Episode 2 Part 1: Race and Medical Education

[0:00:00 Speaker 2] wear a resource for learners, including every member of the live strong cancer institutes. On track Educational pipeline, from middle school to residency were growing collection of interviews, talks and experiences the uncover the myths and the uncertainties of cancer and careers in cancer in order to empower and inspire generations of thinkers and leaders. This is cancer uncovered, uneducated in and empowerment podcast by the live strong cancer institutes.

[0:00:34 Speaker 4] It’s weird because I’m sort of like, you know, black and Brown people have been being killed by the police, right? And so this is not

[0:00:42 Speaker 5] new. It’s great the conversations we’re having. Um, but then you see kind of like it start to paid from the media and from people. Social media.

[0:00:56 Speaker 3] I’m hurt. I’m frustrated emotionally. I am also I’m sad, cautiously optimistic over

[0:01:08 Speaker 0] it. Brianna Taylor Tamir Rice Trayvon Martin, Eric Garner, Michael Brown The list of names of black Americans who have been killed by law enforcement goes on and on. The recent murder of George Floyd has sparked a conversation about systemic racism and white supremacy in the media, federal, state and local governments and college campuses across the country. For this month’s podcast, We take a step back from cancer specific topics to join the conversation on racism. We wanted to hear from medical students to learn about their experience as black Americans in health care and medical education, as well as the challenges they’re overcoming on their path to become physician leaders. Our moderator for the discussion is Dr Brandon Al Port Rto. Dr. Alpert Lto is an assistant professor of population, health, internal medicine and pediatrics at UT Austin’s Del Medical School and is a clinician educator serving as co director of the primary care family and community medicine clerkship at the Dell Medical School. He also practices as a primary care internists and pediatrician at Lone Star Circle of Care, a federally qualified health center in Austin, Texas.

[0:02:20 Speaker 1] I wanted to just start it off by asking, sort of generally how everyone’s doing, how everyone’s feeling right now and, more specifically, how the recent extra judicial killings off black people and other people of color have affected you sort of a non emotional or personal level.

[0:02:36 Speaker 0] C R. A. Brown is a third year medical student at the Dell Medical School. She’s originally from Houston and is interested in emergency medicine or internal medicine.

[0:02:45 Speaker 3] I’m feeling okay. Generally, I think that we’re in the middle of Clinical Z and lots of busy time. So, um, lots of different responsibilities to keep us busy. But this thing is still happening at the same time, so I’m unable to just be completely engrossed in work right now. Eso on top of just being okay? Feeling a bit unfocused?

[0:03:18 Speaker 5] Yeah.

[0:03:20 Speaker 4] Cr, uh, had a wide range of emotions that which I can definitely understand.

[0:03:29 Speaker 0] Decoy Burton is also from Houston. He is currently 1/4 year medical student at Del Medical School and is applying to a combined residency for internal medicine and pediatrics.

[0:03:41 Speaker 4] Yeah, I’m OK too. But there moments where you’re, like, overwhelmed and moments where you’re like, OK, everything’s gonna be okay. Um but it’s particularly interesting that it has sort of come into the mainstream consciousness right now, and I think a lot of that has to do with, like, you know, the pandemic. On top of what we’re able Thio spread on social media and CNN s O. But overall, day by day, I’m okay. There are moments of you know where I’m not okay, but, you know, we just keep going.

[0:04:15 Speaker 5] Um, I obsolete between hopeful and guarded. And so that makes me It reminds me of things that have happened in the past. When we see this big wave across, you know, it’s in people’s minds. It’s all over social media. It’s all over the news. And then what changes? And then it’s like a cycle.

[0:04:38 Speaker 0] Diana Reiss White was born and raised in upstate New York. For the past eight years, she has been in Texas where she was a high school science teacher in guidance counselor. She is now currently 1/4 year medical student at Del Medical School and is pursuing neurology.

[0:04:55 Speaker 5] And so I’ve been oscillating between just feeling really hopeful and, you know, empowered to like that things are going to change that I’m able to do really good work and then, you know, But is it gonna Is it gonna stick? Um, for me, the the killings of black people on, you know, with everywhere and just being being in your face all the time, it caused a lot of anxiety. I would wake up in and check Facebook on Bond. Just be angry. Be anxious. Um, and then that would stay with me throughout the day. Um and I know after the murder of Trayvon Martin, I stopped watching the news completely. Um, it’s all my mom watches on TV. So I would like if I would go to her house, I turn it off or I’d be in a different room. So, um, but you just couldn’t get away from from it. And you can’t really hide from it. And, um so it was really hard on. And it’s still really hard. And then later on, a pandemic. But I’m trying to be like CR said, cautiously hopeful.

