Decolonizing STEMM Training for a Just Biomedical Research Future

This piece received an honorable mention in the Reimagine Biomedical Research for a Healthier Future Essay Challenge, organized by the Health Research Alliance and PLOS.

Authors:
Debra Karhson, PhD, was a Basic Science Research Scientist at Stanford University School of Medicine and is currently incoming assistant professor of Psychology at University of Texas Permian Basin.
Shaila Kotadia, PhD, is the Director of Culture and Inclusion at Stanford University School of Medicine.
(Drs. Karhson and Kotadia contributed equally to this essay.)
Taylor Jones IV is a Graduate Student Researcher at Stanford University.
Jesse Isaacman-Beck, PhD, is a Postdoctoral Fellow at Stanford University School of Medicine.
Eamon Byrne, DPhil, is a Postdoctoral Research Fellow at Stanford University.
Brenda Flores is a Research and Program Officer at Stanford University.

Summary: We propose widespread adoption of our justice-based program, the Certificate in Critical Consciousness and Anti-Oppressive Praxis to embed the values of justice, equity, diversity, and inclusion within research training for students and trainees in Science, Technology, Engineering, Mathematics, and Medicine (STEMM). Our program uses a Black feminist and womanist epistemological framework to ground participants in the principle of intersectionality, exploration of identity-driven power dynamics, and how this framework can be used to move to action. With this decolonial positioning, students and trainees can cultivate an anti-oppressive praxis that transforms the future of biomedical research, in the present moment.

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­­­­­­­­­The COVID-19 pandemic and the continuing importance of the Movement for Black Lives present a watershed moment for Science, Technology, Engineering, Mathematics, and Medicine (STEMM) education and research. COVID-19 disproportionately affects racial minority populations, low-income groups, and disabled individuals, due to systemic inequities that long predate the pandemic [1]. Moreover, it has amplified health disparities for those in the above groups as well as vaccine hesitancy in these communities [2]. These issues have also been recapitulated on a global scale. For example, while European health officials initially suggested testing of COVID-19 vaccines on people within the African continent [3], there are now looming threats of vaccine apartheid in the Global South [4].

Current pedagogical standards, which have led to these disparities, speak directly to the unmet training needs of biomedical researchers. Yet, while the resources that address these persistent inequalities exist, they are mostly relegated to the humanities, creating barriers to STEMM students and trainees who are self-motivated to seek out such education. Given the central importance of rigor and responsible conduct of research in STEMM, there is an explicit and immediate need to address these training limitations. It is essential that biomedical research invest in a pedagogical framework that centers the values of justice, equity, diversity, and inclusion (JEDI).

To date, in the absence of an anti-oppressive pedagogical infra­­structure, the students and trainees most affected by systemic oppression are the same individuals tasked with creating programmatic stop-gaps. As a result, historically and presently excluded students and trainees are asked to ideate their aspirational careers while also attempting to build an equitable academic infrastructure; imagine building the train tracks ahead of a train while also conducting its travel.

Euphemistic terms have been created to describe the specific situations above: “diversity/minority tax” and “mentoring-up” [5]. Each of these terms is meant to convey the challenging space between the “research training” rock and the “creating institutional infrastructure” hard place that historically-excluded STEMM students and trainees occupy. This exact situation was the context in which we, as graduate students and postdoctoral scholars in 2018, ideated the creation of explicit training for STEMM students and trainees who are motivated to engage in JEDI initiatives but lack the framework to move to action.

When we created the Certificate in Critical Consciousness and Anti-Oppressive Praxis (CCC&AOP) program we were motivated by the Movement for Black Lives and the lack of resources accessible to students and trainees in STEMM spaces. We wanted infrastructure to engage with, and in, JEDI efforts from a Black feminist/womanist perspective and how to use this perspective to move to action.

