Enriching the Cognitive Apprenticeship in Nursing Curricula: Combatting Racism and Improving Inter-Professional Communication and Teamwork

November 8, 2021 Patricia Benner, R.N., Ph.D. FAAN

We continue to focus on enriching and integrating the three high-end apprenticeships:

1) The Cognitive Apprenticeship dealing with the science, technologies, humanities required for knowledgeable, safe nursing practice;

2) The Practice Apprenticeship focuses on skilled know-how,  the productive higher-order thinking in action required for safe and effective practice;

3) Ethical Comportment and Formation refers to enacting skills, character, and knowledge to provide excellent nursing care in actual, practice situations. Ethical Comportment and Formation, the Third Apprenticeship is the most integrative of the three high-end apprenticeships because without enacting notions of good internal to the practice of nursing, one cannot effectively use situated judgment about which course of action is most prudent and in the best interests of the patient.

All three apprenticeships are highly inter-related and must be considered as a “whole cloth” in the thinking of educators, students, and practicing nurses.

All health care workers have a moral mandate to end the racism that daily takes a large toll on all diverse populations, and this requires enriching curriculum to address healthcare inequities caused by systemic, implicit bias, and all forms of preferential treatment based upon race or any form of diversity in the population. Racism has been declared a public health crisis, and nurse educators, nursing students, and practicing nurses have a long tradition of championing social justice as a means to improving the health of the population (Fowler, M., 2016). As Kenya Beard notes in this month’s video presentation, when health care professionals engage in racism, “People die.” As noted in a primer on Anti-Racism (Jackson, O’Brien & Fields, 2020):

Racism affects one’s lived experience in ways that have tangible consequences. Stereotyping, bias, lack of representation, and racism perpetuate false beliefs, lead to misdiagnosis, dangerously narrow clinical decision making, and perpetuate implicit bias, all of which lead to real health disparities. These forces also affect the integrity and safety of the learning climate and thus may impact the success of our learners. Therefore, as educators and clinicians, for our students and our patients, we have a moral imperative to confront and dismantle racism (Jackson, O’Brien & Fields 2020, P. 1)

Dr. Kenya Beard offers the following guidelines for “Facilitating Race-Related Discourse:

Recognize:  Respond to race-related bias.

Restate:  Seek clarification as to what was said.

Remove:  Redirect stigmatized information away from the individual.

Reflect:  Potential biases erroneously influence thoughts.

Recover Illuminate and Recover:  Illuminate and discuss deeper perspectives.

Rebuild: Delegitimize Stereotypes and reaffirm professional values.

An educational climate that is silent on the public health crisis of systemic, and implicit unacknowledged racism is complicit with racism and the current health care crisis created by racism in our society (click here).

Paul, Knight, Campbell, and Aronson note:

Over the past decade, this legitimization of public health challenges in White communities and the diminishment of analogous public health challenges in Black communities has played out prominently in medicine’s responses to police violence and gun violence. In 2013, young Black Americans formed Black Lives Matter, a national movement against anti-Black racism and the unjust killing of  Black people by police. Police violence is one of the leading causes of death among young Black American men: the lifetime risk of death at the hands of police for Black men is estimated to be 1 in 1000 (Edwards, Lee, Esposito, 2019). Police violence against unarmed Black Americans has been shown to cause serious psychological suffering among Black Americans generally, (Bor, et.al., 2018) and racism-related stress adversely affects Black Americans’ health regardless of their socio-economic circumstances or geographic location. Yet with rare exceptions, including the American Public Health Association and the medical student-led White Coats for Black Lives organization, medical societies, and public health organizations have until recently remained silent on the issue of protecting Black lives from police violence (Paul, Knight, Campbell & Aronson, 2020).

Informed Awareness: Raising Consciousness on the Public Health Care Crisis of Systemic Racism and Implicit Racism Biases

Nursing curricula must thoroughly inform the student of the current public health crisis of the poorer health care outcomes for patients of color. The first obligation to address the high impact of systemic racism and implicit bias on clinical diagnosis and treatment is to inform students about this real and extensive public health care crisis. Without awareness of the extent of the problem, students will not practice, nor engage in policy activism to radically reform our health care institutions to make them more equitable for all races. To that end, we offer a list of references and resources at the end of this article.

Designing Front-Line Practice Interventions for Implicit and Systemic Racism

Every student nurse can be coached to intervene in system biases in each of their patient care assignments. Students can be taught to discover and directly intervene in implicit and systemic racism such as the following evidence-based racial disparities: 1) less than adequate and equitable pain management for people of color; 2) diminished sharing of Information and patient education for people of color; 3) less thorough work-up and diagnostic accuracy and follow-up for people of color; 4) lack of aggressive diagnostic testing, treatment, and follow-up in emergency room visits for people of color compared to white persons (Institute of Medicine, 2003).

