On June 5, Debbie Fadoju stood before the hundreds gathered on the lawn at the Ohio State University Wexner Medical Center and raised her voice.
Fadoju, a second-year medical student, had organized the White Coats For Black Lives demonstration — mirroring similar demonstrations on dozens of medical campuses across the country — less than two weeks after George Floyd, a Black man, was killed by Derek Chauvin, a White police officer, in Minneapolis, Minnesota. The protesters, many in their white coats and nearly all wearing masks, knelt for 8 minutes and 46 seconds — the amount of time Chauvin kept his knee on Floyd’s neck.
“We kneel today to loudly and emphatically exclaim that the outcries of marginalized voices will no longer fall on deaf ears,” Fadoju said to a somber crowd. “We kneel today to acknowledge that police brutality and systemic racism are not political problems, they are public health crises just as alarming — just as devastating — as the COVID-19 pandemic. We kneel today as Ohio State Buckeyes who affirm that we will not turn a blind eye to the problems that have been plaguing Black and brown communities for decades.”
In the two months since Floyd’s death, as countless protesters opposing systemic racism and police brutality have taken to the streets all over the world, medical students who have been speaking out against racism in health care and within their own institutions are taking a stand with renewed energy.
While students who become anti-racist advocates must navigate challenges — from facing pushback for what can be perceived as political activism to spending their limited time and energy on advocacy — many believe that the stakes are too high to remain silent.
And now, it seems that people are listening and ready to act.
A shift in consciousness
Betial Asmerom, a fourth-year medical student in the University of California (UC), San Diego, School of Medicine Program in Medical Education – Health Equity and one of the leaders of the Anti-Racism Coalition, has spent much of her time in medical school and before working against racial inequity. She’s worked in the community, fought for opportunities for younger students of color to pursue careers in medicine, and submitted complaints to the school’s administration about a curriculum that perpetuates racism.
She’s well aware that many have gone before her in advocating for the same things.
Progress has moved slowly, but Asmerom has sensed a change in recent weeks.
“There’s this collective shift in consciousness where everyone thinks it’s politically correct to talk about anti-racism,” Asmerom said. “Before, we were ostracized … What’s different is how people are perceiving our demands. Right now is a very unique time.”
“There’s this collective shift in consciousness where everyone thinks it’s politically correct to talk about anti-racism.”
Fourth-year medical student at the University of California, San Diego, School of Medicine
Other student activists have felt similar momentum among their colleagues and the leaders at their institutions.
“The shift is happening where people, before, had an easy time saying, ‘Well, that’s not me. Racism does not apply to me,’” said Russyan Mark Mabeza, a third-year medical student at the University of California, Los Angeles (UCLA), David Geffen School of Medicine and president of his class. “I think now conversations are happening where White people and non-Black people of color are turning inward and saying, ‘Wait. No, no, no. Let me see if I’m actually anti-Black.’”
Many medical institutions crafted public statements condemning the high-profile deaths of Black people at the hands of police and pledging to do more at their own institutions to promote diversity and equity.
Student leaders, like Asmerom and Mabeza, saw it as an opportunity to demand tangible action.
At UC San Diego, Asmerom and other Black students sent their institution leaders a list of demands. They included allocating funding to anti-racist initiatives, compensated and mandatory anti-racist training for faculty and staff, designated time for students to participate in anti-racist training, creating new positions to focus on anti-racist initiatives, and forming an anti-racist task force with student and resident involvement to review specific initiatives to combat racism within the medical school, among other demands.
Those leading the charge at other institutions have taken similar approaches, sometimes reaching out to each other through student associations to learn what is and isn’t working elsewhere.
“Collaboration amongst Black medical students and diverse partners, including faculty in the humanities and public health, is essential,” said Kaosoluchi Enendu, a fourth-year medical student at the University of California, Irvine, School of Medicine. “Instead of reinventing the wheel each time a racial crisis occurs, we are able to pull from the collective knowledge of history and current needs to guide our steps.”
One of the issues that Enendu, who co-founded her school’s Leadership Education to Advance Diversity-African, Black and Caribbean program, has emphasized to leadership is the need for medical institutions to recognize the anti-racist work that students and faculty of color are doing, especially without monetary compensation or academic credit.
“Many student advocates are senior students studying for [United States Medical Licensing Examination] Step exams and doing clinical rotations who spend countless hours on institution-assigned working groups out of a labor of love to better their schools,” she said. “This is an additional burden that other classmates do not carry. To truly show value for our perspectives, skills, time and sacrifices, my opinion is that underrepresented students should be compensated with more than just words of appreciation.”
“It just looks like the whole world has had enough.”
Quinn Capers IV, MD
Interventional cardiologist, professor of internal medicine, and vice dean for faculty affairs at the Ohio State University College of Medicine
The students aren’t the only ones who have felt a shift in the responsiveness to racism within academic medicine.
Quinn Capers IV, MD, an interventional cardiologist, professor of internal medicine, and vice dean for faculty affairs at Ohio State who has long been an advocate for enhancing diversity in medicine, said that, while medical students have spoken out against injustice in the past, this is the first time that he’s seen the outrage over the police killings of Black people echo globally and continue for weeks.
