When Marta N. Flory, MD, a clinical assistant professor of radiology at Stanford University, recognized the scope of racial inequities in healthcare, she realized that she needed to start from the ground up to address the problem. To support physicians in interacting with patients from diverse backgrounds, Flory, along with contributors Heike E. Daldrup-Link, MD, PhD, and Iris C. Gibbs, MD, FACR, created a new education module, “Life in Black and White: Race in Radiology, Healthcare, and Health Outcomes,” as part of the Radiology-TEACHES® health equity series. Radiology-TEACHES is an online portal that uses case vignettes integrated with the ACR Select® clinical decision support to simulate the process of ordering imaging studies. Flory spoke to the Bulletin about how the module came to be and why health equity must be a core focus of radiology practices.
How did the module come about?
The wave of racial violence and strife in our society during 2020, in conjunction with the COVID-19 pandemic, ignited a lot of distress for people. I felt an urgent need to connect with colleagues about these important issues of systemic racism and health inequity, and that it was time to have such conversations on a professional level. Radiology-TEACHES offered me the opportunity to expand this conversation on a national level through an educational module, where participants could go through the course and engage with the material at their own pace. Since I believe this material is enriched through conversations with peers and colleagues, I created a small-group facilitator guide to go along with the module to facilitate discussion and engagement in an intimate format. From my perspective, the module is the beginning of an ongoing conversation and process of examination of racial inequity in healthcare systems. The goal is to make thinking about and addressing health equity a habit, not a box that you check off your list of things to study or do. I would love to see health-equity education integrated into all radiology training programs.
How did you decide on the module’s topics?
Before diving into the very complex challenges of healthcare inequity and systemic racism, I first thought it was important to examine some basic assumptions about self and privilege and establish a common understanding and language that students can use as they move through the module. We start with “Identity and Privilege,” considering what makes us who we are and influences how we act as individuals, and move to “Microaggressions and Tone Policing,” as these concepts are the most microscopic, things that we control in our everyday interactions as individuals. When we understand our own privilege and systemic racism as a concept, then we can think about how it plays into our interactions with people in general, including our patients and colleagues. Then we zoom out to view equity on a more macro scale. We look at racism in healthcare, with the section on “Health Outcome Disparities,” and learn about what we can do about these problems. Finally, we learn how to address these problems through “Allyship” and co-collaboration.
How does the module support the ACR’s efforts around healthcare disparities?
I think the module gives people the language that they need to understand the conversations around healthcare disparities — hopefully in an engaging way. This module shows students how healthcare disparities exist in our everyday lives. Inequity is not something that’s external or outside of us, but a part of our reality. It has probably come into play in our experiences and medical training.
I think the module gives people the language that they need to understand the conversations around health care disparities — hopefully in an engaging way.
How does the module support the ACR’s efforts around healthcare disparities?
I think the module gives people the language that they need to understand the conversations around healthcare disparities — hopefully in an engaging way. This module shows students how healthcare disparities exist in our everyday lives. Inequity is not something that’s external or outside of us, but a part of our reality. It has probably come into play in our experiences and medical training.
How can radiologists work to change racist systems and assist people in healthcare?
I believe it starts on an individual level, spreading the word locally and creating a culture of equity and inclusion in your own practice and at your own institution. Challenge people to think: What is your privilege? How might you leverage it to promote health equity at your institution or beyond?
While being humble, I recognize my own privilege as a White, academic radiologist, training generations of radiologists and with a small impact on radiology research and evidence-based medical care. I talk to my colleagues, sonographers, RTs, and patients about health equity and systemic racism, including habits of behavior such as microaggressions and tone policing. I believe that we can have a small but important impact when we think about health equity as we work with patients and colleagues in the reading room every day.
Ultimately, a systemic solution is needed for a systemic problem. I don’t know what that solution is yet, but I’m committed to supporting my colleagues and patients of color and to working toward a solution.
Why should radiologists get involved in advancing health equity?
Ultimately, it’s the best thing for patient care and it will lead to better patient outcomes. From a financial standpoint, the more you’re able to reach and care for a diverse patient population, the larger your referral base will be. But most importantly, it’s just the right thing to do.