Nursing students can be coached on how to directly run interference and correct oversights in the quality of health care to patients of color. This kind of consistent front-line nursing intervention has the potential of mitigating some of the inequitable health care delivered in our current health care system. While intervening in sub-standard care caused by racism may seem beyond the scope and the imagination of nursing students, in fact, it is in line with the student nurse’s/nurse educator’s partnered legal and professional responsibility to ensure that best evidence-based medicine and nursing is practiced, correcting for sub-standard practice where it occurs. This mandate to ensure the highest standards of practice by student nurses can be made into a formal compact between nursing and health care administrators and the School of Nursing in order to support the nursing student’s lower-power position as a student practicing professional nursing.

Teaching Students to Identify and Change Racist Health Care Practices

Equally important is to teach students to address policies, and practices that cause a lack of equity in access and treatment of patients of color. Addressing racist health care policies and practices needs to be integrated throughout the curriculum, and not just in a single topic in a single course. Giving the gravity of inequities in health care availability and quality for people of color, concerted and systematic approaches in the day to day health care delivered to individual patients and families, and the policies and practices that contribute to inequities in health care for people of color must be a top priority in all educational settings, as well in all sectors of health care.

Improving Interdisciplinary Communication and Teamwork

Dr. Meg Zamorodi brings home the connections between the need to eliminate systemic racism and the role of effective interprofessional communication to assist in that goal. Teamwork and collaborative practice with a shared vision for eliminating health care inequities and social injustice due to racism are essential to dismantle racism in all health care settings. Dr. Zamorodi, a doctorally prepared nurse, is Assistant Provost for Interdisciplinary Education at the University of North Carolina. She offers a vision for interprofessional education throughout the curriculum as a strategy for improving the quality of care and decreasing health care errors.

Health care errors are the third leading cause of death in the United States. She notes that 70% of health care errors involve a breakdown in communication among the health care team. These communication errors can be reduced if the health care team members improve their communication strategies and their understanding of one another’s practice. She encourages nurse educators to coach their students to ‘stay in the room’ when doctors enter, to increase communication and clarity about shared health care goals and collaborative patient care. She and her colleagues at the University of North Carolina have worked out many teaching-learning activities threaded through all health care professions’ courses, including active projects to improve health care in specific health care delivery sites, such as rural health care centers. Their interdisciplinary curriculum encourages that students from different health care disciplines learn from and about each other throughout their curricula.

Conclusion

These are but two urgent, high-priority examples of curricular areas that need to be re-examined in the Cognitive Apprenticeship. We also have an urgent need to streamline and simplify our curriculum offerings based upon the most frequently encountered patient care needs in today’s health care systems and in caring for our aging population. Many schools are expanding their community and ambulatory care in their cognitive apprenticeship in response to the shift in the majority of health care being delivered outside of hospitals and health care centers. From the Carnegie Study (Benner, Sutphen, Leonard-Kahn & Day, 2009), we know that we need to upgrade the level of pathophysiology and pharmacology taught in nursing schools, especially for students returning to schools of nursing to obtain their baccalaureate degree, and beyond. Most nursing curricula do not assess students’ gaps in knowledge that have occurred since the nurse was last engaged in nursing education. The Cognitive Apprenticeship has to be constantly renewed, updated, and adjusted for cognitive overload. Courses need to focus on content that is most relevant in today’s health care system.

References:

Andrea Jackson, MD, MAS, Meghan O’Brien MD, MBE, and Rachel Fields, MS, (2020) Anti-Racism and Race Literacy: A Primer and Toolkit for Medical Educators. Updated June 26, 2020. The University of California, School of Medicine.

Benner, P., Sutphen, M., Leonard-Kahn, V., Day, L. (2010) Educating Nurses: A Call for Radical Transformation. Jossey-Bass & Carnegie Foundation for Advancement of Teaching.

Bor J, Venkataramani AS, Williams DR, Tsai AC. (2018) “Police killings and their spillover effects on the mental health of black Americans: a population-based, quasi-experimental study.” Lancet 2018;392:302-310.

Edwards F, Lee H, Esposito M. (2019) “Risk of being killed by police use of force in the United States by age, race-ethnicity, and sex.” Proc Natl Acad Sci U S A 2019;116:16793-16798.

Fowler, Marsha D.M. (2016) “Heritage ethics: Toward a thicker account of nursing ethics.” Nursing Ethics 23 (1): 7–21.

https://nexusipe.org/informing/about-national-center/news/ipe-guidance A Resource for Developing Interprofessional Education. Guidance on Developing Quality Interprofessional Education for the Health Professions

Institute of Medicine; (2002) Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care…Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care; Smedley BD, Stith AY, Nelson AR, editors Washington (DC): National Academies Press (US); 2002

IPE Simulation – Interprofessional Competencies. https://www.simulationiq.com/software/ipe-training

Notable Anti-Racism Curriculum Resources

Disparities. June 2017. Available: https://www.irp.wisc.edu/resource/mortgage-markets-and-the-roots-ofracial-health-disparities/

https://implicit.harvard.edu/implicit/aboutus.html Project Implicit is a 501(c)(3) non-profit organization and international collaboration of researchers who are interested in implicit social cognition. Project Implicit was founded in 1998 by three scientists – Dr. Tony Greenwald (University of Washington), Dr. Mahzarin Banaji (Harvard University), and Dr. Brian Nosek (University of Virginia). Project Implicit Health (formerly Project Implicit Mental Health) was launched in 2011 and is led by Dr. Bethany Teachman (University of Virginia) and Dr. Matt Nock (Harvard University).

