Race, bias, and otherness in medicine
The School of Medicine diversity office—over the decades led by William Wallace, Carolyn Carter, Nancy Washington, Paula Davis (who is now assistant vice chancellor for diversity), and, for the past several years, Chenits Pettigrew—has been home base for generations of students seeking friendship, guidance, and assurance that they belong. In April, Pitt Med hosted a dialogue with alumnae who are now diversity and inclusion officers at schools and hospitals around the country. Student Nia James, president of Pitt’s chapter of the Student National Medical Association, moderated the conversation that touched on the stakes of unconscious bias, student dilemmas, and what’s working well at their institutions.
|Associate Director, Center for Diversity and Inclusion, Massachusetts General Hospital
Faculty Assistant Dean, Student Affairs,
Assistant Director, Office of Recruitment and Multicultural Affairs, Harvard Medical School
(Class of ’21)
|President, Student National Medical Association, University of Pittsburgh|
(MD ’94, Res ’98)
Obstetrics and Gynecology
|Director and Endowed Chair, Center for Clinical Excellence
and Diversity, University Hospitals Cleveland Medical Center
Pediatric Emergency Medicine
|Associate Dean of Diversity and Inclusion, University of Cincinnati College of Medicine|
|Diversity Liaison for Student/Resident Advising,
Geisel School of Medicine at Dartmouth College
Nia James: What is your most successful project to date?
Margaret Larkins-Pettigrew: My residents have an opportunity to work in Guyana, and their residents come here. We are graduating our third class this year, so they will have a total of about 12 ob/gyn physicians in Guyana. Since the start of the program, maternal mortality has decreased by 50 percent in that country. Stillbirths went down from 20 percent to 15 percent in the first three years, and last year it was at 13.8 percent.
It’s not only teaching residents to be great practitioners but also changing the culture. Because the issues we have around structural racism and bias in how we treat women—they have the same issues in Guyana.
Stephanie White: The thing I'm most proud of is the connections and the relationships that I've been able to make with students—the fact that I get to celebrate their victories along the way. I also feel that I've been able to be a catalyst to continue speaking about the “isms” and race in medicine. Not that those conversations weren’t happening, but the more conversations you have, the more you can push the ball forward.
Mia Mallory: Over the past three years, over 90 percent of our diverse students who matriculate to UC have attended one of our diversity interview days. I am excited that 20 percent of our current first-year class is from an underrepresented minority background. One of my main goals is to increase the number of minority physicians in the workforce to care for the growing diverse patient population. We are building on the success of our diversity interviews days to increase the number of resident physicians in our programs. [Those efforts have] helped us recruit several residents from diverse backgrounds.
Sherri-Ann Burnett-Bowie: I have been able to create connections with trainees across the span of the journey from medical students to junior faculty. I've always tried to approach how I give feedback in a loving manner, because [the time spent in] medical school, residency, and fellowship, and as junior faculty ares challenging. Additionally, I have been pushing my organization to think critically about unconscious bias and how it affects hiring and decisions made around recruitment. By being consistent about creating a safe space for people to have uncomfortable conversations, we’ve been able to change our process and significantly reduce the impact of unconscious bias—both who we lean toward and who we lean away from.
NJ: Is there a part of your job that surprises you?
MLP: I need to continue to check myself about where my bias lies.
SW: Lots of schools have made it pretty far being well-intentioned. To really continue to push issues forward, there need to be standardized ways of accomplishing things—and metrics for evaluation.
MM: I am often surprised that not everyone believes in the importance of diversity in the health care workforce, especially given that the population of the patients that we are caring for is becoming increasingly diverse.
NJ: What is trending in the world of diversity and inclusion offices?
SABB: There is a significant conversation that’s ongoing around supporting learners and faculty with disabilities. The idea that you have to be perfect is a real barrier to both seeking wellness and seeking accommodation.
SW: Students are coming in with more experience dealing with social justice. Think about the key events that took place in their formative years with Trayvon Martin and the inappropriate deaths of black males. This has been in their lives for as long as they remember, and it’s really hard as faculty to keep in mind that they do think about things differently. We’re going to have to bridge that gap, because they’re going to continue to want to talk about it.
