The Future Physicians of America
I distinctly remember the day I was accepted into the University of Washington’s School of Medicine. I remember the clothes I was wearing, the room I was standing in when I received the phone call, and the tears of ecstasy and relief streaming down my face. As I begin to reflect on my first year in medical school, the joy of learning from the people I have had the honor to meet hasn’t left me. However, I continue to be reminded of all that I haven’t been able to learn in class. While I am incredibly thankful to the instructors that take time to help my classmates and I learn to be physicians, I simultaneously feel as if certain identities are missing from my education.
Let’s begin with the admissions process. Medical schools across the country have made “diversity and inclusion” a new goal. As of 2009, the Liaison Committee on Medical Education (LCME) began requiring that “an institution that offers a medical education program must have policies and practices to achieve appropriate diversity among its students, faculty, staff and other members of its academic community, and must engage in ongoing, systematic and focused efforts to attract and retain students, faculty, staff, and others from demographically diverse backgrounds (Barzansky).” From an initial perspective, this seems to be a noble, well-meaning effort to train better future physicians. After all, the patient populations we serve come from diverse socioeconomic and cultural backgrounds. Who better to serve these populations than individuals from the same community? However, closer reflection of this policy reveals another narrative. Focusing solely on the language used by LCME, the phrase “must engage in ongoing, systematic and focused efforts to attract and retain students…” speaks volumes to the motives behind the move to “diversify” incoming medical school classes. The effort lies in attracting and retaining more students. The benefit of this policy falls not on the students that are breaking barriers and returning to their communities to serve, but to the schools that are becoming more “attractive” to future students and faculty. From a critical race theory (CRT) perspective, this policy falls well into the theme of interest convergence: people with power will support ideas that may serve others when there is some benefit for their own privilege embedded within (Lindo). By including specific criteria for diversity and inclusion in the admissions process, not only are medical schools abiding to accreditation standards, they are able to boast about their commitment to service and unique classes.
The reality of this initiative is not as idealistic as it seems from the outside. “Diversity and Inclusion in Medical Schools: The Reality” explores this policy further from the perspective of medical students who originate from marginalized groups. These students “aren’t getting what they bargained for. This admission comes with a cost. Once they are in school, they are told to leave precisely what they bring to the table at the threshold of the hospital. Women are taught to emulate men (but not too much)…some are asked to scrub their tongues clean of accents or Ebonics while queer and transgender students are trained to quiet their identities…and black and brown students feel pressure to suffer explicit racial insults in silence (Tsai).” Data states that “30 percent of those who matriculate (LGBTQ students) report concealing their identity, of those, more than 40 percent do so secondary to fear of discrimination (Tsai).” If the policy were truly meant to benefit students from marginalized groups, there would be further efforts to ensure that they are not forced to silence the very basis of their identity upon admission for the sake of professionalism. If the diversity of the students is of true value, it would not be stifled. It is clear here that for many medical colleges, the true value of the diversity lies not in the students that bring unique and important perspectives, but in the image that is created by “diversifying” an incoming medical classes. According to the article, “institutional inclusion is promised so long as under-represented identities remain unobtrusive (Tsai)”.
In a world of true justice, diversifying the medical class would not occur for the betterment of the image of the school but for the benefit of the students and the patients they will treat in the future. According to the counter narrative and counter-storytelling theories of CRT, justice is achieved by hearing the stories of those often left out of the conversations- the most marginalized and oppressed (Lindo). Current medical education has created a hierarchy in which students feel as if they must emulate the residents, attending physicians, nurses, and mentors who teach them how to interact with patients. These residents and attending physicians also provide grades that impact the future of the medical student. Students that do not fit the current mold of what a “good” medical student looks like face the consequences of poor grades. Until residents and physicians reflect on and are attuned to their implicit biases, this grading will continue to suppress identities. We must first ensure that our teachers are trained to identify their biases and how to address them. A recent New York Times article found that “merely informing teachers about their stereotypes closed gaps in grading. An hour long online tutorial for teachers has halved suspension rates for black students, after training educators on how to value students’ perspectives and view misbehavior as a learning opportunity (Miller).” However, I believe simply training existing teachers is not enough, schools must make conscious efforts to hire mentors and teachers that originate from marginalized backgrounds. These instructors must then respond with the humility, strength, and perseverance their students deserve.
Here at the University of Washington, the Ecology of Health and Medicine Course offered over four separate weeks during the 18 month Foundations curriculum often addresses the current culture of medicine. We have discussed what professionalism means to us a class, how we plan on balancing our personal and professional identities, and what it means to currently be at the bottom of the hierarchy. Until the voices of the students who feel the most stifled are not listened to and advocated for, change is impossible. Furthermore, until medical students can celebrate and freely express their diverse identities without fear of repercussions, true justice will not occur. As my first year comes to a close in the next two weeks, I continue to have hope for the future of medicine. As my classmates and I continue to engage in these conversations and advocate for ourselves, perhaps by the time we are residents and attendings, we will make conscious efforts to allow the medical students we mentor to express themselves without fear of repercussions. More importantly, perhaps we will be a part of the future of medicine that is better suited to serve the populations it is surrounded by.
Works Cited
Barzansky, Barbara. “The History and Application of the LCME’s Diversity Standards.” Powerpoint Presentation.
Lindo, Edwin. “What is Critical Race Theory (CRT)?” May 2019. Powerpoint Presentation.
Miller, Clair Clane. “Does Teacher Diversity Matter in Student Learning?” New York Times. September 10, 2018. www.nytimes.com/2018/09/10/upshot/teacher-diversity-effect-students-learning.html.
Tsai, Jennifer. “Diversity and Inclusion in Medical Schools: The Reality.” Scientific American: Voices. July 12 2018. blogs.scientificamerican.com/voices/diversity-and-inclusion-in-medical-schools-the-reality/?redirect=1. June 2 2019.
Image: Michigan Medicine University of Michigan https://labblog.uofmhealth.org/sites/lab/files/2016-10/UMH_L_PreMed-02%402x.png