Using a Black feminist and womanist epistemological framework grounds the CCC&AOP program’s principles in intersectionality and the exploration of the relationships that exist between identities and systems of power. It also deconstructs the ontological borders of oppression (e.g., ideological, geographical, and historical borders) and allows participants to scale their self-reflection accordingly. Frameworks such as this cultivate actions like the reparations provided to the family of Henrietta Lacks (the unconsented source of HeLa cells) by the Howard Hughes Medical Institute [6].

The principle of praxis is also embedded in the program’s infrastructure in order to push forward and amplify justice work at the institutional and field-specific levels, while valuing small-scale change. In education, praxis is most often defined by Paulo Freire’s Pedagogy of the Oppressed, where it describes a process to evaluate your positionality and identity in the world, as well as transform the present conditions and your “conscientizaçãco” (translated from Freire: “refers to learning to perceive social, political, and economic contradictions, and to take action against the oppressive elements of reality”). Praxis moves beyond “service learning” (which is characterized as a time-limited practice of “doing for” a community) to empower individuals to “shape and be with change” [7] as co-conspirators (use of this term denotes an ally assuming the highest level of risk, assistance, and fiscal support) across a lifetime.

For STEMM participants, praxis mandates cyclic assessment of their power as the creators of our future reality and cultivation of lived experiences with the community, especially if impacted by their scientific pursuits.

Figure 1. Programmatic components for the Certificate for Critical Consciousness and Anti-Oppressive Praxis

These foundational perspectives and principles are recapitulated by the program’s main goals: 1) critical understanding of identity and positionality; 2) exploration of the current and historical oppressive infrastructures that have arrested progress towards a just future; and 3) development of a culturally aware praxis to substantiate transformative and inclusive change.

The above goals shaped the programmatic components: a series of intergroup dialogue workshops, a journal club series, coursework/elective(s), and a praxis “project” to provide the activation energy to individually commit to JEDI work (see Figure 1). Use of intergroup practica begins to concretize the totalizing impact of oppression and cultivates action to achieve justice and equity. The program utilizes the resources available within the university (e.g., special events, invited seminars, and mini-courses), creating accessible pathways to those siloed outside of STEMM spaces as well as decreasing the need to develop novel course materials. Then, as a student and trainee group, the last obstacle we faced was launching a program like this at the university level.

For grassroots programming spearheaded by students and trainees, administrative support is necessary in order to solidify a home and resources for the program, as well as to assist in navigating institutional structures and nuances, thereby removing the “hard place.” This model is seen in successful programming, but is limited by the number and capacity of administrative staff. For CCC&AOP, this meant that to bring the program into actuality required our administrative co-conspirators to do much of the heavy lifting. This administrative co-conspiratorial action for justice, equity, diversity and inclusion, was not only necessary for the creation of CCC&AOP, it was integral to our success.

Through this partnership, the core founding CCC&AOP team consists of one graduate student, two postdoctoral scholars, and two administrative staff. As individuals, we came from different levels of experience with equity work and different expertise in our working lives, and we shared the same radical belief that transformative change of the academic structure is necessary. We knew that this change was possible because as products of STEMM pedagogy, we are also current creators of the biomedical research future [8]. With the help of our administrative co-conspirators, CCC&AOP effectively had people to “lay the tracks”, allowing the student and trainee founders to focus on conducting the train. The administrators took on the largest burden of labor for the program, with the graduate student and postdocs lending labor when feasible. Moreover, as students and trainees with administrative co-conspirators, the ability to teach the university how to responsibly and rigorously build these “trains” also became possible.

While we established this grassroots, justice-based program at our biomedical research institution, our collective success was not fully realized based on its implementation. Our inaugural cohort was in the middle of our curriculum when the pandemic lockdowns started in California. As the months progressed, direct actions to support the Movement for Black Lives also became an active part of everyone’s lives.