[0:06:14 Speaker 1] Yeah, I would echo, um, what you guys were talking about in terms of, you know, this is not anything new. And, um, you know, I think initially I was a little bit dismissive of, um, of the sort of public attention that was was going on. Um, and then s o the difference that I’ve noticed because this is not something new is that more people are are focusing on it. So I think in that way, this is sort of Ah, positive moment. Um, in some ways, but obviously it’s also, you know, a very stressful thing to go through and and as someone who is, um, Caribbean, American. So I have a little bit of a different background and didn’t necessarily grow up. You know, my my grand parents grew up in majority black countries, and so some of the generational, um, stress that other people have experienced, I haven’t experienced. And so it’s interesting. I think, that instead of sort of decreasing over time, my anxiety about public interactions is increasing as I’m mawr immersed in sort of what goes on in America.

[0:07:28 Speaker 4] And it’s also interesting because I think for the first time, ah, lot of people are like, Wow, our our government health care, all of our republic institution that’s supposed to protect us, that all Americans are not necessarily doing that. And I think it’s been interesting to sort of, just

[0:07:48 Speaker 5] see,

[0:07:48 Speaker 1] you know, starting with that as a baseline. I wanted toe talk more about our experiences in the health system and in academic medicine, specifically So, um, in terms of your rotations, your interactions with the health system so far, what manifestations of systemic racism have you seen? Have you observed?

[0:08:06 Speaker 5] I think there’s there’s a lot of a lot of examples we could give. And we’ve seen, um, even thio, you know, So looking around our class, our classes and just the demographic makeup of who is at Della Medical School Medical School in general, just

[0:08:25 Speaker 4] a simple fact that we’re one of how many black students in our school. Um, there’s not very many of us, Andi, I think. Although I don’t think people Or maybe it was I don’t know who built the system, but that’s just what it is. That’s the one. The med school admission system having to do well in college. Having thio honestly have, ah, a fair amount of, um, cash on hand in order to even apply to medical school and persist throughout medical school is very, um, it discourages a lot of black and brown folks from going and staying. I think that we have to really think about if we want our physician, you know, work force to look like our patient population, what it means to really make medical school and medical education accessible to all

[0:09:25 Speaker 5] people. But even like what? What we’re taught and how we’re taught. So if you think of like on my Pedes rotation and thinking about like rashes of childhood. We never see what those rashes look like on black and brown skin. Um, you know, it’s just simple things like that that just kind of continue this pattern. But again, like what? Decoy said. Getting black and brown kids into medical school on it. So one of the main reasons I went to medical school from teaching, teaching kids who wanted to be, you know, doctors and nurses and showing them that you can get here and then being a mentor to them, they need to see us here.

[0:10:13 Speaker 3] The low amount of representation in students and also in faculty in medical education, um, really affect me in seeing patients? Um, I sometimes feel burden, and I don’t say that to be a negative thing. But I sometimes feel burdened when there’s a black patient on a service that I may be on to make sure I am caring for them to really take more control of their care, because I think that there is already ah, thought in my mind that’s been validated, that they may receive subpar care or, um, they may not be listened to, or their concerns may not be, um respected, um, or even addressed. Or they may be labeled something that is not them. And I think that it’s ah, I’m okay to be in that position as a medical student, but I don’t think that it’s absolutely necessary. And I don’t think I should be the only one that feels like that. Andi, I don’t think that my other, um, classmates have to really deal with that. Um, when they are interfacing with the patient,

[0:11:44 Speaker 1] you raise a couple really good points. I think, um, you know, one thing that really resonated with me is talking about the burden that you know, we experience, which, um, it is a negative word, and we don’t necessarily apply negativity those experiences. But like, for example, I’m here right now spending an hour and a half of doing this, and I’m happy to be doing it. I’m so glad this conversation is happening, but I’m not getting paid to do this. And I’m you know, I have other things that I need to be doing. Um, and other people who have similar jobs or not, you know, burdened with, um with activities like this, Um I think another thing you pointed out was some of the systems that we work in. S O I think both on the individual patient level in terms of not being able to diagnose rashes and certain people, for example, or not being not treating pain appropriately in all populations. So those are, um you know, on the individual level, but on a systems level working in ah federally qualified health center, which is, ah, system that the focus is treating people who don’t have insurance or under insured. And you know, this is not a knock on my specific FQ etc. But it’s sort of a nationwide problem where we are working in this, um, this scope of scarcity, um, to treat these people and we’re not providing the same care that they would get elsewhere. And it’s very frustrating for me has a provider to know that that people could be getting better care if they had that access, and it’s not explicitly tied to race. But, you know, we see the statistics and we know what populations that impacts disproportionately. So So that’s, I think, a really important point.

