT does not have a racist bias, even though the scores of Blacks and Latinxs are lower.
Bright HR, et al.²⁷, 2019, USA, Quantitative Study	I; II	Comparing the perceptions of two groups of students on race and health	84 students	Participants in the training reported greater comfort when talking about race and racism.
Low D, et al.²⁸, 2019, USA, Quantitative Study	I	To evaluate the association between race/ethnicity in student assessments.	7366 words in 1096 assessments	There is a racialization in performance evaluation summaries, internship grades and written exams.
Grimm LJ, et al.²⁹, 2020, USA, Quantitative Study	I; III	Identify the use of the expressions: agency and community skills in Letters of Recommendation.	2624 Letters of Recommendation	The term community was used more to describe black people and agency for women.
Perry SP, et al.³⁰, 2016, USA, Quantitative Study	I; III	Identify how students feel at university.	4732 students	Racial prejudice from white students is detrimental to the well-being of black students at university.
Chin MH, et al.³¹, 2022, USA, Qualitative Study	I	To check whether students identify racial inequalities and prejudices.	17 students	The activity gave the students the skills to understand racial prejudice.
Degife E, et al.³², 2021, USA, Quantitative Study	I; II	To know the knowledge of students and facilitators to address racism.	102 students and 40 facilitators	Anti-racist teaching has enabled a critical view of the misuse of the concept of race in clinical contexts.
Capers Q, et al.³³, 2017, USA, Quantitative Study	I; II	Measuring implicit racial bias in college admissions.	43 professors and 97 students	There is racial prejudice in college admissions. We need to increase racial diversity.

Authors, Year of publication, country of study and method	Thematic category	Objectives	Sampling	Main findings / conclusions
Stegers-Jager KM, et al.³⁴, 2016, Netherlands, Quantitative Study	II	Investigate low performance in selection processes.	2432 students	Racial prejudice does not explain the low performance of students from racial minorities.
Teherani A, et al.³⁵, 2020, USA, Quantitative Study	II; I	Evaluate the impact of a more equal selection process in the medical course	992 Selection processes	The holistic process can create racial equity in selection processes.
Polanco-Santana JC, et al.³⁶, 2021, USA, Quantitative Study	II; I	Evaluating bias in student performance exams.	339 entrance exams.	There is racial discrimination only in the description of black and Latinx candidates.
Colson ER, et al.³⁷, 2020, USA, Quali-quanti study	II; I	Identify potential causes of racial inequalities.	840 student data and Focus group (six students, six directors, two teachers and eight staff)	They developed an approach to reduce racial inequalities.
Newcomb AB, et al.³⁸, 2021, USA, Qualitative Study	II; I	Design a pilot for the implementation of an anti-bias curriculum.	20 students and 16 residents	They developed skills to respond to racism through curriculum creation.
Kukulski P, et al.³⁹, 2022, USA, Quantitative Study	II; I	Identify differences in the classifications of black and white students.	1555 students	There is racial prejudice even after controlling for other predictors of performance.
Onyeador IN, et al.⁴⁰, 2020, USA, Quantitative Study	II; I	To examine the effect of interracial contact in the medical school environment.	3134 students	The training enabled more positive attitudes and less racial prejudice.
Loue S, et al.⁴¹, 2015, USA, Quali-quanti study	II; I	Identify gaps in the concept of racism in the curriculum.	333 students and Focus Group with 16 students 4 students other group	Learning about racism can increase personal awareness and change
Mathieu J, et al.⁴², 2022, Canada, Quantitative Study	II; III	To investigate the experiences of black medical students.	52 students	Racial discrimination interferes with the learning of black male and female students.
Odonkor C, et al.⁴³, 2022, USA, Quantitative Study	II; I	Compare the profile by race/color of candidates for the pain medicine specialty.	30415 students	Of all the applicants for pain medicine residency, almost all are white.
Mosley MP, et al.⁴⁴, 2021, USA, Qualitative Study	II; I	Analyze the learning of the concept of race for clinical practice.	22 students	A critique of the concept of ‘race’ must be promoted in order to deconstruct the association between race and disease.
Wusu MH, et al.⁴⁵, 2019, USA and Canada, Quantitative Study	II, I	Evaluate a strategy to increase the number of Black and Latino students.	2552 candidates	With a strategic recruitment plan, they increased the number of Black and Latino candidates.
Claridge H, et al.⁴⁶, 2018, England (UK), Qualitative Study	II; I	Identify factors that hinder better performance.	41 students and eight staff members	Racial discrimination has a negative impact on exams and the choice of specialization.
Robinett K, et al.⁴⁷, 2021, USA, Quantitative Study	II; I	Analyze the results of the admission process.	48 students and 143 teachers	In order to achieve equity in health, racial and ethnic diversity in medicine must be increased.
Mujawar I, et al.⁴⁸, 2014, USA, Quantitative Study	II; I	Investigating racial diversity over 12 years.	740 students	After changes in the curriculum there were improvements in self-perception about equality and diversity.
Spector AR, et al.⁴⁹, 2019, USA, Quantitative Study	II; I	Analyzing racial prejudice in student selection.	1.093 students’ exams	After a review of the selection process, the gap between black and white candidates narrowed.

Authors, Year of publication, country of study and method	Thematic category	Objectives	Sampling	Main findings / conclusions
Brown O, et al.⁵⁰, 2021, USA, Quantitative Study	III; II; I	Identifying gender, race/ethnicity bias in letters of recommendation.	3,060 recommendation letters	Surgical and leadership skills were identified mostly in white men.
Gerull KM, et al.⁵¹, 2021, USA, Qualitative Study	III; I	To investigate whether the feeling of belonging to the university affects professional choice.	23 students	Black female students don’t feel represented in some specialties.
Wijesekera TP, et al.⁵², 2019, USA, Quantitative Study	III; I	Evaluate the effects of race and gender on recommendation letters.	11781 registrations	There are differences in the letters of recommendation and lower scores for women and black people.
Royal KD, et al.⁵³, 2018, USA, Quantitative Study	III; I	Assessing whether medical students are connected to each other.	184 students	Black women are less socially connected with their classmates.
Gwayi-Chore MC, et al.⁵⁴, 2021, USA, Qualitative Study	III; I	Evaluate the experiences of students, teachers and staff.	28 teachers and/or staff and 36 students	The School of Public Health at the University of Washington promotes actions to reduce racial and gender prejudice.
Dream S, et al.⁵⁵, 2021, USA, Quantitative Study	III; II; I	To examine whether there is gender and racial bias in the selection of general surgery residents.	149 recommendation letters	The best evaluations were given to whites. Black female students are the most discriminated against.
Dorsey C, et al.⁵⁶, 2021, USA, Quantitative Study	III; II; I	Assessing diversity in vascular surgery, general surgery and orthopedics	61043 residents	Black students and women are under-represented in all specialties.
Ross DA, et al.⁵⁷, 2017, USA, Quantitative Study	III	Assess the prevalence of gender and race inequality.	N=6.000 students’ assessments	There are differences in the description of candidates according to their race and gender.
Williams RL, et al.⁵⁸, 2018, USA, Quali-Quanti Study	III; I	Identify contexts of racial/gender prejudice in the clinic. .	104 teachers and/or staff and 21 students Focus group with 196 students	Training can reduce racial/gender prejudice among students.
Martin GC, et al.⁵⁹, 2016, USA, Quantitative Study	III; I	Investigating gender/race prejudice in slides.	34219 slides	The images used in the lessons are not representative of black people and women.

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[1] Source: own authorship.