As program founders, while we were unsure of our own impact in this praxis, that doubt quickly faded as we watched in awe as each of the ten intrepid members of our first cohort took the pandemic and the protests for racial equity as a clarion call to double down on action. In addition to navigating the new reality of scheduled lab shifts and online classes, they created a mutual aid program for the home-bound vulnerable Stanford community. They photographed, penned, fundraised, and acted in solidarity with the movement for racial equity on campus, off campus, and through social media. They held space for and created moments of joy with children affected by the pandemic.

Throughout the pervasive uncertainty of 2020, our participants acted with the world—sure of their impact, sure of their praxis, and sure of their part to let justice in. It was and continues to be the truest measure of our collective success.

To a broader audience, these changes in our cohort were also recognized. For example, the success of the CCC&AOP program has been lauded by Stanford University through its institutionalized adoption of the program into the Inclusion, Diversity, Equity and Access in a Learning Environment (IDEAL) initiative. Additionally, through a collaboration with researchers in the Stanford Center for Comparative Studies in Race and Ethnicity (CCSRE), we are preparing a forthcoming paper using text and sentiment analyses to quantitatively define the qualitative changes observed in the first two cohorts. Through this publication, we aim to provide others the specific tools necessary to mount similar programs in their own institutions.

Grace Lee Boggs famously stated, “to transform the world, you must first transform yourself.” Yet as the innovators of our future world, STEMM students and trainees are given little to no framework to do so. Moreover, despite mandatory training on the responsible conduct of research to promote “public confidence in scientific knowledge and progress for the public good” [9], students and trainees receive little to no explicit training on JEDI issues in the STEMM research workforce.

Training oversights like this have contributed to our current health and workforce disparities on a national and global scale. In creating CCC&AOP, we have sought to locally address this critically unmet need at our institution.

To achieve global or systemic change, we can find insight from fractal patterns [10], where change at a macro level (e.g., the biomedical workforce) extends from changes seen at a micro level (e.g., a single institution). Therefore, in re-imagining the future of biomedical research, we envision widespread expansion of this decolonial shift in pedagogy across academic institutions and STEMM education and training. Through programs like CCC&AOP, the biomedical workforce can take just action to leverage the full capacity of institutional power and the emergent position of students and trainees to realize the equitable future of STEMM, in the present moment.

References

1.         Lopez L, Hart LH, Katz MH. Racial and Ethnic Health Disparities Related to COVID-19. JAMA. 2021;325: 719. doi:10.1001/jama.2020.26443

2.         Nguyen LH, Joshi AD, Drew DA, Merino J, Ma W, Lo C-H, et al. Racial and ethnic differences in COVID-19 vaccine hesitancy and uptake. medRxiv. 2021; 2021.02.25.21252402. doi:10.1101/2021.02.25.21252402

3.         Coronavirus: Africa will not be testing ground for vaccine, says WHO. BBC News. 6 Apr 2020. Available: https://www.bbc.com/news/world-africa-52192184. Accessed 11 Mar 2021.

4.         Yamey G. Developing vaccines for neglected and emerging infectious diseases. BMJ. 2021;372: n373. doi:10.1136/bmj.n373

5.         Campbell KM, Rodríguez JE. Addressing the Minority Tax: Perspectives From Two Diversity Leaders on Building Minority Faculty Success in Academic Medicine. Acad Med. 2019;94: 1854–1857. doi:10.1097/ACM.0000000000002839

6.         Witze A. Wealthy funder pays reparations for use of HeLa cells. Nature. 2020;587: 20–21. doi:10.1038/d41586-020-03042-5

7.         Gumbs AP. Undrowned: Black Feminist Lessons from Marine Mammals. AK Press; 2020.

8.         Butler OE. Parable of the Sower. Open Road Media; 2012.

9.         Responsible Conduct of Research Training | NIH Office of Intramural Research. [cited 11 Mar 2021]. Available: https://oir.nih.gov/sourcebook/ethical-conduct/responsible-conduct-research-training

10.       brown adrienne maree. Emergent Strategy: Shaping Change, Changing Worlds. AK Press; 2017.

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