The mission of Project Implicit is to educate the public about bias and to provide a “virtual laboratory” for collecting data on the internet. Project Implicit scientists produce high-impact research that forms the basis of our scientific knowledge about bias and disparities.

Please visit https://www.projectimplicit.net to learn more about our team and the programs and services that we offer.

Recommended Books

Listed in Andrea Jackson, MD, MAS, Meghan O’Brien MD, MBE, and Rachel Fields, MS, (2020) Anti-Racism and Race Literacy: A Primer and Toolkit for Medical Educators. Updated June 26, 2020. The University of California, School of Medicine

Coates, Ta-Nehisi. We Were Eight Years in Power: An American Tragedy. New York: One World.2017.

Davis, Angela Y. 1944-, and Frank Barat. Freedom Is a Constant Struggle: Ferguson, Palestine, and the Foundations of a Movement. Chicago, Illinois: Haymarket Books, 2016.

Green, Laurie B., Mckiernan-González, John, & Summers, Martin, eds. Precarious Prescriptions: Contested Histories of Race and Health in North America. University of Minnesota Press, 2014.

Irvin Painter, Nell. The History of White People. W. W. Norton & Company, 2010.

Kendi, Ibrham. Stamped from the Beginning: The definitive history of racist ideas in America. Random House; 2017.

Khan-Cullors, Patrisse. When They Call You a Terrorist: A Black Lives Matter Memoir. First edition. New York: St Martin’s Press, 2018.

Roberts, Dorothy. (2011). Fatal Invention: How science, politics, and big business re-create race in the twenty-first century. New York, NY: The New Press.

Stanfield, John. Rethinking Race and Ethnicity in Research Methods. New York, Routledge, 2011. Thandeka. Learning to be White: Money, Race, and God in America. Continuum, 1999.

Zuberi, Tukufu. Bonilla-Silva Eduardo. White Logic, White Methods: Racism and Methodology. Lanham, Rowman & Littlefield Publishers, Inc., 2008.

Noteworthy Syllabus on Anti-Racism from UCSF:Noteworthy Syllabus on Anti-Racism from UCSF

Antoine S. Johnson, Elise A. Mitchell, Ayah Niriddin, (August 12, 2020) Syllabus: A History of Anti-Black Racism in Medicine  Department of Human and Social Sciences, UCSF. Humsci@ucsf.edu By Antoine S. Johnson, Elise A. Mitchell, Ayah Nuriddin August 12, 2020

Week 1. Medical and Scientific Theories of Racial Difference

• Lee D. Baker, From Savage to Negro: Anthropology and the Construction of Race, 1896-1954 (Berkeley: University of California Press, 1998).
• Mia Bay, The White Image in the Black Mind: African-American Ideas about White People, 1830-1925 (Oxford University Press, 2000).
• Sharon Block, Colonial Complexions: Race and Bodies in Eighteenth Century America (Philadelphia: University of Pennsylvania Press, 2018).
• Andrew Curran, The Anatomy of Blackness: Science and Slavery in the Age of Enlightenment (Baltimore: Johns Hopkins University Press, 2011). 
• Thomas Foster, Rethinking Rufus: Sexual Violations of Enslaved Men(Athens: University of Georgia Press, 2019).
• Rana A. Hogarth, Medicalizing Blackness: Making Racial Difference in the Atlantic World, 1780-1840 (University of North Carolina Press, 2017). 
• Terence Keel, Divine Variations: How Christian Thought Became Racial Science (Stanford: Stanford University Press, 2018).
• María Elena Martínez, Genealogical Fictions: Limpieza de Sangre, Religion, and Gender in Colonial Mexico(Stanford: Stanford University Press, 2008) 
• Jennifer L. Morgan, “”Some could suckle over their shoulder”: Male Travelers, Female Bodies, and the Gendering of Racial Ideology, 1500-1770,” The William and Mary Quarterly 54, no. 1 (1997): 167-192. 
• Britt Rusert, Fugitive Science: Empiricism and Freedom in Early African American Culture (New York University Press, 2017). 
• Suman Seth, Medicine, Race, and the Eighteenth-Century British Empire (New York: Cambridge University Press, 2018). Mark Smith, “Getting in Touch with Slavery and Freedom,” The Journal of American History 95.2 (2008): 381-391.
• Linda Villarosa, “Myths about physician racial differences were used to justify slavert–and are still believed by doctors today,” 1619 Project.
• Christopher Willoughby, “”His Native, Hot Country”: Racial Science and Environment in Antebellum American Medical Thought,” Journal of the History of Medicine and Allied Sciences, 72.3, 328–351.

