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Racism: the other pandemic

BMJ 2020; 369 doi: (Published 11 June 2020) Cite this as: BMJ 2020;369:m2303

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Rapid Response:

Diversifying medical school education to represent BAME backgrounds

As we have observed in the covid-19 pandemic, excellently highlighted by Godlee, there has been a disproportionate number of deaths amongst the BAME population (1). Godlee rightly stresses that “racism is a public health issue because it kills people” (1). I argue that a lack of diversity in teaching at UK medical schools, mirrored by many medical textbooks, perpetuates racial inequality.

As a medical student myself, physiology and anatomy textbooks were the backbone of my education in my first few years at medical school. However, it’s difficult not to notice that the overwhelming majority of clinical images and case presentations are illustrative only of white patients. This is not representative of the society we live in. Reflecting on this, I felt increasingly unsure how I would identify features such as cyanosis, erythema, and pallor in patients of different skin colour.

Although slightly dated, Plataforma SINC raised this issue over a decade ago, demonstrating the historical nature of this matter, which should have been addressed a long time ago (2). More recently an American study found that in leading textbooks the skin tones represented were 74.5% light, 21% medium, and 4.5% dark, compared to a distribution of 62.5% white, 20.4% black, and 17.0% person of colour in the wider US population (3).

Failure to educate medical students in the variety of presentations and clinical signs seen in all ethnicities, propagates racial inequality. If healthcare professionals are unable to identify these signs, potentially unwell patients will not be appropriately treated leading to increased morbidity and mortality amongst the BAME population. Recently this topic has gained attention amongst medical students throughout the country in the form of a petition calling for a change to their curriculums (4).

Acknowledging and addressing the lack of ethnic diversity in the medical school curriculum will ensure the doctors of tomorrow have a better ability to recognise, diagnose, and treat patients from all ethnic backgrounds. Representation is vital for doctors to provide the same high level of care to all patients, reflecting the principle of justice in medical ethics.

1. Godlee F. Racism: the other pandemic. BMJ [Internet]. 2020 Jun 11 [cited 2020 Jun 13];369:m2303. Available from:
2. Plataforma SINC. Medical Textbooks Use White, Heterosexual Men As A “Universal Model” -- ScienceDaily [Internet]. Science Daily. 2008 [cited 2020 Jun 13]. Available from:
3. Louie P, Wilkes R. Representations of race and skin tone in medical textbook imagery. Soc Sci Med. 2018 Apr 1;202:38–42.
4. Agu C. Petition · Medical schools must include BAME representation in clinical teaching · [Internet]. 2020 [cited 2020 Jun 13]. Available from:

Competing interests: No competing interests

13 June 2020
Cameron A Lynch
Fourth Year Medical Student
University of Manchester, Manchester M13 9PL, UK