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Medical schools need to do much more to protect students of color from racism

Christle Nwora, MD
July 14, 2020

As an interviewee, I endured racist comments. In courses, I saw patients of color omitted from lessons. Here's what medical schools need to do to address these ills — and create a culture that makes Black students feel truly welcome.

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Christle Nwora, MD, dons personal protective equipment for her internal medicine and pediatrics residency at Johns Hopkins Medicine
Christle Nwora, MD, dons personal protective equipment for her internal medicine and pediatrics residency at Johns Hopkins Medicine.
Courtesy: Christle Nwora, MD

Editor’s note: The opinions expressed by the author do not necessarily reflect the opinions of the AAMC or its members.

The night before my first medical school interview, I could barely sleep, and by the time I arrived on campus, I was brimming with anxiety. I was a little relieved to recognize one college classmate, who also happened to be the only Black person I would see that day.

As a staff member escorted me to my first session, I tried to remind myself that I could actually become a doctor. The interviewer opened his office door and extended his hand. I shook it, introducing myself. “Ah yes, Christle,” he said. “I knew you’d be Black by your name.” I froze, pasting a half-earnest smile on my face. I didn’t understand what he meant, but I sat down and tried hard to focus on the interview.

We discussed my leadership positions, volunteer experiences, and finally, my academic research. I am a first-generation Nigerian American, and my college thesis explored how members of the Nigerian diaspora help support their home country through remittances. The interviewer looked at me and asked if I felt like I was impacted by the historical injustices against Black people in the United States since I was Nigerian. Again, I froze for a moment.

“Ah yes, Christle,” he said. “I knew you’d be Black by your name.” I froze, pasting a half-earnest smile on my face.

I told the interviewer that even though I was of Nigerian heritage, I was still Black and subject to discrimination. He then went on to note that some local residents enjoyed going to the nearby cotton fields as a weekend outing. Even if this was a normal activity for some people, the comment made me feel incredibly uneasy in the context of an already uncomfortable interview.

Ideally, I would have used the post-interview feedback form or an anonymous reporting tool to inform the medical school about my experience. But as one of two Black students interviewing that day, I knew it wouldn’t be difficult to trace the report back to me, and I didn’t want to start off labeled as a “troublemaker.” I had no other option but to accept this as my welcome into the field of medicine and move on.

Few events have made me feel so small as that interview experience. I was a Black undergraduate student with dreams of becoming a doctor. He was a White tenured professor who felt bold enough to say whatever crossed his mind without a thought to how it would make me feel. I had no power and no confidence that the application process would protect me.

Unfortunately, harrowing racial experiences of many types continued to follow me throughout my four years of medical school.

During the first week of courses, an ethics lecturer asked the class if we knew about the U.S. Public Health Service Syphilis Study at Tuskegee. All the students of color raised their hands, but I was shocked that few of my other classmates knew about this monumental failure in research ethics. Then, as the instructor recounted the troubled history of medical ethics, he omitted that researchers had performed disturbing experiments on the bodies of enslaved people. When a student challenged him about the exclusion, he simply brushed off the critique.

I was a Black undergraduate student with dreams of becoming a doctor. He was a White tenured professor who felt bold enough to say whatever crossed his mind.

I experienced many other microaggressions throughout my education. I was constantly confused for my other Black classmates, and I had people make comments about my hair, my tone of voice, and my "intensity." Each time, I had to make a choice. Would I stay silent and try to protect my peace, or would I speak up in hopes of changing the learning environment? As I formed a small but supportive community of Black faculty, staff, and students I felt comfortable confiding in, I became more confident about speaking up, but that only happened over time.

Although I don’t speak for all Black medical students, I know my experience is not unique. We have suffered comments made about our appearances, for example, and have had security guards question our presence on campus. We carry these and other disturbing experiences with us to class as we study our pathology notes and worry about our next board exams. In addition, we bear the news of the extrajudicial killings of Black people and learn about health disparities that are robbing our communities of life. The stress of it all can be crushing.

Now, medical schools are rushing to make statements affirming that “Black Lives Matter” and claiming that they are anti-racist. As a recent graduate, I am surprised by how medical educators are suddenly more receptive to naming racism and anti-Black practices. I also know that much of this is because of the dedication of Black students, faculty, and staff to helping enact change.

We carry these and other disturbing experiences with us to class as we study our pathology notes and worry about our next board exams.

Meanwhile, medical schools need to do much more to address racism in practical and meaningful ways.

These changes start from the first moment an applicant interacts with a medical school. When I suffered during my first interview, I lacked the confidence to speak up because it was not obvious to me that medical schools actively cared about Black students. When I looked at their websites, I didn’t see evidence such as diversity and inclusion programming that indicated they were doing more than the minimum to recruit Black students. This is one place to start.

Admission committees also should consistently assess whom they allow to interview prospective students and train interviewers in how to be welcoming and equitable. In addition, before interviews begin for the day, schools should tell applicants that they want to ensure that everyone has a fair experience.

Schools also should recognize that students may not feel comfortable disclosing racist remarks while on the interview trail. Instead of making a general call for feedback from applicants after interviews, schools should offer ways for students to provide feedback after acceptances are sent. This distance would provide a buffer for students and help protect their anonymity.

When it comes to courses, curriculum committees should audit lectures and flag problematic content, such as lessons that perpetuate false notions around race. These audits also should make sure that the images and cases covered are representative of diverse patient populations. I still remember that as a first-year medical student, I received a dermatology lecture that had no images of Black or brown skin. In response, a fellow student and I attended meetings to ensure that the lecture would be more inclusive going forward. But this patchwork approach relies excessively on students to ask for change. A systematic review of curricula would make sure that all lectures are meeting the standards called for by anti-racism measures.

Anti-racism is not just the work of committees. Individual staff members should speak up when they hear racist remarks. The hidden curriculum — unintended lessons learned by students from the behavior of faculty — is powerful.

When people in positions of power start to normalize calling out inappropriate remarks, students will feel more supported.

At times, my school would hold general conversations about racism, and leaders would make a concerted effort to create a safe space. However, when classmates would voice troubling viewpoints — such as that Black students are present only because of affirmative action — these often went unchecked by the facilitator. 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.

I am incredibly proud to join the 6% of Black physicians who serve communities across the United States. As I look back at my four years of medical school, I am glad I was able to contribute to larger conversations about racism in medical education and campus climate.

However, a part of me wishes that I didn’t have to be in so many meetings or on so many task forces, committees, and email chains. It was an extra burden that I and many Black students take on to make the experience better for those who come behind us. It’s time now for medical schools to take on more of the responsibility for making our campuses places where all students feel equally welcome.

Christle Nwora is an internal medicine and pediatrics intern at Johns Hopkins Medicine. She’s interested in primary care, health equity, and medical education. 

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