Medical Education and Training Reimagined: Moving Structural Racism and Trustworthiness from the Margins to the Center

Historically, medical education has not adequately addressed racial and ethnic inequities in healthcare or prepared physicians to earn patient trust, especially among marginalized communities. While some curricula cover health inequities and cultural competency, they focus more on encouraging patient trust than on teaching physicians how to demonstrate trustworthiness. By distinguishing between mistrust, distrust, and trust, we highlight a crucial gap in medical training: current training promotes patient trust without equipping physicians with the skills to earn it. The focus must shift from encouraging patients to trust the healthcare system to directly training providers in behaviors and systemic changes that demonstrate trustworthiness in order to gain trust. We propose a reorientation of medical education: one that emphasizes promoting trustworthiness and directly addresses the systemic and provider-level factors that have contributed to the erosion of patient confidence in medicine and their medical providers.