I am the only black man in my medical school class. Let me specify — I am the only black gay man in my class, and I come from a low-income background. As the child of teenage parents, I went to underperforming public schools and am the first person in my family to enter medicine.
Years of hard work and persistence culminated in my admittance to medical school, a feat that landed me on the cover of Texas Medicine and featured on my school’s website. I never asked for it, but I took each opportunity as a sign that my school and state were embracing and engaging the need for diversity and inclusion in medicine. I was ecstatic to be a part of an institution that “got it,” and to have the chance to participate in conversations regarding race, ethnicity and the complexities of caring for people of color.
But these ideas were rooted in a fantasy far from what has been my reality.
On the first day of class, there were very few people who looked like me, much less those who shared similar identities. Throughout my first few semesters, instructors and staff would stare at me for wearing certain clothes as if I were an outsider intruding on their space. I found solace in my classmates until they made off-hand remarks about living in the “bad” or “sketchy” parts of town — the parts of town that are mostly black or Hispanic, low-income, and where children attend underperforming schools; the parts of town that I grew up in.
Rap music was my coping strategy — a reminder of time spent with my father when I was young. His vehicle always blasted the latest catchy lyrics over creative rhythms; naturally, I still listened to the same genre because it made me feel close to home. One morning, as I rolled into a parking spot at school with music blasting, I looked up to notice a weird look on a professor’s face. I knew what he was thinking, but nodded and smiled anyway.
As small interactions began to pile up, severe depression, anxiety, and isolation followed. Yet I persisted. Microaggressions came and went. I learned enough to pass my courses, but what I really needed was an introductory course in “how to be black, but not too black.” If I was too black, then it made some people uncomfortable. By hiding who I truly was, I became the classic case of the person of color accommodating the privileged majority.
As my clinical year approached, I was excited to begin. It meant that I would see more people of color in our patient population. However, it also meant facing encounters of unintentional racism from faculty and staff.
In the resident room of an outpatient clinic, the staff had hung a puppet with a name-tag marked “LA-SHA” with the name’s pronunciation spelled out as “La-Dash-A.” At first, when I saw the doll, I laughed, but then I examined her appearance — brown skin, full lips, and an unusual name. I have brown skin and an unusual name. Were they making fun of me? After notifying the medical school, the clinic removed the doll within hours. However, over the next few weeks residents and interns alike would ask “Where is LA-SHA?,” forcing me to relive the trauma of seeing a black puppet as the punchline of a cruel joke. This highly educated staff who served mostly patients of color tacked this doll up on the wall as a clinic-wide gag with no thought of how a physician of color might feel when seeing it.
According to the Association of American Medical Colleges (AAMC), black men continue to apply and matriculate into medical school at dismal rates. In 2017, the year that I applied, about 1,500 black men in the entire nation applied to medical school, of which only 600 matriculated. There were more students in my high school graduating class than black men entering medical school that year. Because of this, academic medicine tends to highlight young black men that “beat the odds” and enter medical training.
But I often feel like a prop in a “diversity” scheme. My face is plastered around my school, yet I feel like a stranger. Medicine values my skin color in magazines and articles, but it wants nothing to do with the culture that makes me who I am. I am told to be happy to have made it this far while ignoring microaggressions based on false and dangerous assumptions about my identity. If diversity and inclusion consist of pasting black male trainees’ faces on brochures, posters, and in articles, then academic medicine has succeeded. But it has also created this painful irony that I am faced with every day. Nearly every medical school has faculty and staff dedicated to diversity and inclusion, and they will quickly feature students of color to highlight the “work” that is being done. Yet, studies continue to show that trainees of color feel marginalized and isolated during medical school and residency.
I, like many of my colleagues of color, want to see more institutional skin in the game regarding diversity and inclusion. If we continue to consent to our faces plastered on brochures and websites, we should demand that institutions do the work to minimize the trauma of existing within their walls.
What does the work look like? It is no longer adequate just to talk about allyship, to have implicit bias training over lunch, or to train us about educating the offender. All these “solutions” task students, faculty, and staff of color with doing the work of creating institutions that supposedly already value us.
I am doing the work on behalf of my institution in writing these words.
Institutional values require institutional mechanisms to ensure that they are instilled, developed, and maintained. When someone acts against such values, there is a standard course of remediation in which they are either required to correct this action or given the opportunity for personal and professional development. Most importantly, system-wide mechanisms are put in place to prevent such grievances. We use the scientific method to study medical interventions, quality improvement and much more. Yet when it comes to one of the most pervasive illnesses plaguing academic medicine, we do very little if anything at all. Instead, underrepresented students are told to simply be more resilient.
When surgeons began leaving sponges inside of patients, scrub techs started counting all the sponges in the room before closing the incision. We did not ask patients to get their own x-rays to prove that procedures were safe. When an academic hospital noticed an alarming rate of the duplicate lab, imaging, and medication orders amongst ER physicians, a simple visual aid was placed in the electronic medical record and its effect was studied for two subsequent years. There was a statistically significant reduction in unnecessary orders.
Symbolic gestures are only as effective as the actions they represent. While my black skin on printed paper is a symbol of diversity and inclusion for my institution, for me it is an incessant reminder of actions that reveal an opposite reality. We know it takes institutional actions rather than superficial formalities to make a difference in health. Substantial, meaningful action is necessary for us to change the space in which we work, learn, and grow on our journey to becoming physicians.
It is nice to see my face in print, but it would mean more if my school actually implemented and enforced the values it so proudly espouses. While many of my colleagues will never know what it truly means to be black in America, I hope that academic medicine recognizes me as more than a prop to attract other men and women of color. I, like any human, need to feel institutionally accepted, valued, and celebrated to achieve self-actualization and thrive.