Week 2. The African Diasporic Roots of Western Medicine and Science

• Benjamin Breen, “Fetishizing Drugs: Feitiçaria, Healing, and Intoxication in West Central Africa,” in The Age of Intoxication: Origins of the Global Drug Trade (Philadelphia: University of Pennsylvania Press, 2019).
• Pablo Gómez, “Incommensurable Epistemologies? The Atlantic Geography of Healing in the Early Modern Caribbean,” Small Axe 18.2. 44 (2014): 95–107.
• Margot Minardi, “The Boston Inoculation Controversy of 1721-1722: An Incident in the History of Race,” The William and Mary Quarterly 61.1 (January 2004): 47-76.
• Kathleen Murphy, “Translating the Vernacular: Indigenous and African Knowledge in the Eighteenth-Century British Atlantic,” Atlantic Studies, 8.1 (2011): 29-48.
• Katherine Paugh, “Yaws, Syphilis, Sexuality, and the Circulation of Medical Knowledge in the British Caribbean and the Atlantic World,” Bulletin of the History of Medicine 88.2 (Summer 2014): 225-252.
• Londa Schiebinger, “West Indian Abortifacients and the Making of Ignorance,” in Agnotology: The Making and Unmaking of Ignorance, ed. Robert N. Proctor and Londa Schiebinger (Stanford: Stanford University Press, 2008), 149-162. 
• Londa Schiebinger, Secret Cures of Slaves: People, Plants, and Medicine in the Eighteenth-Century Atlantic World (Stanford: Stanford University Press, 2017). 
• Timothy Walker, “The Medicines Trade in the Portuguese Atlantic World: Acquisition and Dissemination of Healing Knowledge from Brazil (c. 1580–1800),” Social History of Medicine 26.3 (2013): 403-431.
• Kelly Wisecup, “African Medical Knowledge, the Plain Style, and Satire in the 1721 Boston Inoculation Controversy,” Early American Literature 46.1 (2011): 25-50.

Week 3. Medicine, Health and the Slave Trade(s)

• Dauril Alden and Joseph Miller, “Out of Africa: The Slave Trade and the Transmission of Smallpox to Brazil, 1560-1831,” The Journal of Interdisciplinary History 18.2 (1987): 195-224.
• Manuel Barcia, The Yellow Demon of Fever: Fighting Disease in the Nineteenth-Century Transatlantic Slave Trade (New Haven: Yale University Press, 2020).
• Daina Ramey Berry, The Price for Their Pound of Flesh: The Value of the Enslaved, from Womb to Grave, in the Building of a Nation (Beacon Press, 2017).
• Marcus M. J. de Carvalho and Aline Emanuelle De Biase Albuquerque, “Os desembarques de cativos africanos e as rotinas médicas no Porto do Recife antes de 1831/ Landing African Captives and Medical Routines at the Port of Recife, Brazil Before 1831,” Almanack, 12 (2016): 44-64.
• Sidney Chaloub, “The Politics of Disease Control: Yellow Fever and Race in Nineteenth Century Rio de Janeiro,” Journal of Latin American Studies 25.3 (1993): 441-463
• David Lee Chandler, Health and Slavery in Colonial Colombia (New York: Arno Press, 1972).
• Philip Curtin, “Epidemiology and the Slave Trade,” Political Science Quarterly 83.2 (June 1968), 190-216.
• Dale Graden, Disease, Resistance, and Lies: The Demise of the Transatlantic Slave Trade to Brazil and Cuba (LSU Press, 2014).
• Walter Johnson, Soul By Soul: Life Inside the Antebellum Slave Market (Cambridge: Harvard University Press, 1999).
• Sowandé Mustakeem, Slavery at Sea: Terror, Sex, and Sickness in the Middle Passage (University of Illinois Press, 2016).
• Carolyn Roberts, To Heal and To Harm: Medicine, Knowledge, and Power in the Atlantic Slave Trade (Forthcoming).
• Stephanie E. Smallwood, Saltwater Slavery: A Middle Passage from African to American Diaspora (Harvard University Press, 2007).
• Richard Sheridan, “The Guinea Surgeons on the Middle Passage: The Provision of Medical Services in the British Slave Trade,” The International Journal of African Historical Studies, 14.4 (1981): 601-625.
• Sasha Turner, “Slavery and the Production, Circulation and Practice of Medicine,” Social History of Medicine 31.4 (November 2018): 870-876. 

