There is a fine line between tokenism and diversity, and medicine is an institution that loves to toe that line. As defined by the Encyclopedia of Race and Racism, tokenism is “the practice of making only a perfunctory or symbolic effort to do a particular thing, especially by recruiting a small number of people from underrepresented groups in order to give the appearance of sexual or racial equality within a workforce.” In addition to its denotation, tokenism has molded its own connotation in my life.
As I went through the medical school application process, I realized that I was yet again going to play the token Black girl at school. I have played the role consistently from primary school through my gap years in corporate America. If I had to say so myself, I would say I have played the token Black girl pretty well. I grew up in an affluent White bubble and outside the walls of my immigrant household, life was shaped by White cultural activities like tennis, summer camp and country music (to all the people of color reading this: I know, and I am sorry, but not all of it is horrible). I have always been Black but not too Black; “Oreo” and “White Black person” were common descriptors of me amongst my White affiliates. For years, I maintained the status quo to make my White peers comfortable. I only began to challenge my peers and their opinions of Blackness as the country started another chapter of its own racial awakening in June 2020.
In a way, I am lucky I “sound White” when I talk because it has given me an inherent level of privilege. Working my way through corporate America and medicine without the need to code switch as frequently as some of my Black peers has given me, and will continue to give me, more space in rooms that Black people are not welcomed in. But the concept itself frustrates me. Leighann Blackwood articulately put it when saying:
First of all, white is not a language. I speak English, and I speak it with the societally acceptable grammar and diction that our white patriarchal society deems as eloquence. It does not make me any less black or any more white. It just makes me a person who speaks a certain type of English. I have been privileged enough to go through certain educational avenues that taught me how to speak with eloquence and in a manner that is more widely accepted than some variations of English slang. That is all. And, let’s get one thing straight: whiteness is NOT the epitome of intelligence.
During the time of national focus on American racial history in June 2020, I reflected on the pressure I had put on myself to be the acceptable Black girl. I remember speaking on a podcast about the topic with someone who is now a good friend of mine. We reflected upon our friendship, noting we likely had not become close friends in high school because we were afraid of the optics of two Black adolescents befriending each other in our White town. Within the White spaces of our high schools, we were afraid to speak out on the microaggressions we had faced until after graduation. Within the last two years, we have come together with other students of color from our school to work on reforms at our high school, including banning the confederate flag. While I am proud of the progress we have made at home, the simple fact that progress was only made after we graduated furthers my worries about the inherent power dynamic set up in medical education that prevents students from confronting racial aggressions as they occur.
My worries are not solely due to the lack of diversity in medical schools but rather to the heavy emphasis medical schools have placed on the tokenism of their underrepresented minority in medicine (URiM) students. I laughed as I submitted one secondary application after another, each school asking how I would add diversity to their student body. It is ironic to think that every medical student in the United States has written one of these statements, yet the homogenous racial identities of incoming medical school classes reflect otherwise. While racial diversity is by no means the only type of diversity that secondary questions aim at, it is one of the primary components of diversity that will directly impact the health outcomes of future patients. This is why tokenism is so dangerous.
The problem with most diversity initiatives in medical education is the misunderstanding between tokenism and diversity. There may be medical school administrators reading this article thinking, “Our school has great diversity.” And to that, let me tell you, every medical school I interviewed made sure to note, “Our medical school has X percentage of URiM students!”
I attended interview after interview in which I was the only person of color in attendance on interview day. I took the risk of falling into a cliche; I could read the faces of my fellow interviewees and interview day administrators that seemed to say, “Of course the Black girl is asking about diversity.” And to that I say – yes, she is, and she will continue to ask and talk about it until medical education sees diversity as more than a group of tokenized students who mark the diversity checkbox off for medical schools.
You see, tokenism hurts not only those who are tokenized but the systems that participate in tokenism as well. I have grown up in a world where every action and word I speak represent not only myself but my entire race. One of the biggest pieces of advice I got from my mentor before beginning school was to avoid falling into the “perfectionist Black girl” trap. It is frustrating that without any additional context, I knew exactly what she was talking about. It is the unspoken pressure to represent yourself and your entire race with every action you do. Being the token has put an unprecedented amount of pressure on me, most of which I have only just begun to unpack and work through.
Unfortunately, it does not matter how many URiM students your school has. You can have one or 100 URiM students, and each of these students can feel tokenized. Diversity has never and will never be about making sure 15% of the entering medical school class is classified as a URiM; it is about giving that 15% space to openly be heard, welcomed and empowered without the pressure of having to educate classmates, act a certain way to please peers and perform better than White classmates to please White professors and attending physicians.
At the end of the day, I am a busy medical student. Just like my peers, I am studying, shadowing, conducting research and participating in extracurriculars, all while trying to maintain a level of sanity. It is a full-time job that is compounded by the second full-time job many URiM students carry in being the tokenized student of color. In an ideal world, I would dedicate more time and energy towards diversity, equity and inclusion (DEI) efforts in medical school, but both my time and energy are limited resources that I cannot equally divide between academics and racial equity in medicine.
You ask, “What can we do?” If I knew the answer, I would likely be working full-time in the DEI world rather than pursuing a career in medicine. But what I do know is that there needs to be a greater emphasis on not only recruiting but maintaining the wellness of URiM students.
I do want to take a moment to thank everyone in medical education who is actively working on reducing tokenism in medicine. It is not an easy job, and to be honest, I do not think it is a job that will ever be finished. To everyone working to make substantial change in medical DEI: you are seen, heard and highly appreciated by URiM students.
By the way, I am not angry, just Black.
Image credit: Think different by torremountain is licensed under CC BY 2.0.
Medical Student Contributing Writer
Case Western Reserve University
Afua Ofori-Darko is a first-year medical student at the Case Western Reserve University School of Medicine. She graduated from Tufts University with a Bachelor of Science in Biology and Community Health. In her free time, she enjoys traveling, exploring new restaurants and playing tennis.