[0:13:32 Speaker 3] I think that we’re I think, that we are taught about systemic racism in the medical field at our school. From a very academic standpoint, a very objective standpoint that really removes a lot of the emotional component of this argument out in order for it to be better received. In my opinion, let’s give you stats. Let’s give you, um, studies. Let’s let’s tell you that a study was done that says black Children got pain medications at a longer time, period after presentation than a white child did for the same pathology. But I think taking that objective approach and how we’re taught really removes the like, most authentic piece of what we feel of systemic racism. And that is the emotional component that is like the patient that is frustrated, that’s not being listened to and how that makes them feel, and how that makes them not trust the health care system and things like that. I think it’s just a, I think, just a level of education. But we’re missing when it comes to that. So it’s able to manifest, and I think that I just try to get in front of it by being there for the patient. But I’m only a student, so it’s kind of it’s kind of hard thio always do that. You always kind of feel like your balance against this system. This unspoken thing. Um, so, yeah,

[0:15:12 Speaker 1] As an educator, it’s really good feedback to hear that. Maybe we’re being too academic as we’re teaching about these inequities. And, um, you know, I think in our clerkship we’ve really tried toe highlight patient voices, but I think we can do even more toe in that direction. So thank you for that feedback for the educational system as well.

[0:15:32 Speaker 5] I’d like to, like circle back to that. That feeling that c R A said and she use the term bird. And I agree. I agree with that. Um, I I felt that as well when I was on doing my my second year in my rotations. Um, in that every black patient that was on on the list was my patient. Um, even if I my list was full, I I made sure that I saw that patient too. So they felt like there was someone there who I looked like them or had their back. Or because we see when that way feel that need because we know that the system is not set up for them. I remember studying for with Deploy, and my brother ended up being ill and having to go to the ER. And this feeling of dread went over me. And I had toe run across the street from the med school, too, like, and I had to think, Why did I feel that way? Like Okay, he’s He’s sick. He’s okay, though. So what does that feeling come from? What did I feel that need to go over there and be a representative and advocate for him? Because we know the system isn’t in place. That’s for him. It’s not set up for him, especially as a black man. Um, and I think we probably feel that within our own families, um, but with patients, they become our family with black patients, especially as I felt like when they’re on your list, they’re yours, and it’s like you said a burden, but not in that negative connotation. But I agree. Sciarra completely.

[0:17:20 Speaker 1] Okay, so So I think we’ve talked a little bit generally about about the system, and some of you have touched a little bit on your personal, um, impacts. But, um, maybe we can elaborate a little bit more on how you feel like race has impacted you personally and your medical careers. Whatever you’re sort of willing to share about them.

[0:17:41 Speaker 5] I would say everybody in medical school has some sense of this imposter syndrome. Um, this doubt should should they be here? Are they smart enough? But I think we walk around with so much more added. On top of that, um, when you have an you know, I’ve had things overtly said to me, um, by faculty members like asking for help with Step two when we were studying or Step one. And you know, it goes back to that giving just objective data. So having someone say, Well, black students don’t do well on Step one at the beginning of our study time when I’m not performing well on practice exams and then toe have that play in your head for the next six months of studying and then the eight hours of taking the exam. That’s not that’s a different level of imposter syndrome. That’s a different level of self doubt. Um, and it’s exhausting, just trying to prove that you belong,

[0:18:48 Speaker 3] so I’ll go ahead and go. Um, this question for me Makes me kind of think about Intersectionality, um, and what it is like to be black, but also a woman. And when people that have, um, not had the privilege of being around a lot of black people in their life think of stereotypical black woman that media likes to put out of being loud and angry and things like that. I fit the bill. I am very much of the stereotypical black woman for a lot of people. And I think that affecting the correct the fact that has on my medical career is that I I am constantly, um, proving myself to the people that I’m around, um, that I’m as smart as them. And I know as much information and, um, that I’m as prepared a Z M and I’m as academically competitive or whatever, even if no one says this is the competition that is in the air. And so you come into it trying toe work twice as hard and get there and everyone in the building, um or most people in the building can already feel have feelings of impossible syndrome. But for you is even more deeper than that because there’s this pressure of working against a stereotype. No, I’m not the angry one or or things like that. I’m not less smart because of my skin color because I’m a girl or whatever. But then there’s also this sense where it took me a little while to kind of get there, where I’m going to be proud of where I come from. I’m going to be proud of being allowed person. I’m gonna be proud of my hair, how it is, and it’s natural state and be more unapologetic about that. And it’s on everyone else to grapple with how to make sense of that. Um so I think that it’s been a journey for me. But I think that that initial hurdle and obstacle, um, can really make a lot of people break. And it doesn’t mean that you want a strong person. It just means that that was a hurdle that wasn’t really meant for anyone to really overcome. And that’s actually been my experience as someone that actually started Indiana and decoys class and left because of lots of mental and emotional pressures that resonated in my academic performance. And for the first time, I wasn’t performing well, academically. But there is no difference in who. I It was as a person besides just being constantly lonely, constantly said, constantly feeling like I wasn’t connecting to people and it took me over to exit to come back to really excel, because I have to just be around. Some people that looked like me be around some experiences that were like my and kind of get that validation externally before re entering, which I don’t feel like that should have. Even that should have been a requirement to be successful. Um, so yeah, I think that nothing is nothing is there explicitly say it out loud. But there’s a lot of implicit bias. There’s a lot of microaggressions. There’s a lot of small things that add up, Um and ah, lot of it is interactions with other people and how you’re how you are treated and not anything that they overtly say. But a lot of the actions, facial expressions, things like that and those little things just add up. And it is very easy to burn out