Week 4. Slavery Era Medical Practitioners and Practices

• Katherine Bankole, Slavery and Medicine: Enslavement and Medical Practices in Antebellum Louisiana (Garland Publishing, 1998).
• Christiane Bougerol, “Medical Practices in the French West Indies: Master and Slave in the 17th and 18th Centuries,” History and Anthropology 2.1 (1985): 125-143.
• Herbert Covey, African American Slave Medicine: Herbal and Non-Herbal Treatments (New York: Lexington Books, 2007).
• Sharla Fett, Working Cures: Healing, Health, and Power on Southern Plantations (Chapel Hill: University of North Carolina Press, 2002).
• Pablo Gómez, The Experiential Caribbean: Creating Knowledge and Healing in the Early Modern Atlantic (Chapel Hill: University of North Carolina Press, 2017).
• Niklas Thode Jensen, For the Health of the Enslaved: Slaves, Medicine and Power in the Danish West Indies, 1803-1848 (Museum Tusculanum Press, 2012).
• Stephen C. Kenny, “The Development of Medical Museums in the Antebellum American South: Slave Bodies in Networks of Anatomical Exchange,” Bulletin of the History of Medicine 87.1 (2013): 32-62.
• Peter McCandless, Slavery, Disease, and Suffering in the Southern Lowcountry  (Cambridge University Press, 2011).
• Mariza de Carvalho Soares, “African Barbieros in Brazilian Slave Ports,” in The Black Urban Atlantic in the Age of the Slave Trade, eds. Jorge Cañizares-Esguerra, Matt D. Childs, James Sidbury (University of Pennsylvania Press, 2013), 207-232.
• Steven Stowe, Doctoring the South: Southern Physicians and Everyday Medicine in the Mid-Nineteenth Century (Chapel Hill: University of North Carolina Press, 2004)
• Richard Sheridan, Doctors and· Slaves: A medical and demographic history of slavery in the British West Indies, 1680-1834 (Cambridge University Press, 1985).
• Sean Morey Smith, “Seasoning and Abolition: Humoural Medicine in the Eighteenth-Century British Atlantic,” Slavery and Abolition 35.4 (2015): 684-703.
• James Sweet, Domingos Álvares, African Healing, and the Intellectual History of the Atlantic World (University of North Carolina Press, 2011).
• Sasha Turner, “The Nameless and the Forgotten: Maternal Grief, Sacred Protection, and the Archive of Slavery,” Slavery & Abolition 38.2 (April 2017): 232-250.
• Karol Weaver, Medical Revolutionaries: The Enslaved Healers of Eighteenth-Century Saint Domingue  (University of Illinois Press, 2006).

Week 5. Disability in Slavery and Freedom

• Jennifer Barclay, “Differently Abled: Africanisms, Disability, and Power in the Age of Transatlantic Slavery,” in Jennifer Byrnes and Jennifer Muller eds. Bioarchaeology of Impairment and Disability: Theoretical, Ethnohistorical, and Methodological Perspectives (Springer: Cham, 2017): 77-94.
• Dea Boster, African American Slavery and Disability: Bodies, Property, and Power in the Antebellum South, 1800-1860 (New York: Routledge, 2013).
• Jeff Forett, “‘Deaf & Dumb, Blind, Insane, or Idiotic’: The Census, Slaves, and Disability in the Late Antebellum South,” The Journal of Southern History 82.3 (2016): 503-548.
• David Ingleman, “Kojo’s Dis/Ability: The Interpretation of Spinal Pathology in the Context of an Eighteenth?Century Jamaican Maroon Community,” in Bioarchaeology of Impairment and Disability: Theoretical, Ethnohistorical, and Methodological Practices, eds. Jennifer F. Byrnes and Jennifer L. Muller (Springer: Cham, 2017): 95-117.
• Meredith Mininster, “”Female, Black, and Able: Representations of Sojourner Truth and Theories of Embodiment,” Disability Studies Quarterly 32.1 (Winter 2012).
• Stefanie Hunt Kennedy, Between Fitness and Death: Disability and Slavery in the Caribbean (University of Illinois Press, 2020).
• Ellen Samuels, “Examining Millie and Christine McKoy: Where Enslavement and Enfreakment Meet,” Signs: A Journal of Women in Culture and Society 37.1(Autumn 2011): 53-81.
• Leonard Smith, Insanity, Race and Colonialism: Managing Mental Disorder in the Post-Emancipation British Caribbean 1838–1914 (London:  Palgrave Macmillan,  2014).
• Andrea Stone, “Lunacy and Liberation: Black Crime, Disability, and the Production and Eradication of the Early National Enemy,” Early American Literature  52.1 (2017): 109-140.

Week 6. Medicine, Reproduction, and Childhood in the Era of Slavery

• Jennifer Barclay, “Mothering the “Useless”: Black Motherhood, Disability, and Slavery,” Women, Gender, and Families of Color 2.2 (Fall 2014): 115-140.  
• Tara Inniss, “From slavery to freedom: Children’s health in Barbados, 1823–1838,” Slavery and Abolition 27.2 (2006):251-260.
• Deirdre Cooper Owens, Medical Bondage: Race, Gender, and the Origins of American Gynecology (University of Georgia Press, 2017).
• Deirdre Cooper Owens and Sharla M. Fett, “Black maternal and infant health: historical legacies of slavery,” American Journal of Public Health 109.10 (2019): 1342-1345.
• Lorena Féres da Silva Telles, “Pregnant slaves, workers in labour: amid doctors and masters in a slave-owning city (nineteenth-century Rio de Janeiro),” Women’s History Review 27.6 (2018): 924-938.
•  Diana Paton, “Maternal Struggles and the Politics of Childlessness Under Pronatalist Caribbean Slavery,” Slavery and Abolition, 38:2 (2017): 251-268.
• Tânia Salgado Pimenta, “Midwifery and Childbirth Among Enslaved and Freed Women in Rio de Janeiro in the First Half of the Nineteenth Century,” Women’s History Review 27.6 (2018): 910-923.

