Racism in residency programs.

[Truthbetold123]

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Why is racism tolerated in some or not all of residency programs in this country? I have heard of stories where a resident is either terminated or extended just because an attending is racist. Why is this tolerated in any residency?

 

[anonperson]

Why is racism tolerated in some or not all of residency programs in this country? I have heard of stories where a resident is either terminated or extended just because an attending is racist. Why is this tolerated in any residency?

You made a new account just to post this?

 

[HemeOncHopeful19]

You made a new account just to post this?

YOU might be the racist now just by questioning them!

 

[Dral]

Why is racism tolerated in some or not all of residency programs in this country?

Does this mean "some or many?" Or does it mean "some or even all of them?"

It's unclear to me. I hope it's not the latter because that's a poor assumption.

 

[IonClaws]

Why is racism tolerated in some or not all of residency programs in this country? I have heard of stories where a resident is either terminated or extended just because an attending is racist. Why is this tolerated in any residency?

Two reasons.
1. Residency evaluation, like most jobs, can be very subjective, and it is very easy to hide racial bias behind vague clinical critique (doesn't synthesize clinical information well, poor interpersonal skills, etc.).

2. The culture in medicine is very conservative and change is often resisted. Old attendings (and institutions) are usually stuck in their ways and don't have insight into their own biases.

 

[Goro]

Why is racism tolerated in some or not all of residency programs in this country? I have heard of stories where a resident is either terminated or extended just because an attending is racist. Why is this tolerated in any residency?

Always remember that there are two sides to every story.

 

[EthylMethylMan]

Where exactly is this happening? Medical education in general is quite progressive, so I'm surprised this is the first I'm hearing of this.

 

[GoSpursGo]

Always remember that there are two sides to every story.

This was my initial reaction, TBH. However, on the same day that the OP posted this, the following article was circulated by a very well-respected Black faculty member at my institution:

‘It was stolen from me’: Black doctors are forced out of training programs at far higher rates than white residents

A STAT investigation found that Black residents leave or are terminated from training programs at far higher rates than white residents.

www.statnews.com

No, I've never heard of statnews either, but they cite some solid peer-reviewed publications. It's difficult to come away any conclusion other than graduate medical education, on the national level, does have a race problem. Of course nobody ever thinks it is a problem at their own institution, but I think this is something we need to be cognizant of and vigilant to ensure that we are, in fact, affording the same opportunities to all trainees. Being aware there is a problem in the first place and acknowledging that it exists is the first step to fixing the problem. And we all should strive to do better.

 

[Redpancreas]

Why is racism tolerated in some or not all of residency programs in this country? I have heard of stories where a resident is either terminated or extended just because an attending is racist. Why is this tolerated in any residency?

It seems like it exists if those numbers are saying that. I read the same article today as @GoSpursGo and I think it’s pretty easy to see how someone can get away with such a thing. Evaluations can be exaggerated, quite subjective, and there are so many toxic/judgmental people in medicine who would rather spend their time documenting that than teaching.

 

[WishYouLuck]

It is against the law to fire someone simply because of anyone’s race. It is not tolerated. Your question makes a very strong assumption based on the “stories” heard. I have worked and lived in the US as an immigrant for 20+ years and I can say with very high confidence that racism is not tolerated here. The stories you might have heard may be coming from people who got fired due to incompetency or poor attitude. Of course, such people are going to blame racism since it is an easy excuse. Not saying that racism does not exist—it exist in every country, but racism/castism are 100x greater in other countries such as India as compared to US.

 

[wholeheartedly]

It is against the law to fire someone simply because of anyone’s race. It is not tolerated. Your question makes a very strong assumption based on the “stories” heard. I have worked and lived in the US as an immigrant for 20+ years and I can say with very high confidence that racism is not tolerated here. The stories you might have heard may be coming from people who got fired due to incompetency or poor attitude. Of course, such people are going to blame racism since it is an easy excuse. Not saying that racism does not exist—it exist in every country, but racism/castism are 100x greater in other countries such as India as compared to US.