[0:23:09 Speaker 5] being that intersectionality piece CR is dead on, like being talked over. And you wonder like, is it because I’m black. Is it because I’m a woman? Is it? Why is this happening to me? Um, being told that there’s an issue with my attitude during team Ah, lot of our team teaching activities. When I do, then speak up for myself. Um, that I need to give my feedback in a way that’s lighter. Uh, it’s it’s exhausting. Its’s another layer on top of the already strenuous medical curriculum. Medical education that we go through. Then toe have this layer layered on these micro aggressions and macro aggressions, and people just outwardly saying things and because maybe they’re just giving you the objective data. But that isn’t what we need. Um,

[0:24:15 Speaker 4] sure, I’m so I’m the only black man in my class. And so that is, I think what most people want to be is understood and particularly in medicine. You, if medicine will sort of challenge who you are as a person and your experience, it’s just really, really difficult. And I think finding you know, they talk about finding your community and finding your voice and finding your confidence in medicine. And that I would say I struggled with that for a long time. I struggled a lot with Do I belong here? And where are my people and can I stay here? Do I deserve to be here? And clearly I got in just like everybody else and have passed on my courses and still here now. But there’s always that that sort of doubts of, like are these people, my people and my one of them. And a lot of that gave way for me to like depression and anxiety, particularly at the end of my freshman me on my second year. Excuse me. Um, I lost like I’m not a I’m skinny as it is. And I lost £15 and like, wasn’t eating. And Deana was studying with me during staff and she saw me and I was point of medical school and sort of the It’s literally trauma, right? Like when you go into a place and you have all these micro aggressions and you’re you’re just tryingto get through medical school. But you’re having all these mental hurdles and experiences, and, um so it’s been hard. But I will say that, um, I’ve learned a lot about myself, and I’ve learned a lot about how to navigate this system and what I’m willing to give up in what I’m not. And so it’s made me a better person and a better future position. But that doesn’t necessarily mean I came out of it, um, without any bruises or scars or any long term trauma. So where could do that constantly?

[0:26:26 Speaker 1] Yeah, I would. You know, looking back on my own medical school experience, um, you know, imposter syndrome, like you says Israel for everyone, but is definitely sort of at a different level. Um, for us having toe kind of prove ourselves at all times. And I don’t think I ever consciously thought, um that it would go away after graduation. Um, but it was a little bit of it has been a little bit of a shock. Uh, toe realize that, you know, it’s it’s a lifelong thing. It’s gonna be around for a long time, you know, throughout the career. So

[0:27:03 Speaker 0] this conversation is too important to end in a single episode. Next week, we will release part two of this podcast, which focuses on actions that we can take as learners, educators and people to become anti racist and to support members of our community. Until then, we hope you will listen to Part one and reflect on the experiences that Dr Al Poor Lto, Deana Decoy and Siara have shared. It’s through stories like theirs, where we will better understand racism in medical education and in health care and begin to make significant changes. I’m Nick Smith Stanley from the live strong cancer institutes, and this has been cancer uncovered. Okay, we would like to thank Dr Al Port Lto, Siara, Decoy and Deana for making this conversation possible. We’re grateful for their brave spirit and willingness to carry the burden of teaching us through their experiences. For more information about the live strong cancer institutes, check out del med dot utexas dot e d u. You can follow our director and chair on Twitter at S. Kale Eckhart Eckhart is spelled E c k h a R D t. If you have questions or have ideas of topics that we can uncover, email us at live strong cancer institutes at del med dot utexas dot et You please make sure institutes is plural, and if you like the podcast, make sure you subscribe. This is cancer uncovered. Thank you for listening.