The Royal College is pleased to announce Saleem Razack, MD, FRCPC, as the 2023 Professor-in-Residence. 

Dr. Razack, whose research focuses on equity, diversity and inclusion, is a pediatric intensive care physician. He recently joined the faculty at the University of British Columbia/BC Children’s Hospital after a 25-year career as a pediatric intensivist and medical educator/education researcher at McGill University. Currently a CanMEDS educator at the Royal College, his volunteer work has previously extended to exams and accreditation. 

Recently, we spoke with Dr. Razack and asked him about his research, his upcoming Professor-in-Residence lecture and what he hopes to accomplish as the 2023 Professor-in-Residence. 

Congratulations on being named the 2023 Professor-in-Residence. Can you tell us a bit about your research and what drew you to this work? 

I am deeply humbled and grateful for this recognition, which means so much to me. My research focuses on equity, diversity, and inclusion – specifically anti-racism in medical education. What drew me to this work was a recognition and understanding of the pervasive impact of social context and social determinants on health. This includes the highly unjust society and the highly unjust health care systems in which we work – which we need to work at changing. 

What progress have you observed over your career in terms of equity, diversity and inclusion in health care? What are the main challenges facing physicians and health care professionals now? 

The progress I have observed over my career has been one of increasing recognition that there is a problem, understanding it is systemic, and the beginnings of strategies to address it. In Canada, and this is my own opinion as a Canadian, there has been a decreased ability to see the inequities and injustices within our own system. 

COVID-19, the death of Joyce Echaquan, the murder of George Floyd, and the many tragedies that have come before have spurred a reckoning that there is systemic racism in Canada, that both the medical profession and the health care systems that we work in are an integral part of that system, and that the solutions need to be multi-pronged. We are also seeing teaching develop around systemic issues in health care systems. 

We are in health care systems that are stretched to the limit and that is one of the main challenges facing physicians and health professionals now. We need to work at building resiliencies within the system so that we’re not operating in an emergency all the time and we can look at these systemic issues – which very much affect health – and begin to address them.     

Can you talk about the importance of incorporating social context and social determinants of health into a physician’s understanding of the patients they treat?  

We can talk about things like providing culturally safe care as one of the ways to move forward, but I want to offer a bit of a different example. If I walk into the intensive care unit where I work and say there are 16 beds, it’s the middle of winter and seven of those beds are occupied by infants from 1-3 months of age who all have respiratory syncytial virus. They all have right-upper lobe collapse in their lungs and are all on respiratory support. And here is the other thing that unifies them: they’re all from northern Indigenous communities. That means that seven out of 16 beds are occupied by those patients, but the population share of those patients is nowhere near seven out of 16. It means there’s significant overrepresentation of Indigenous babies with respiratory infections. It’s an important teaching point: why this patient, with this problem, to this degree, now? You must move beyond physiologic explanations.

One of the goals of the Professor-in-Residence Program is to inform and advance Royal College programs. What are you hoping to accomplish during your year as Professor-in-Residence?

I am hoping to delve into the nitty gritty of systemic discrimination in health care, systemic racism in health care and other forms of inequitable access. For example, a baby in Canada might have to fly the distance of London to Moscow to access a ventilator; our country is very geographically dispersed and there are forms of inequity that happen because of that. I’d like to start a conversation about the knowledge systems that we’re teaching. How are we teaching about these kinds of inequities and the profession’s role in them? And how are we teaching people to recognize these inequities and to actually develop the habit of mind to address them when they occur? They can be seen as occurring at this broad level, but they’re also occurring every day inside the hospitals, inside the clinics, where people are being treated and where people are being trained and those are teaching opportunities and opportunities to explain that this is the job of specialty physicians. These knowledge systems about inequities should be part of how we conceptualize the work of the Royal College in terms of training, credentialing, assessing through exams, and so on – and that’s the conversation that I want to have. 

Are you able to share a few ideas about the discussion for your upcoming Professor-in-Residence Lecture? 

The basic idea that I want to build on is if we are all working within health care systems that were actually designed to discriminate, that is a profoundly different way of conceptualizing our work, how we train people and the kind of competencies they need to operate within the system than if we view the system as neutral around those issues.

That means that people have to learn and develop skills in recognizing structural inequities and working towards change within health care systems and they have to, from an attitudinal basis, see themselves as engaged citizens of the system – not subjects of the system – that have a key role to play.  

What does that mean for the training of specialty physicians? I think that we need to incorporate concepts like [Paolo Freire’s] pedagogies of love to humanize learning in residency education.

The annual Professor-in-Residence Program fosters innovation and knowledge exchange at the Royal College by inviting a renowned expert to join the Royal College leadership team to examine health education and health policy with the goal of improving Royal College programs. The invited guest also presents the annual Royal College Professor-in-Residence Lecture.