Week 7. Medicine and Health in Post-Emancipation Era Societies

• Juanita De Barros, Reproducing the British Caribbean: Sex, Gender, and Population Politics After Slavery (University of North Carolina Press, 2014).
• Dayle DeLancey, “Vaccinating Freedom: Smallpox Prevention and the Discourses of African American Citizenship in Antebellum Philadelphia,” The Journal of African American History 95,3-4 (2010): 296-321.
• Jim Downs, Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction (Oxford University Press, 2012).
• Gretchen Long, Doctoring Freedom: The Politics of African American Medical Care in Slavery and Emancipation (University of North Carolina Press, 2012).
• Gretchen Long, “‘I Studied and Practiced Medicine without Molestation’: African American Doctors in the First Years of Freedom,” in Precarious Prescriptions: Contested Histories of Race and Health in North America, ed. Laurie B. Green, John McKiernan-Gonzales and Martin Summers (Minneapolis: University of Minnesota Press, 2014).  
• Christienna Fryar, “The Moral Politics of Cholera in Postemancipation Jamaica,” Slavery and Abolition 34.4 (2013): 598-618.
• Melissa N. Stein, Measuring Manhood: Race and the Science of Masculinity, 1830–1934 (University of Minnesota Press, 2015).

Week 8. Medicine, Public Health and Racial Uplift

• Susan Muaddi Darraj,  Mary Eliza Mahoney and the Legacy of African-American Nurses. (Philadelphia: Chelsea House Publishers, 2005).
• Vanessa Northington Gamble. Making a Place for Ourselves: The Black Hospital Movement, 1920-1945 (New York: Oxford University Press, 1995).
• Vanessa Northington Gamble, “‘Outstanding Services to Negro Health’: Dr. Dorothy Boulding Ferebee, Dr. Virginia Alexander, and Black Women Physicians’ Public Health Activism,” American Journal Public Health Vol. 106, No. 8 (August 2016): 1398-1404
• Vanessa Northington Gamble, “‘No Fight, No Struggle, No Court Battle’: The 1948 Desegregation of the University of Arkansas School of Medicine,” Journal of the History of Medicine and Allied Sciences Vol. 68, no. 3 (July 2013): 377-415.
• Darlene Clark Hine, Black Women in White: Racial Conflict and Cooperation in the Nursing Profession, 1890-1950 (Bloomington: Indiana University Press, 1989)
• Susan Lynn Smith,  Sick and Tired of Being Sick and Tired: Black Women’s Health Activism in America, 1890-1950. Philadelphia: University of Pennsylvania Press, 1995.
• Sabrina Strings, Fearing the Black Body: The Racial Origins of Fat Phobia (New York: New York University Press, 2019).
• Lynn M. Thomas, Beneath the Surface: A Transnational History of Skin Lighteners (Durham: Duke University Press, 2020).
• Thomas J. Ward Jr., Black Physicians in the Jim Crow South (Fayetteville: University of Arkansas Press, 2003).

Week 9. Eugenics and Progressive Era Racial Science

• Gregory Michael Dorr, Segregation’s Science: Eugenics and Society in Virginia (Charlottesville: University of Virginia Press, 2008).
• Gregory Michael Dorr and Angela Logan, “‘Quality, Not Mere Quantity, Counts’: Black Eugenics and the NAACP Baby Contests,” in A Century of Eugenics in America: From the Indiana Experiment to the Human Genome Era, ed. Paul Lombardo, Bloomington: Indiana University Press, 2011.
• Daylanne K. English,  Unnatural Selections: Eugenics in American Modernism and the Harlem Renaissance. Chapel Hill: University of North Carolina Press, 2004.
• Paul Lombardo, “Anthropometry, Race, and Eugenic Research: ‘Measurements of Growing Negro Children’ at the Tuskegee Institute, 1932-1944,” in The Uses of Humans In Experiment: Perspectives from the 17^th to the 20^th Century, eds. Erika Dyck and Larry Stewart, Leiden: Brill, 2016.
• Michele Mitchell,  Righteous Propagation: African-Americans and the Politics of Racial Destiny after Reconstruction. Chapel Hill: The University of North Carolina Press, 2004.
• Ayah Nuriddin,“The Black Politics of Eugenics,” Nursing Clio blog, June 1, 2017.
• Ayah Nuriddin, “Engineering Uplift: Black Eugenics as Black Liberation,” in Nature Remade: Engineering Life, Envisioning Worlds, eds. Luis Campos, Michael R. Dietrich, Tiago Saraiva, and Chris Young, Chicago: University of Chicago Press, 2020. (forthcoming)
• Dorothy E. Roberts,  Killing the Black Body: Race, Reproduction, and the Meaning of Liberty. New York: Pantheon Books, 1997

