Black student underrepresentation is well described within medical schools and other health professions. Evidence from multiple contexts has shown that increasing diversity of the health care workforce improves patient care, including both access to and efficacy of care. From the learner perspective, diversity can improve healthcare training by enriching the learning environment, providing role models and, in some situations, promote better understanding of patient realities. For these reasons, healthcare education programs are deploying many efforts to increase diversity in their cohorts.
The underlying causes of Black student underrepresentation in health sciences are complex. Their roots lie upstream to admissions processes, intersecting with many other sociodemographic characteristics and variables. Given this complexity, analysis with a view to finding solutions is inherently perspectival in nature. If largely white faculty work at developing solutions to Black "underrepresentation", proposed solutions risk failing to meet the needs of the populations they seek to serve or being colonizing. Therefore, co-construction of knowledge and solutions with community-based partners seems to be an essential approach.
Co-construction is a concept that is used in many fields, including education and project management. It usually involves a participatory approach where partners from different backgrounds are working together toward common goals and go beyond consultation or concertation. Using co-construction as a guiding principle, the two Montreal-based Faculties of medicine partnered with several health sciences programs (nursing, dentistry, pharmacy, optometry, public health) and two community-based organizations: Quebec Black Medical Association and Black Youth Socio-Economic Development Summit, to organize a virtual public consultation about Black student representation in health sciences. A working group was created to coordinate the event and ensure subsequent follow-up with action plans.
The forum took place on April 14, 2021, and about 100 representatives from universities and community-based organizations were invited and attended the event. The day was split into four activities: A focus group platformed 8 participants, who shared their experience within the education and healthcare system, including experiences of anti-Black racism. A short presentation introduced available descriptive data on the representation of Black students in the two involved universities. The main activity of the day was a series of breakout room discussions built on the "World Café" methodology. A wrap-up session explored the main themes of the day.
Major themes discussed by participants throughout the World Café included: The importance of financial support for learners with financial challenges; The need to refine or implement recruitment programs for health sciences while providing good orientation counselling upstream; The importance of increasing the visibility and number of role models from the Black communities; The need to review and update admission policies in universities; The importance of fostering an inclusive and diverse learning environment; The need to include more elements in health care curricula that are specific to Black Health.
The first clear priority action was the importance of collecting sociodemographic data including self-declared race, ethnicity and socioeconomic status within institutions. Data other than counting people are also important priorities. The lived experiences of Black students within admissions processes and within health sciences programs must also be collected. Specific pathways for Black applicants have been implemented or are being implemented in many medical schools across Canada. Our citizen forum was appreciated by all participants and constituted an important step to foster partnerships with community-based organizations.