I’m a white, cisgender male and the privilege associated with that has given me tremendous advantages to getting me to where I am today as a surgery resident. That is a sentence that has taken me far too long to say, and I’m still working to become comfortable with it. Why has it taken 30 years to get here? I have succeeded in a system that provides me with tremendous privilege and, until more recently, rarely challenged my thinking on racial equity.
I grew up in a small town of 99% middle to upper-class white people. I was raised by two loving parents who taught me to love people regardless of the color of their skin, sexual orientation, or any other characteristics, but lacked any real exposure to true diversity. I lived the first 18 or so years of my life without thinking much about race at all, certainly without putting serious thought into the barriers and racism encountered by people of color in this country. It didn’t apply to me, and I paid it no attention. In fact, it’s worse than that. I held embarrassingly ignorant views:
- Sure, some people come from disadvantaged backgrounds, but hard work and perseverance are the great equalizers.
- My family has struggled in a number of ways. Life hasn’t always been easy. Privilege doesn’t always exist for me.
I’ve come to be horrified by these previous thoughts. I share them because I don’t think I’m alone in this position. Many of the people who I grew up with, in that small town never left and still hold these views. Much of white America is similar. Much of medicine is similar. This attitude is more pervasive than we might believe, and we must work to overcome it.
College became my first real exposure to people from different backgrounds. My friends were of different races and ethnicities and had different upbringings, but any growth during that time was quite shallow. I continued to selfishly live in a world that supported my privilege and did not challenge me to acknowledge racial inequities, much less to act as an ally or advocate for racial equity. Around the time I entered medical school, Trayvon Martin, Michael Brown, and Eric Garner were killed and the Black Lives Matter movement started. For the first time, I was witnessing and beginning to understand the severe discrimination against Black Americans. I began to educate myself more on my privilege and racial injustice. Simultaneously, I observed the disparities that exist within medicine. There was a lack of Black medical students and doctors around me. Minorities and non-heterosexual or cisgender people received different treatment by the medical system. This learning of gender and race equity came mostly through passive observation. My experiences in residency have been similar.
It has taken me 30 years to get to this point, and I realize I’m only at the beginning of this journey. If I’m not alone in years of indifference or inaction, this observation highlights the critical need to confront trainees like me with their privilege at all levels of education. We must challenge them to not be passive, but rather take an active stance against racism. Learners should be taught to recognize their privilege and to act as allies and activists for those who lack that privilege.
As this blog is about surgical education, I will focus my thoughts on this area. As surgeons and educators, we are provided with an incredible opportunity to educate and challenge learners on a daily basis, but we aren’t exploiting these opportunities. In my experience, curriculums to directly and actively teach about racism, anti-racism, and allyship are not prevalent. I’ll highlight a few areas I see for intervention.
Our colleagues, from medical students to attendings, are often the recipients of blatant discrimination from patients, whether on the basis of race, gender, or sexuality. Many of us have observed leaders confront these acts. If you’ve never directly confronted a patient for a discriminatory statement, knowing the appropriate way to address the patient and situation may feel difficult, especially when not in a position of higher authority. Saying something is certainly better than nothing, but saying the right thing immediately and confidently is best. A toolkit to swiftly and appropriately react to these patients would help team members to act. Medical students and residents should receive training and mock scenarios on how to challenge discrimination from patients so they are ready to appropriately address these situations.
This discrimination, whether implicit or direct, goes both ways though. Study after study has demonstrated that minority patients, patients from disadvantaged backgrounds, LGTBQ, and other disenfranchised groups do not receive equitable care. This represents another opportunity to provide educational interventions to help providers recognize these inequities, their own implicit bias, and to act to improve care for these patients.
Finally, there is a severe shortage of Black and Latinx medical students and physicians. This disparity is pervasive through all levels of the surgical field from residents to chairs. Surgeons play a crucial role in stimulating interest in our field among medical students and promoting surgeons into leadership positions. There is a tremendous opportunity for interventions targeted at recognizing and overcoming implicit bias and recruiting more minorities to our field. I recently saw a tweet from Dr. Quinn Capers about grading fellowship applicants for an interventional cardiology program. Tied for the most heavily weighted category was “Diversity/Ability to Enhance Cultural Competency”. These type of criteria should be used for general surgery residency/fellowship applicants and faculty recruitment and promotion. It is our responsibility to educate our colleagues and enact these criteria within our programs.
As noted above, I’m no expert in this area. I’m only at the beginning of my journey. I’m certain there are many more areas for intervention. However, today marks the beginning of my goal of becoming an ally and anti-racist. It seems like as future leaders in academic surgery, we shouldn’t rely on our learners to teach themselves about these issues. Allyship and anti-racism shouldn’t be learned passively over years of observation and through life experiences. It should be thoughtfully and intentionally taught at all levels of education. The Association for Academic Surgery has taken a strong stance against racial discrimination and toward promoting anti-racism and racial equity. As surgical educators, we owe it to our patients, our learners, and our colleagues to study and implement interventions in medical school and residency curricula and in recruitment. I’m confident we can lead this effort and be a model for programs throughout the country.
Patrick Underwood
Latest posts by Patrick Underwood (see all)
- Rethinking Residency Interviews - September 17, 2021
- My Journey with Privilege - July 21, 2020