Week 10. Black People as Experimental Subjects

• Daina Ramey Berry, The Price for Their Pound of Flesh: The Value of Enslaved, from Womb to Grave, in the Building of a Nation (Boston: Beacon Press, 2017).
• DeNeen L. Brown, “‘You’ve got bad blood’: The Horror of the Tuskegee Syphilis Experiment.”
• Allen Hornblum, Acres of Skin: Human Experiments at Holmesburg Prison (New York: Routledge, 1998).
• Allen Hornblum, Sentenced to Science: One Black Man’s Story of Imprisonment in America. University Park, PA: Pennsylvania State University Press, 2007
• James H. Jones, Bad Blood: The Tuskegee Syphilis Experiment (New York: The Free Press, 1981).
• Susan Reverby, Examining Tuskegee: The Infamous Syphilis Study and Its Legacy (North Carolina: University of North Carolina Press, 2013).
• Rebecca Skloot, The Immortal Life of Henrietta Lacks (New York: Crown Publishers, 2010).
• Harriet A. Washington, Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present (Doubleday Books, 2006).

Week 11. 20th Century Race and Mental Health

• Price M. Cobbs and William H. Grier, Black Rage (New York: Basic Books, 1968).
• Matthew Gambino, “‘These Strangers Within Our Gates’: Race, Psychiatry, and Mental Illness Among Black Americans at St. Elizabeths Hospital in Washington, DC, 1900-1940,” Journal of the History of Psychiatry 19, no. 4 (2008): 387-408.
• Gabriel Mendes, Under the Strain of Color: Harlem’s Lafargue Clinic and the Promise of an Antiracist Psychiatry (Ithaca: Cornell University Press, 2015).
• Jonathan Metzl,  The Protest Psychosis: How Schizophrenia Became A Black Disease (Boston: Beacon Press, 2009).
• Ayah Nuriddin, “Psychiatric Jim Crow: Desegregation at the Crownsville State Hospital, 1948-1970,” Journal of the History of Medicine and Allied Sciences, Vol. 74, Iss. 1, January 2019.
• Martin Summers, “Diagnosing the Ailments of Black Citizenship: The African American Medical Profession and the Politics of Mental Illness, 1895-1940.” In Precarious Prescriptions: Contested Histories of Race and Health in North America, edited by Laurie Green, John McKiernan-Gonzalez, and Martin Summers (Minneapolis: University of Minnesota Press, 2014).
• Martin Summers, Madness in the City of Magnificent Intentions: A History of Race and Mental Illness in the Nation’s Capital (Oxford University Press, 2019).
• Martin Summers, “‘Suitable Care for the African Afflicted with Insanity’: Race, Madness, and Social Order in Comparative Perspective,” Bulletin of the History of Medicine 84.1 (Spring 2010): 58-91.
• Zosha Stuckey, “Race, Apology, and Public Memory at Maryland’s Hospital for the ‘Negro’ Insane,” Disability Studies Quarterly 37.1 (2017).

Week 12. Race and Medicine from Civil Rights to Black Power

• John Dittmer, The Good Doctors: The Medical Committee for Human Rights and the Struggle for Social Justice in Health Care (Oxford: University of Mississippi Press, 2009).
• Wangui Muigai, “”Something Wasn’t Clean”: Black Midwifery, Birth, and Postwar Medical Education in All My Babies.” Bulletin of the History of Medicine 93.1 (2019): 82–113
• Alondra Nelson, Body and Soul: The Black Panther Party and the Fight against Medical Discrimination (Minneapolis: University of Minnesota Press, 2013).
• Ezelle Sanford III, “Civil Rights and Healthcare: Remembering Simkins v. Cone,”  Black Perspectives, (February 2017).
• David Barton Smith, The Power to Heal: Civil Rights, Medicare, and the Struggle to Transform America’s Health Care System (Tennessee: Vanderbilt University Press, 2016).

Week 13. 20th and 21st Century Social and Environmental Effects of Racism

• Mindy Thompson Fullilove, Root Shock: How Tearing Up City Neighborhoods Hurt America, And What We Can do About It (New York: New York University Press, 2016).
• Evelynn M. Hammonds and Susan Reverby, “Toward a Historically Informed Analysis of Racial Health Disparities Since 1619,” American Journal of Public Health 109.10 (2019).
• Gregg Mitman, Breathing Space: How Allergies Shape Our Lives and Landscapes (New Haven: Yale University Press, 2007).
• David McBride, From TB to AIDS: Epidemics Among Urban Blacks since 1900 (New York: State University of New York Press, 1991).
• Richard M. Mizelle, Jr., Backwater Blues: The Mississippi Flood of 1927 in the African American Imagination (Minneapolis: University of Minnesota Press, 2014).
• Samuel K. Roberts, Infectious Fear: Politics, Disease, and the Health Effects of Segregation (Chapel Hill: University of North Carolina Press, 2009).
• Keith Wailoo, Dying in the City of Blues: Sickle Cell Anemia and the Politics of Race and Health (Chapel Hill: University of North Carolina Press, 2000).
• Harriet A. Washington, A Terrible Thing to Waste: Environmental Racism and its Assaults on the American Mind (New York: Hachette Book Group, 2019).