MM: We’ve been seeing an uptick in patients who display biases against our students and physicians for a variety of reasons, whether it’s because they belong to a certain racial group, ethnic group, gender group, or sexual identity group. Now we are working to develop standards to educate and empower our students to combat the biases they are facing.
MLP: We just recently changed our patient bill of rights, because we had so many cases where our patients refused to have people, who are of the Jewish faith or African American, take care of them. We have decided to have a no-tolerance response. We say to a patient that we are all diverse, and this is a training institution; but if you are uncomfortable here, we will transfer you at cost to another institution.
SW: If faculty members hear their students encountering something, they need to speak up for them at the time and not just ignore it, because that can be very demeaning. Students are in a difficult place, because in most situations, their grades and evaluations depend on their actions, and they don’t necessarily know what the attending would think if they verbalized their concerns.
NJ: Are there challenges that may be more significant than what you already listed?
MLP: I still feel that we can talk about all the “isms” that exist in our world today—as it relates to our LGBT population, our women—but at the end of the day, the people who are dying in my field [obstetrics and gynecology] are black women and black babies. Part of our responsibility is to recognize that unconscious bias does kill, and it can kill at the bedside.
SBB: Physicians and health care providers—not just physicians—sometimes need convincing that we have bias, because there’s such empathy that’s inherent in the choice to provide relief of suffering. Sometimes people make the mistake of thinking, I can’t be biased, because I’m in this pursuit [i.e., healing]. . . .
There is so much upheaval in our geopolitical context that it’s a hard time to be a student who is concerned about social justice. I have sent out e-mails about what I think are really heartbreaking national tragedies—after Charleston [church massacre], after Orlando [gay nightclub massacre]—where I share that I’m struggling with what has transpired, and that I would anticipate that they would be struggling as well, and that there are resources here to help them.
SW: Students really want change, like, yesterday. They are much more social-justice minded, and they’re pushing academic medicine educators to think about how we’re doing everything within the classroom, clinics, and medical school environment.
NJ: We're going to switch gears a little bit, and I'm going to ask you: What were your favorite aspects of attending the University of Pittsburgh and living in Pittsburgh, and is there anything you miss about it?
SW: I think the thing that stuck out most about my Pitt experience is that you genuinely felt like people had your back. Whether it was Miss Carol [Carol Blackman, administrative support staff member in diversity programs] or Dr. Bob [Robert Connamacher, who ran outreach programming for many years] or Paula Davis. You felt like people had your back. Miss Dottie at the copy center downstairs was another friendly face as you passed by. And while I was a student, there was a much greater initiative from Gateway Medical Society to mentor medical students.
MM: Just like Stephanie said, with the Gateway Medical Society, as medical students we were paired with diverse physician mentors in the community who took us into their homes and really treated us like their own kids. That really made a difference in my career path and my success in medical school.
Really just everything that I’m doing now is based on the time and experience I had when I was in medical school. . . . Pitt has been the standard by which I have measured myself and the development of our office of diversity and inclusion here in Cincinnati. When I was a medical student at Pitt, the Office of Diversity led by Dr. Nancy Washington was home base for us and where we gathered as a family for support. That’s the environment I want to create here.
MLP: I just have to say Pitt wasn’t there all the time, and the point where they’re at now is something that they have evolved into. When Mia and I were students there, . . . very overtly racist things were happening to us. Professors were still writing on our evaluations things like, She did very well for a black person. . . .
Pitt taught us through not only trials and tribulations, but also by embracing the concerns that we had as students and really helping to make a difference for those people who are there now.
NJ: I could really relate to some of the things you were saying. Thank you Dr. Burnett-Bowie, Dr. Larkins-Pettigrew, Dr. Mallory, and Dr. White for your time and thoughtful responses. You brought up key points that are really important for the community and the next generation of minority physicians.
Comments have been edited for length, style, and clarity.