Your experiences are your own and you can’t generalize them to the entire rest of the country. Just because you haven’t seen or experienced something doesn’t mean it doesn’t exist.

I’m a blond haired blue eyed white woman and I have witnessed a decent amount of overt racism first hand..

 

[wholeheartedly]

I should note this includes the hospital setting.

 

[anonperson]

This was my initial reaction, TBH. However, on the same day that the OP posted this, the following article was circulated by a very well-respected Black faculty member at my institution:

‘It was stolen from me’: Black doctors are forced out of training programs at far higher rates than white residents

A STAT investigation found that Black residents leave or are terminated from training programs at far higher rates than white residents.

www.statnews.com

No, I've never heard of statnews either, but they cite some solid peer-reviewed publications. It's difficult to come away any conclusion other than graduate medical education, on the national level, does have a race problem. Of course nobody ever thinks it is a problem at their own institution, but I think this is something we need to be cognizant of and vigilant to ensure that we are, in fact, affording the same opportunities to all trainees. Being aware there is a problem in the first place and acknowledging that it exists is the first step to fixing the problem. And we all should strive to do better.

Can there be racism in medical training, sure but as a whole, medicine nowadays is relatively straightforward and is probably more fair than other jobs in my opinion. There are a fair amount of minorities in leadership positions in the medical field. The problem some people have is that the minorities are typically East/South Asian and not other minorities so they discount that.

There is nepotism and favoritism but I see that in other professions/industries as well.

There are too many variables though. Each residency program is its own personal fiefdom. One specialty culture can vary greatly versus another even in the same institution

For the physician in the article, it is a bit one sided. How were her in service scores? Was she as good as she thinks she was in the OR? Did she have enough self awareness to know her deficiencies? She may have been a great intern/junior resident, but did she make the leap to being a good upper level resident?

Who knows?

ENT residencies are typically on the smaller side. Plus it isn't exactly an easy process to fire a resident. There is a fairly lengthy process of documentation and steps that need to be taken. Could the new PD have been a flaming racist and gone through this long process and open the institution to lawsuit because they didn't want to have a Black resident? Sure. Could the physician in the article not really have been that good at her job. Also possible. I will be interested to see how the case turns out.

Attrition is an unfortunate part of all medical training. Even more so in a procedural/surgical specialty because there is the clinical knowledge, but can you also perform the technical aspects of the job? I could know all of the indications to do a hysterectomy, but if I constantly tag a ureter, I'm not really adept at my job.

Not every medical student/resident is going to make it. The vast majority do, but just like in sports, sometimes your first round draft pick flames out. Maybe the physician in the article would have succeeded in a more supportive residency program...

The article also points out that Black students are supposedly held out of lucrative specialties like dermatology and plastics. Kind of a ridiculous assertion without more data.

Derm is notorious for using high step 1 scores as a hard cut off. As far as I am aware, there is evidence of MCAT scores being predictive of success on USMLE Step 1. The AAMC publishes applicant/matriculant data by race. This isn't meant to be inflammatory but one can easily see the average MCAT scores/GPAs of Asians/Blacks/Whites and see the difference. It's pretty obvious. It would make sense that this would translate on Step 1 for most students.

I would have loved to do derm for the lifestyle/pay, but it wasn't going to happen with my scores.

 

[Browns99]

everywhere else in society.

I do not believe that racism is "tolerated" everywhere is society. Is there racism in this country, yes, is it as widespread and prevalent as some make it out to be, no. Anyway, I hope that we can eradicate racism, especially in medicine.

Your experiences are your own and you can’t generalize them to the entire rest of the country. Just because you haven’t seen or experienced something doesn’t mean it doesn’t exist.

I’m a blond haired blue eyed white woman and I have witnessed a decent amount of overt racism first hand..

Not trying to be smart, but couldn't the same thing be said the other way in that some are generalizing the rest of the country as being racists....Also, In all of the "decent amount of overt racism" that you saw firsthand, what did you do about it?

