Response to Critical Race Theory for Pharmacy Diversity Curriculum

To the Editor: We thank Dr. Rockich-Winston for taking the time to both read our review article and provide constructive feedback.¹ We hope our collegial exchange on this important topic will add depth to the conversation of diversity in pharmacy education and serve as a catalyst to move this timely work forward. We would like to respond to two major points identified by Dr. Rockich-Winston.

First, Dr. Rockich-Winston’s letter highlighted the usage of the phrase “intellectual and cognitive diversity” in our article. Intellectual and cognitive diversity, also referred to as diversity of thought, is key in advancing pharmacy education. As stated by Yanchick and colleagues, “…full diversity goes far beyond culture, race, gender, sexual preference, etc. It also encompasses the diverse orientation, education and practice development of our workforce.”² However, phrases such as “diversity of thought” and “intellectual and cognitive diversity” are often met with skepticism by those of us in the trenches of diversity and social justice work because, in some instances, as opposed to advancing diversity, such phrases have been used to: impede significant diversity efforts, serve as an ill-advised compromise for structural diversity, or most objectionable, serve as a deliberate replacement to uphold the status quo. When using the phrase “intellectual and cognitive diversity,” our intention was not to suggest neglecting or replacing other significant forms of diversity (eg, race, gender, sexuality, etc.) and the oppressive and discriminatory contexts substantiating the need for institutionalized diversity efforts.

Our inclusion of intellectual diversity was intended to encourage the expansion of our research and methodologies to include more rigorous exploration of diversity-related topics. In our review, for example, several articles primarily provided the demographic information of majority (eg, Caucasian) and minority students (eg, Hispanic, African-American, women, etc.) as indicators of diversity as opposed to reporting and extensively analyzing substantive experiences of diverse populations. The scope of diversity is trending toward building cultural dexterity to improve demographics and increasing opportunities for innovation in the profession. While reporting demographic metrics is important, we suggest that researchers consider employing more rigorous statistical tests and qualitative approaches to better understand and make sense of the diversity in pharmacy education.

Dr. Rockich-Winston also makes a compelling argument for “…adopting critical race theory (CRT) as one of the primary organization capabilities (of the Learning, Diversity, and Research [LDR] model) driving the curricular and co-curricular experiences of student pharmacists.” Though our article’s primary purpose was to conduct an environmental scan on diversity-related research in pharmacy education, we agree that CRT could provide critical insight into the many ways that diversity can be integrated into research, the curriculum, and co-curricular experiences. In our article, Table 1 provides a non-exhaustive list of primary organizational capabilities in which CRT could be employed (eg, centralized diversity requirements, ethnic studies, diversity programs, etc.).¹

As pharmacy education researchers, we must approach our research on diversity with a lens that enables us to better understand the lived experiences and outcomes of students and faculty. We must also be aware of the historical contexts that shape this lens. Accordingly, we agree with Dr. Rockich-Winston’s assertion that “racism is woven into the fabric of the United States.” And racism is, perhaps, the element most ingrained within that fabric. CRT clearly provides a lens with which to better understand and address this important topic.

However, as great of a role that racism has and continues to play in creating and perpetuating the destructive systems resulting from this fabric, it is not the only element. If we stretch the fabric of the United States to its edges we will find racism at its foundation, but we will also uncover other “-isms” that are deeply rooted in oppression. Such “-isms” include but are not limited to racism, classism, sexism, and a host of multiple and/or intersecting oppressed identities (eg, someone identifying as black, poor, and female).^3,4 As demonstrated across the three models (ie, Affirmative Action and Equity [AAE], Multicultural and Inclusion Diversity [MID], and LDR), the target of efforts evolved over time from a central focus on African-Americans and women to include other bounded social identity groups affected by the aforementioned “isms.” Taking this into consideration, we felt this model was appropriate to characterize the breadth and depth of diversity-related research in pharmacy education.

Therefore, as we continue to broaden and deepen diversity-related research in pharmacy education, we must consider the impact of racism individually, in tandem, and combined with other “-isms” if we are to develop culturally competent practitioners. Thus, while employing CRT to focus on the racism that undergirds our society is one example of following the LDR’s suggestion to infuse diversity into the curriculum and co-curriculum (as well as research), we should extend our theoretical lenses to include the experiences of other federally protected people, minorities, and social identity groups (including majority groups). In addition to CRT, other theories, frameworks, and models we should consider incorporating into our research include: social identity, white privilege, hegemony, racial and ethnic identity theories, sexual orientation identity, spiritual and religious identity, gender identity, first generation student retention models, and intersecting identities, among others.^3,5,6

As our article reported, scholars often cited the shifting patient population and the workforce needs as the influences of their research (ie, LDR model). However, the majority of the articles included in our work focused on compositional diversity. Though we are nearly 70 years removed from the events that initiated the AAE model (1950s), pharmacy education research lags behind. Thus, we can posit that the scholars primarily focused on compositional diversity out of necessity to raise awareness and lay the foundation for future research.

In our perspective, though envisioned as a wide-ranging guide for higher education through the institutional level lens, the LDR model is a well-established framework that describes where pharmacy education should be. It is the ideal space in which diversity is woven into the research and the curriculum to benefit our diverse patient population and targets both minority and majority groups with the understanding that we all play a role in diversifying pharmacy education – either impeding or advancing diversity efforts. We are not there. But we can get there.

To advance diversity in pharmacy education we must continue to work to improve the composition (structural diversity) of underrepresented faculty and students within our pharmacy schools (AAE); be transparent about current and historical institutionalized exclusionary barriers that impede our efforts (eg, mission statements, admissions, strategic plans, etc.) (AAE); recalibrate pharmacy school climates to create supportive and conducive learning and work environments for individuals from diverse backgrounds (MID); and infuse diversity into our curriculum and research in ways that support the development of culturally competent students, faculty, and practitioners, such as exploring the psychological climate (eg, perceptions and attitudes toward diversity) and behaviors (eg, interactions across diverse groups, challenges to teaching diversity, etc.) (LDR).^1,7,8 In summary, we agree with Dr. Rockich-Winston’s suggestion to employ CRT in research and include it in our curricular and co-curricular efforts as we believe this is one of a variety of approaches implied through the LDR model, but not explicitly mentioned within our article.

• © 2018 American Association of Colleges of Pharmacy