A. Critical Teaching Tools for the Infusion of CRF into Medical School Curriculum
The infusion of CRF theory as a means to ensure cultural competent curricular in medical schools has been advanced. “[C]ritical race feminists provide the tools for challenging subordination at its core and understanding how various oppressions are connected and interrelated - setting the stage for truly transformative change in our society.” This *185 section will examine basic tenets of CRF theory and their effectiveness toward assisting medical schools to satisfy culturally competent mandatory accreditation standards. CRF traditionally “draws from critical legal studies the idea of deconstruction along with the critical analysis of the traditional legal canon.” J.M. Balkin argues that:
Lawyers should be interested in deconstructive techniques for at least three reasons. First, deconstruction provides a method for critiquing existing legal doctrines; in particular, a deconstructive reading can show how arguments offered to support a particular rule undermine themselves, and instead, support an opposite rule. Second, deconstructive techniques can show how doctrinal arguments are informed by and disguise ideological thinking. This can be of value not only to the lawyer who seeks to reform existing institutions, but also to the legal philosopher and the legal historian. Third, deconstructive techniques offer both a new kind of interpretive strategy and a critique of conventional interpretations of legal texts.
I contend that medical school curricula will move toward satisfying cultural competence mandates through critical teaching tools, such as deconstructive techniques as employed by CRF theory. Professor Adrien Wing asserts that critical race feminism draws from critical legal studies the idea of deconstruction along with the critical analysis of the traditional legal canon.
An example of deconstructive inquiry can be gleaned from some key Critical Race Theory or CRF components set forth by Margaret Montoya:a. The role that science has played and continues to play in constructing racial identities, and the concepts we understand as “race” or “racialized ethnicities.”
b. How law has created and sustained white supremacy.
*186 c. How law creates and maintains race-based power imbalances.
d. How law intersects with the collective racial histories of the respective racialized groups in the U.S.
e. Why social burdens or benefits accrue because of race.
f. Why narratives are used to express and examine racial identities.
g. Why legal discrimination needs the concept of intersectionality, (i.e., the interlocking oppressions affecting women, such as racism, sexism, heteropatriarchy, classism, agism, etc.).
The fusion of the delineated inquiries into medical education would prove beneficial for addressing the need for culturally competent curricula. Montoya correctly points to the propensity of medical schools to “rarely name or analyze” race in terms of its socially constructed nature and resulting social inequalities.
Montoya notes innovative efforts by medical schools to address cultural competence and its shortcomings:[I]n the Videotape: Worlds Apart: A Four-Part Series on Cross-Cultural Healthcare produced by Stanford University Center for Biomedical Ethics (2003) wherein the narrator, Robert Phillips ‘makes a passing reference to the Tuskegee experiments' to explain the distrust that many African Americans have of doctors and the health profession. . . [accompanied by] a one sentence slide that purports to explain to the Stanford medical students what the Tuskegee experiments were.
A critical examination of the Tuskegee Syphilis Study is necessary in order to adequately make a deconstructive inquiry into its biomedical significance to women and research. Champion notes an example of using the Tuskegee Syphilis Study as a means to illicit discussion on professional responsibility in informed consent and scientific experimentation issues amongst college students enrolled in a physical therapy education course:The Syphilis study was used as a teaching example - it should *187 be noted that none of the students were familiar with the study. The six-hour instructional unit included 1) in class viewing of the video, Miss Evers Boys, 2) individual student completion of a “Probing Question Guide” to define ethical dilemmas and consider value conflicts, and 3) focused discussion about issues such as medical paternalism, autonomy, informed consent, honesty, “whistle-blowing”, and the conflict between scientific inquiry and patient rights; as complicated by role definition and responsibility within the health care system. . . . 64 of the 68 students (95%) reported that this instructional approach was more satisfying than traditional formats used in applied ethics. Specific outcomes of this experience were described in terms such as “. . .brought theory to life in the classroom”, “now understanding the underlying value of valid informed consent”, “will not soon forget this violation of human dignity and its impact”, and” . . . learning from the experience of others helps me to clarify the issues.” At the conclusion of the unit, 100% of the students requested additional time for further discussion.
The reality that none of the students were familiar with the Tuskegee Syphilis Study prior to the viewing of the 1997 HBO movie, Miss Evers Boys, is especially disturbing because the “facts” of the study are now skewed by a fictional account of a significant human atrocity in U.S. medical history that marginalizes the women of the Tuskegee Study directly impacted by the effects of untreated syphilis. It is the “rarely named or analyzed” prevailing issues that CRF cast light upon in order to promote a curricular delivery that meets the current medical accreditation cultural competency standards.