 

[mvenus929]

It is against the law to fire someone simply because of anyone’s race. It is not tolerated. Your question makes a very strong assumption based on the “stories” heard. I have worked and lived in the US as an immigrant for 20+ years and I can say with very high confidence that racism is not tolerated here. The stories you might have heard may be coming from people who got fired due to incompetency or poor attitude. Of course, such people are going to blame racism since it is an easy excuse. Not saying that racism does not exist—it exist in every country, but racism/castism are 100x greater in other countries such as India as compared to US.

Yes, it is against the law to discriminate on the basis of race. But No one here is suggesting that people are being overly racist (though some people are). In my residency program, we had one service who failed 2 people in 2 years, and didn't fail the person that actually was struggling and making questionable decisions. The two people who failed were both Black women, and the one who was not was white. Other Black residents had rotated and were not failed. I would've trusted one of the ones who was failed with my life--she was definitely not incompetent--and she was the happiest resident in our program, so it wasn't an attitude problem either. But on subjective evaluations, it's hard to determine if something is there based on implicit (or explicit) bias vs true incompetency, especially as someone who is not directly observing the behaviors of the resident in question.

Black men tend to be seen as more aggressive when they argue, whereas a white man in the same situation may be considered to be standing up for his patient, and a woman just considered 'hard to work with'. Patients may report 'feeling threatened' by a Black man more often than a white man or a woman.

Should any of this be happening? No. But it definitely does. Just because it happens worse somewhere else doesn't mean that it doesn't happen here.

 

[wholeheartedly]

I do not believe that racism is "tolerated" everywhere is society. Is there racism in this country, yes, is it as widespread and prevalent as some make it out to be, no. Unfortunately I believe that our president has failed to really unit this country as I believed he would pre-election. Anyway, I hope that we can eradicate racism, especially in medicine.

Not trying to be smart, but couldn't the same thing be said the other way in that some are generalizing the rest of the country as being racists....Also, In all of the "decent amount of overt racism" that you saw firsthand, what did you do about it?

not really. that doesn’t make sense.

What I did depended on the situation. When someone drove by and screamed racial slurs at a friend, i didn’t know what to do. When someone i know says something, i’ve often said something, either called them out or done some education. some times i reported it. some times i did nothing.

 

[Browns99]

You acknowledge that at least some racism exists in our country, does it not then follow that it is tolerated by at least some people?

Yes, I just don't believe it is as widespread as some believe it to be.

 

[Browns99]

not really. that doesn’t make sense.

What I did depended on the situation. When someone drove by and screamed racial slurs at a friend, i didn’t know what to do. When someone i know says something, i’ve often said something, either called them out or done some education. some times i reported it. some times i did nothing.

Not really what and what does not make sense?

 

[Truthbetold123]

You made a new account just to post this?

what new account? this is my one and only account? and you think you know me? You must be YODA?

 

[Truthbetold123]

Does this mean "some or many?" Or does it mean "some or even all of them?"

It's unclear to me. I hope it's not the latter because that's a poor assumption.

Well, Maybe some or many or maybe less than 50% or less than 30%. We dont know.

 

[Truthbetold123]

Two reasons.
1. Residency evaluation, like most jobs, can be very subjective, and it is very easy to hide racial bias behind vague clinical critique (doesn't synthesize clinical information well, poor interpersonal skills, etc.).

2. The culture in medicine is very conservative and change is often resisted. Old attendings (and institutions) are usually stuck in their ways and don't have insight into their own biases.

OMG. You got it. My point. Evals are very subjective and one can easily hide bias or racism. Even nursing staff trust white residents more than colored or brown colored residents.

 

[Truthbetold123]

Always remember that there are two sides to every story.

Agreed. but the other lowly side resident will never be heard. Because why? Attendings can make up **** and other attendings will believe the damn story.

 

[Truthbetold123]

Where exactly is this happening? Medical education in general is quite progressive, so I'm surprised this is the first I'm hearing of this.

wait. you never heard of racism ever? its all over the news?

