The shoulders of University of Arizona College of Medicine – Tucson's Oumou Bah sag when asked about racism.

Bah is a past leader for the college's African American Medical Student Association, a local chapter of the Student National Medical Association. The SNMA is affiliated with the National Medical Association, a largely Black physicians group founded in 1895 after the American Medical Association refused to seat Black doctors at AMA meetings.

Bah measures her words carefully, as if tiring at the need to talk about racism in medicine.

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"At least for myself, it's something I've experienced ever since I can remember. It's not just a historical perspective about things everybody knows, like the Tuskegee study or Henrietta Lacks," she said. "It's also about the lack of representation of African Americans in clinical trials and their mistrust of medicine, poor outcomes for Black women in maternal and reproductive health care, and Black life expectancy in general. That's just framing it as an entire issue with the whole health system and how disparities were exposed even more starkly by the COVID-19 pandemic."

George Floyd's 2020 murder, which sparked national conversations about the breadth and depth of racism, occurred at the end of Bah's first year in medical school. But the Tucson native and daughter of Guinean immigrants, who hopes to train as an OB/GYN after she graduates, has been involved in advocacy on the topic since her first rally as an undergrad after Trayvon Martin's death a decade ago this month.

"I've, unfortunately, been very aware of all of the deaths. It's a very long list of people, locally, nationally and internationally, affected by some of the systemic issues that we face every day," Bah said.

"Being in medical school, I just had more thoughts about what my responsibility was being in this role as a future physician. There are too few of us in the field fighting against these issues. And I'm trying to be one of those at the forefront of fighting racism. That's something I'm passionate about."

Bah said the UArizona College of Medicine – Tucson responded to racism's challenges on campus in multiple ways, including creation of diversity committees and trainings. Among the efforts that were more visible to her were better security staffing, after-hours escort services and pass card entry requirements for areas to promote safety. She and other Black students say they also appreciate it when university and college leaders mention key events related to racism in emails or newsletters, as it helps them feel less isolated.

Addressing challenges

Medical students say addressing racism's challenges requires robust, ongoing, creative efforts. They're glad both the College of Medicine – Phoenix and College of Medicine – Tucson introduced "Anti-Racism in Medicine" action plans, but they also want to see concrete changes that offer remedies on these issues.

As with students at the other UArizona Health Sciences colleges, they would like better recruitment and retention of students, staff and faculty who are Black, Indigenous or people of color; more scholarships for those students underrepresented in medicine; better mentoring and support services; curriculum changes; and more diversity among standardized patients.

Standardized patients, often white and older, help in classes and training about specific medical conditions. Students at both medical colleges would like more of a mix of colors, ethnicities and ages among them. Both colleges have made moves to diversify their standardized patient pools, including Tucson's development of bilingual flyers and a video to advertise for a broader base of applicants. Applicants also are offered unconscious bias training as of last year. But some students are getting impatient for change.

"We always hear, 'We want to teach cultural competency to our medical students,' and also teach them to serve all types of skin color. But, when you're teaching us, you're giving us mostly white skin color as the model," said Fatouma Tall, a UArizona first-year medical student in Phoenix. "I want to see real progress, not just tiptoeing around things."

Shannon Alsobrooks, a first-year student and SNMA chapter leader, is the student representative for the class of 2025. As part of the role, Alsobrooks often is invited to take part in interview committees for incoming faculty and staff.

"A couple of months ago we interviewed a potential faculty member who was African American," Alsobrooks said. "I told him, 'We just appreciate you being here and being present.' We had a good discussion and, hopefully, he'll come on as faculty. That just shows the doors are open for change and our school is receptive to that."

Transforming a curriculum

Isabel Strouse and Elen Mendoza are second-year medical students and were co-leaders of the Phoenix college's White Coats for Black Lives chapter last year. Strouse and Mendoza, who are Hispanic, also participate in the college's Anti-Racist Transformation in Medical Education, or ART in Med Ed, cohort. The college was one of 10 medical schools invited last year to join ART in Med Ed, a three-year program at the Carl Icahn School of Medicine at Mt. Sinai Medical Center in New York City designed to build anti-racist practices into the curriculum and how the colleges operate.

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"For future generations of physicians who come and train here, they'll be trained in an actively anti-racist way," Strouse said. "The training that they get, they can take with them into their future careers and help to create a chain reaction of building a more anti-racist medical system."

Mendoza said she already has seen big changes from her first year in how the curriculum is shifting. As an example, she said they're taught to ask questions about a patient's sexual orientation and gender or ethnic identity. 

"We've normalized it so, now, we don't just look at the chart. We ask when we walk into a standardized patient's room how they identify. Then, we ask about behaviors that actually correlate with disease processes, rather than be flustered over how you ask these kinds of questions," Mendoza said.

She's also seen more use of different skin tones in images used to identify lesions or wounds, which previously were all on white skin.

Mentors and mentees

For Pierce Longmire, a third-year Ph.D. candidate in molecular medicine at the College of Medicine – Tucson, widespread shock to how Floyd died, zero tolerance workplace policies against racism, and campus town halls demanding change after Floyd's death opened conversations where he felt freer to discuss his feelings with colleagues who weren't Black – feelings he might have hidden before.

"It was probably the most impactful change," said Longmire, who also is a research assistant in the Department of Immunobiology lab of Felicia Goodrum. "I also really appreciate how in my department, they now require these diversity, equity and inclusion credits per semester. That's something we all should be doing to create a more welcoming space for everybody here at the university."

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Another Tucson native, he often was the only Black student in most of his classes before college. At UArizona, he started in biomedical engineering but found cellular and molecular medicine a better fit. He hopes to be a role model for other Black students to consider biomedical research as a career.

"Growing up, I didn't really see that many examples of Black people or people of color in medicine. And, so, I want to be an example to younger people to say, 'This is something that you can do as well,'" Longmire said.

Efforts to put that into practice include his participating in Colors of STEM, a grassroots group affiliated with the ASEMS, or Arizona's Science, Engineering, and Math Scholars, program. The group hosts monthly luncheons to encourage more people of color to go into STEM careers.

Longmire said he's grateful for Michael D.L. Johnson as a role model, mentor and resource. A prominent UArizona Health Sciences immunobiology researcher, Johnson has been honored for his role founding the National Summer Undergraduate Research Project to create summer research experiences for students of color who found those opportunities limited by the pandemic.

"I'm very grateful to have Johnson close as a prominent Black scientist in my field. In fact, I specifically requested to meet with him while I interviewed for my program to hear about his experience in the field as a Black person," Longmire said.

"I look up to him as a Black researcher and professor who sponsors and organizes multiple initiatives to increase diversity and inclusion in my department and at the college and university."

This is the last in a series of stories on Anti-Racism in Medicine initiatives at UArizona Health Sciences for Black History Month. The first story, on how the Colleges of Medicine responded to demands for change, published Feb. 1. A spotlight on how other Health Sciences colleges are seeking to address systemic issues of racism in medicine published Feb. 14. 

A version of this article originally appeared on the Health Sciences Connect website.