University of Missouri medical students will notice some differences this semester. No, not only mandated masks and socially distant public areas - something a little less noticeable.


In the months since MU Health Care resident Venkata Gupta helped organize a demonstration against police brutality and systemic racism in health care, he’s been working with a group of MU medical students to address racism within health care and how it manifests in the medical school curriculum.


It started with a series of round table discussions among medical students faculty in the weeks after George Floyd’s death in Minnesota.


"Everyone says they aren’t a racist but, we aren’t able to define what racism is within the medical field in that how it affects us and how does it affect our patients," Gupta said. "It’s very minor things that might seem to other people like it’s not racism."


Like, for example, the standard description of Lyme’s disease. The illness is often identified by a red target lesion – a small, red tick bite surrounded by a larger red circle. Except that’s not how Lyme’s disease presents on more pigmented skin. On Black skin the bull’s eye is harder to discern. It can present as discolored, raised lesion without the obvious red circle surrounding it.


But how it appears on white skin is often the instructional default, which means doctors could be much less likely to identify the early stages of Lyme’s disease among Black people.


That, among other things, is what Gupta and the medical students would like to see change.


FRAMING CHANGE


The School of Medicine has a project based learning framework. Students primarily learn in small groups via case studies as opposed to large lecture halls.


"They want more diversity in those cases," Senior Associate Dean of Education and Faculty Development Michael Hosokawa said. "… I think that really makes sense."


Hosokawa said the students gave him a "shopping list" of changes they wanted to see. At least one, creating a new course on diversity, isn’t realistic.


"It’s really hard to put a whole new course in a medical school curriculum," Hosokawa said. "It’s kind of a zero-sum game. If you are going to insert something, you are going to have to take something out."


Others, though, he said, are possible. And they are possible, in part, because of Hosokawa.


In 1992, the then-dean charged Hosokawa with the job of upgrading the program’s curriculum. What Hosokawa landed on was the framework still used today.


"It’s tough to change a curriculum," he said. "But I think our curriculum lends itself to being more flexible, more agile than the old 60-minute-course based curriculum because we can change the cases."


Which is exactly what first and second year med students are likely to see come October. Hosokawa has also invited a family medicine faculty member to help develop more diverse case studies for students.


DISPARITIES OF CARE


Public discourse on race intersected with the pandemic almost from the onset of the recent protests. Gupta said as much during the demonstration he organized against police brutality June 4.


"This is a public health crisis," he said before beginning an 8 minute and 46 second period of silence. "Kneeling on someone’s throat while he cried out ‘I can’t breathe’ is a public health crisis."


Black Americans are also more likely to contract COVID-19. Assistant Director Scott Clardy of the Columbia-Boone County Public Health and Human Services Department said that is evident in local as well as state and national data.


In a recent meeting of the Boone County Muleskinner’s, Clardy reported that Black Boone County residents represent a disproportionate number of total cases. As of Monday evening, 19.2% of the county’s 1,090 cases were among Black residents. About 9.8% of Boone County residents are Black.


"The good news is this used to be much higher," Clardy said. "This used to be 20 percent. I don’t want to minimize that this is a disparity that we are very concerned about, and frankly it mirrors what we are seeing across the country."


The reason for that disparity, is unlikely to be genetic. He’s seen no studies that indicate a greater inherent susceptibility to COVID-19. It’s more likely to do with decreased access to care in Black communities.


For Hosokawa, the larger community has an important role in medical instruction. Students need to understand that the community is a patient as well.


"Their responsibilities don’t end when they leave the hospital," he said. "I think that is part of their action today. They are becoming conscious of their responsibility as a community member."


Although the upcoming changes to the University of Missouri’s medical curriculum aren’t as sweeping as the last round of curriculum reforms Hosokawa was involved in, he’s encouraged by the source of the change. This time, his directive is coming from the students.


"I have to tell the student repeatedly I can’t do everything you want us to do but keep your ideas coming," he said. "So, the students are keeping us on our toes. And that makes it more fun."