Posted on May 3, 2023

Racial Affinity Group Caucusing in Medical Education — A Key Supplement to Antiracism Curricula

Leanna Lews et al., New England Journal of Medicine, April 27, 2023

As academic medicine begins to recognize and examine racism as the root cause of racially disparate health outcomes, we need curricula for training physicians to dismantle the systems that perpetuate these inequities. Since traditional approaches to medical education are themselves founded in inequitable systems, new approaches are essential. Racial affinity group caucuses (RAGCs) are one such approach. RAGCs are facilitated sessions involving participants grouped according to self-identified racial or ethnic identity to support integration of antiracism curricula into clinical practice. Used as part of a broader antiracism and antioppression curriculum, racial affinity group caucusing engages participants in critical introspection through the lens of their own racialized experience and enhances learning by building community and encouraging praxis, the integration of theory, self-reflection, and action. Such caucusing, which some Indigenous scholars believe derives from an Algonquin term meaning a group gathering for wise counsel, involves a thoughtful and purposeful approach to dialogue.

Founded on legacies of colonialism and racism, medical education has historically centered White learners and continues to perpetuate structural racism. Pedagogical approaches often center White learners and ignore the differential impact of content on BIPOC learners (Black, Indigenous, or people of color) with personal experiences of racism that are nuanced and have been informed by interactions and observations over their lifetimes. Immersion in the existing medical education system can therefore be retraumatizing, resulting in imposter syndrome, heightened anxiety, and a reduced sense of belonging. Especially as we seek to recruit more medical students who are BIPOC, we need to recognize this harm and encourage pedagogical approaches that support the needs of BIPOC learners.

RAGCs have been studied in a range of settings, including K–12 education, undergraduate education, and workplace environments, but have not yet been well studied in medical education. Some BIPOC people have been socialized to care for the egos of White people, to express their emotions only in ways that are palatable to White audiences, and to tread lightly around “White fragility” (White people’s discomfort and defensiveness regarding their legacy of racism and complicity in systems of inequality) in order to maintain their relationships, professional status, and safety. In a space without White people, BIPOC participants can bring their whole selves, heal from racial trauma together, and identify strategies for addressing structural racism.


RAGCs for Black learners provide a setting that centers Black experiences as the norm and celebrates diverse Black perspectives. This environment buffers participants from (often daily) experiences of micro- and macroaggressions, structural inequities, and isolating siloes in predominantly White institutions. {snip}

RAGCs for people of color similarly provide participants opportunities to build community, deepen their understanding of and healing from racism, and express a full range of emotions. BIPOC affinity groups acknowledge the intersectional and evolving nature of personal, racial, and cultural identities and honor each participant’s multidimensionality. With this foundation, BIPOC learners are better equipped to interrogate the impact of racism, including how their own communities perpetuate colorism, colonialism, xenophobia, and anti-Black racism.

White trainees benefit from facilitated discussions in which they consider and are challenged by frameworks for dismantling centuries of socialized misconceptions about race and racism. RAGCs for White learners differ from other White-dominated spaces in allowing participants to be held accountable without burdening or retraumatizing BIPOC colleagues who are affected by racism. In RAGCs, White participants can learn to be thoughtful allies who are less dominating in integrated spaces, to elevate the voices and leadership of BIPOC colleagues, and to iteratively reevaluate their own internalized racism and sense of superiority that can obstruct antiracist commitment and action.