Discrimination in Medical School
By Jenika Packiaraj
(Photo Credit: Noah Berger)
"We bring Black med students to these institutions, and they fill quotas, and they make institutions look good. But we're not protecting them. We need to protect them,” – LaShyra Nolen, a first-year medical student and the first Black woman to serve as Harvard Medical School's student council president.
While medical schools are required to fill quotas by accepting people of color, they do not properly protect them from racially targeted discrimination from faculty and other students. This not only discourages minority students from continuing their path to become a doctor, but also normalizes discrimination by healthcare professionals, which then affects the way they treat people of color. The underlying racist structures in the medical field are enforced in medical schools through discriminatory practices that target minority students.
It has been an accepted part of medical school culture for all students to be embarrassed or humiliated publicly by a professor, regardless of race. However, minority students not only deal with targeted racist or bigoted harassment, but are also much more likely to experience general harassment like public humiliation. In a JAMA Internal Medicine study of 27,500 graduating medical students in the U.S, 38% of students from underrepresented racial and ethnic groups in medicine reported mistreatment during medical school, compared to 24% of white students. Minority students, including students who identified as people of color, women, and LGBTQ, are all more likely to experience mistreatment than white, male, heterosexual students.
These targeted discriminatory practices go unchecked in medical schools as minority students are afraid to report any misconduct in fear of more targeting and being labelled a “troublemaker.” Dr. Mensah, now a psychiatry resident at UC San Francisco, recounted how when a white physician repeated the n-word several times to him, he had to choose whether to “swallow my lump of anger and sadness to preserve group harmony, or risk my grade and reputation by confronting my superior.” Underrepresented medical students are constantly put in powerless situations where they are forced to suffer through experiences of discrimination with no safe method of complaining without harm to their academics and reputation. The additional stress of having to tolerate racist remarks in combination with the high intensity workload can be crushing to minority students, residents, and physicians, discouraging them from pursuing healthcare careers and contributing to persistently low numbers of minority physicians.
Additionally, racism is built into medical training and reinforced by discriminatory practices against minority students. Discrimination from medical school faculty and physicians normalizes racist and bigoted behaviors in healthcare to students who then replicate these behaviors. This translates into how future doctors treat patients of diverse backgrounds. Therefore, the challenges minority students face are directly linked to the observed widespread healthcare disparities.
Voices for Change
With the increased focus on systematic racism in the nation, more Black medical students and physicians are sharing their stories and pushing for change. White Coats for Black Lives, a medical student-run organization, was formed in late 2014 with the goal of dismantling racism in medicine. In 2020, many medical students organized peaceful protests to bring attention to systemic racism, health disparities, and police brutality. Additionally, over recent years, more Black medical students and residents are submitting essays to medical journals about their mistreatment, validating their experiences and finding support. Their previously ignored cries for change in the healthcare system are finally being heard on a larger scale. But the question still remains: how do we eliminate systematic racism in medical schools?
Dr. Nwora, an internal medicine and pediatrics intern at Johns Hopkins Medicine, says the first step is to provide an anonymous and safe way for students who face discrimination to report the offending party. She also encourages staff members to speak up when they hear a racist remark. Dr. Nwora explains, “When a faculty member remains silent in the face of racist comments, this teaches students that the statements are acceptable and that Black students are not valued in that space. But when people in positions of power start to normalize calling out inappropriate remarks, students will feel more supported in their learning environments.” Faculty members standing up for minority students make them feel valued in the medical field and teaches other students that discriminatory behavior is not allowed in any context.
Additionally, Dr. Tweedy, a Black professor at Duke University School of Medicine, proposes that medical students must be actively taught to critically evaluate the interplay between race and health. While medical school curriculums have recently adapted to include analysis of implicit bias that influence health attitudes, this is not nearly enough. Longstanding prejudices that perpetuate race-based biological and behavioral myths as well as discriminatory practices against Black patients still linger in clinics and hospitals, where students spend hours in experiential learning. The responsibility to educate students about implicit biases must not rely only on minority professors or one lecture. Institutions must also ensure that that all parts of medical education discourage racial discrimination.
The courage of Black medical students has led to national conversations re-examining the medical field, but medical students still have little power to fight against racism in their institutions by themselves. The additional burden of having to stand up for themselves and their peers can be demanding for already overwhelmed students. However, with the help of supportive faculty, administration, and physicians, medical institutions can strive to eliminate persisting healthcare inequities and work to create a culture that makes Black students feel truly welcome.
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Nwora, C. (2020, July 14). Medical schools need to do much more to protect students of color from racism. AAMC. https://www.aamc.org/news-insights/medical-schools-need-do-much-more-protect-students-color-racism.
Tweedy, D. (2020, July 27). Medical Schools Have Historically Been Wrong on Race. New York Times. https://www.nytimes.com/2020/07/27/opinion/sunday/coronavirus-medicine-blackness.html.