Week 14. HIV/AIDS in Black America and its Legacy

• African American AIDS Activism Oral History Project
• Michele Tracy Berger, Workable Sisterhood: The Political Journey of Stigmatized Women with HIV/AIDS (New Jersey: Princeton University Press, 2004).
• Cathay J. Cohen, Boundaries of Blackness: AIDS and the Breakdown of Black Politics (Chicago: University of Chicago Press, 1999).
• Evelynn M. Hammonds, “Missing Persons: Black Women and AIDS,” Radical America 24.2 (July 1992).
• Evelynn M. Hammonds, “Race, Sex AIDS: The Construction of ‘Other,’” Radical America 20.6 (Nov.-Dec. 1987). 28-38.
• Stephen J. Inrig, North Carolina and the Problem of AIDS: Advocacy, Politics, and Race in the South (Chapel Hill: University of North Carolina Press, 2014).
• Alyson O’Daniel, Holding On: African American Women Surviving HIV/AIDS (Lincoln: University of Nebraska Press, 2016).
• Dan Royles, To Make the Wounded Whole: The African American Struggle against HIV/AIDS (Chapel Hill: University of North Carolina Press, 2020).
• “The Black AIDS Epidemic,” Souls 21.2-3 (2019-2020).
• Linda Villarosa, “America’s Hidden H.I.V. Epidemic,” New York Times, June 6, 2017.

Week 15. Genetics & the Re-biologization of Race

• Laura Briggs, Reproducing Empire: Race, Sex, Science, and US Imperialism in Puerto Rico (University of California Press, 2002).
• Jonathan Kahn, Race in a Bottle: The Story of BiDil and Racialized Medicine in a Post-Genomic Age (New York: Columbia University Press, 2013).
• Alondra Nelson, The Social Life of DNA: Race, Reparations, and Reconciliation After the Genome (Boston: Beacon Press, 2016).
• Anne Pollock,  Medicating Race: Heart Disease and Durable Preoccupations with Difference (Durham: Duke University Press, 2012).
• Dorothy Roberts, Fatal Invention: How Science, Politics, and Big Business Re-create Race in the Twenty-First Century (New York: The New Press, 2011). 
• Dorothy Roberts, “The Problem with Race-Based Medicine,” TED Talk, 2016.
• Michael Yudell, Race Unmasked: Biology and Race in the Twentieth Century (New York: Columbia University Press, 2014).

Week 16. Anti-Black Racism & COVID-19

• Chelsey Carter & Ezelle Sanford III, “The Myth of Black Immunity: Racialized Disease during the COVID-19 Pandemic,” Black Perspectives (2020).
• Merlin Chowkwanyun and Adolph L. Reed Jr. “Racial Health Disparities and Covid-19: Caution and Context,” New England Journal of Medicine, May 6, 2020.
• Lisa A. Cooper, Lakshmi Krishnan and S. Michelle Ogunwole, “Historical Insights on Coronavirus Disease 2019 (COVID-19), the 1918 Influenza Pandemic, and Racial Disparities: Illustrating a Path Forward,” Annals of Internal Medicine, June 5, 2020.
• Antoine S. Johnson, “From HIV-AIDS to COVID-19: Black Vulnerability and Medical Uncertainty,” Black Perspectives (2020).
• Elise A. Mitchell, “‘If Bitterness Were a Whetstone’: On Grief, History and COVID-19,” Black Perspectives (2020).
• Ayah Nuriddin, “Race, Resistance, and the Rona,” Part I, Electric Marronage (2020).
• ——, “Race, Resistance and the Rona,” Part II, Electric Marronage (2020).
• Nic John Ramos, “Solving Our Urban Crisis Involves Addressing Hospitals in Addition to Policing,” Washington Post (2020).
• Linda Villarosa, “‘A Terrible Price’: The Deadly Racial Disparities of COVID-19 in America.”

Recommended Textbooks and Edited Volumes

• Harriet A. Washington, Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present (Doubleday Books, 2006).
• Sean Morey Smith and Christopher Willoughby eds. Medicine and Healing in the Age of Slavery (LSU Press, Forthcoming).
• eds. John Mckiernan-González, Laurie B. Green, Martin Summers, Precarious Prescriptions: Contested Histories of Race and Health in North America (University of Minnesota Press, 2014).
• Byrd, W. Michael, and Linda A Clayton. A Medical History of African-Americans and the Problem of Race: Beginnings to 1900. Vol. 1 of An American Health Dilemma (New York: Routledge, 2000).
• Byrd, W. Michael, and Linda A. Clayton. Race, Medicine, and Health Care in the United States, 1900-2000. Vol. 2 of An American Health Dilemma (New York: Routledge, 2002).

*We are incredibly grateful to Dr. Ezelle Sanford III and Dr. Nic John Ramos for their input, support, and perspectives.