“It just looks like the whole world has had enough,” Capers said.
On his own campus, he’s heard from leaders that they want to do something to make sure they are not contributing to racism.
“I am definitely hopeful that this time is different,” he said.
Advocating for change — from the streets to the classrooms
For some medical students, the question of how to speak up against racism and injustice has proved complicated.
With some anti-racism protests across the country resulting in arrests, students have expressed concern that even peaceful protesting could result in a spot on their record that could influence their chances of getting into medical school, residency programs, or becoming licensed as physicians due to background checks.
“The AAMC encourages admissions deans, student affairs deans, and program directors to seize this opportunity to engage in conversations with applicants, learners, and your broader communities about systemic racism, its impact on health, and the role and responsibility physicians and other health care providers have in effecting change.”
AAMC Guidance on Peaceful Protests by Medical Students and Residents
While each medical school and residency program is responsible for its own selection process and can decide to rule out a student based on arrest history, the AAMC released guidance this month for selection committees in undergraduate and graduate medical education to carefully consider each applicant for their individual attributes and to examine the relevant facts and circumstances surrounding any protest-related arrest.
The AAMC noted that screening out an applicant because of an arrest could disproportionately impact applicants of color, who have a higher likelihood of arrest and conviction than their White counterparts; could go against the principle of presumption of innocence; and could undermine a potential applicant’s constitutional right to peaceful protest.
“The AAMC encourages admissions deans, student affairs deans, and program directors to seize this opportunity to engage in conversations with applicants, learners, and your broader communities about systemic racism, its impact on health, and the role and responsibility physicians and other health care providers have in effecting change,” the AAMC wrote in its guidance document.
Still, the perceived risk makes some students apprehensive.
“If you get arrested for protesting, it can be something that can affect you for the rest of your career,” said Joseph Pena, a second-year medical student at Wake Forest School of Medicine. “We were very concerned about that.”
Pena, who joined protests in Winston-Salem, North Carolina, said that he and his fellow medical students watched out for each other and were able to avoid any encounters with police that would result in an arrest.
For Asmerom, the experience of marching with like-minded individuals was cathartic and well worth the risk of potentially impacting her career prospects.
“To me that’s negligible,” she said of the possibility an arrest could hurt her chances at securing a residency spot. “At the end of the day, I’ve committed myself to a career in medicine. To be of service means you have to be willing to lose something in the pursuit of equity and Black liberation.”
At the same time, she acknowledged that not every medical student is in a position to take such risks.
Capers, the dean from Ohio State, said that his advice to students seeking racial justice is to speak up while also maintaining professionalism, particularly on social media.
“For students, there’s always some vulnerability,” he said. “After you finish this phase of training, you’re applying for another phase.”
Instead, Capers suggested that students wanting to evoke change should connect with the faculty and staff who have a passion for social justice and let the conversation grow from there.
At the University of Central Florida (UCF) College of Medicine, Marcy Verduin, MD, the associate dean for students and a professor of psychiatry, said that she and other administrators welcomed the opportunity to hold a virtual meeting with student leaders earlier this summer and are planning to implement some of the ideas that the students presented.
“I think administrators really want to find positive solutions. We want our students to feel like they have a voice and we hear them and we care about what matters to them and that we’re open to making changes.”
Marcy Verduin, MD
Associate dean for students and professor of psychiatry at the University of Central Florida College of Medicine
For example, UCF will implement a diversity ambassador program that will allow prospective students of color to connect with current students of color to glean information from their personal experiences at the College of Medicine.
“I think administrators really want to find positive solutions,” Verduin said. “We want our students to feel like they have a voice and we hear them and we care about what matters to them and that we’re open to making changes.”
But some students believe it is a combination of collaborative work within the institution paired with social pressure from speaking out publicly and participating in protests that inspires progress.
“You need a plan to make a change, but you also have to be visible and physically mobilizing as well,” Asmerom said. “You need both aspects to initiate change.”
Medicine’s role in racism and fighting it
As the COVID-19 pandemic has laid bare racial health disparities in the United States at the same time the country is renewing its focus on structural racism, many in health care — from students to seasoned faculty — believe that it is their duty to not only treat their patients’ physical ailments but the societal ones as well.
“Part of being a physician is the concern we have to heal our patients and improve our patients’ lives,” Capers said. “It goes beyond the office visit … As a doctor, I have to speak with legislators, protest against racism, and use my pen. If I just ignore those things and write him a prescription, I’m doing an incomplete job.”
Like Capers, many of the medical students who are now leading anti-racist initiatives at their institutions see speaking up against injustice and combating health disparities as part of their duty as aspiring physicians — particularly given the role that the field of medicine has played in perpetuating racism.
“Racism is at play in diagnostic protocols, in how we support patients, for instance, in our perceptions of their pain … our profession contains its own chapter of racism,” said Mikiko Thelwell, a fourth-year student at UCLA.
Thelwell and other student activists hope to be part of a new chapter in the future of medicine, where they can use the respect that their medical training earns them to speak up for the underserved.
“I have a bigger voice now,” Pena, the Wake Forest student, said. “People respect you as a physician … If you use that privilege, you can make a great change.”