 

[Truthbetold123]

This was my initial reaction, TBH. However, on the same day that the OP posted this, the following article was circulated by a very well-respected Black faculty member at my institution:

‘It was stolen from me’: Black doctors are forced out of training programs at far higher rates than white residents

A STAT investigation found that Black residents leave or are terminated from training programs at far higher rates than white residents.

www.statnews.com

No, I've never heard of statnews either, but they cite some solid peer-reviewed publications. It's difficult to come away any conclusion other than graduate medical education, on the national level, does have a race problem. Of course nobody ever thinks it is a problem at their own institution, but I think this is something we need to be cognizant of and vigilant to ensure that we are, in fact, affording the same opportunities to all trainees. Being aware there is a problem in the first place and acknowledging that it exists is the first step to fixing the problem. And we all should strive to do better.

Well in my opinion and well what I have noticed you can easily be put on probation, or even kicked out if you are not white or the preferred race by faculty. Faculty can extend you without reason, and state BS reasons.

 

[Truthbetold123]

Yeah, while I'm not sure that student doctor network dot com is the place we will get to the bottom of the issue, the outright dismissal from some posters above that there's even a possibility that at least the same systemic racism that pervades the rest of society also pervades our workplace, or that attendings, nurses, patients, etc. who are willing to bully residents over plenty of other things just kindly avoid bullying them related to race is...troubling

I have seen nurses treat residents like they are lying and dont know what they are doing because they prefer the white resident to make the decision on managing a patient.

 

[Truthbetold123]

It is against the law to fire someone simply because of anyone’s race. It is not tolerated. Your question makes a very strong assumption based on the “stories” heard. I have worked and lived in the US as an immigrant for 20+ years and I can say with very high confidence that racism is not tolerated here. The stories you might have heard may be coming from people who got fired due to incompetency or poor attitude. Of course, such people are going to blame racism since it is an easy excuse. Not saying that racism does not exist—it exist in every country, but racism/castism are 100x greater in other countries such as India as compared to US.

You must be thinking the law is followed to the T? People can make up ****. Faculty can make up ****, and who will admin believe the resident who is brown or black? You must be lucky to live in a liberal state, but not all liberal states are all liberal. NY was suppose to be liberal but wait wasnt the news all about a NYS native driving to a NYS city and shoot people cause of their race or color.

 

[Truthbetold123]

Yes, it is against the law to discriminate on the basis of race. But No one here is suggesting that people are being overly racist (though some people are). In my residency program, we had one service who failed 2 people in 2 years, and didn't fail the person that actually was struggling and making questionable decisions. The two people who failed were both Black women, and the one who was not was white. Other Black residents had rotated and were not failed. I would've trusted one of the ones who was failed with my life--she was definitely not incompetent--and she was the happiest resident in our program, so it wasn't an attitude problem either. But on subjective evaluations, it's hard to determine if something is there based on implicit (or explicit) bias vs true incompetency, especially as someone who is not directly observing the behaviors of the resident in question.

Black men tend to be seen as more aggressive when they argue, whereas a white man in the same situation may be considered to be standing up for his patient, and a woman just considered 'hard to work with'. Patients may report 'feeling threatened' by a Black man more often than a white man or a woman.

Should any of this be happening? No. But it definitely does. Just because it happens worse somewhere else doesn't mean that it doesn't happen here.

Agree with what you are saying. 100%.

 

[Truthbetold123]

Yes, I just don't believe it is as widespread as some believe it to be.

good sir. while I will try to agree to disagree with what you are saying. Racism is very wide spread. Did you hear the news where a white guy who lives in a fairly liberal state go and drive somewhere just to shoot people. Well, after 1 week in the news or even less story disappeared. If it was a colored individual the news would have lasted 1 month or 1 year.

 

[GoSpursGo]

Well in my opinion and well what I have noticed you can easily be put on probation, or even kicked out if you are not white or the preferred race by faculty. Faculty can extend you without reason, and state BS reasons.

I'm not sure that I agree it is as simple as overt racism where faculty outright decides to get rid of a trainee solely based on their race. However, I do believe that implicit biases may exist and result in some faculty members giving the benefit of the doubt to trainees of a certain race/ethnicity while being overly critical of trainees of racial/ethnic minorities.

Bottom line, while I can respect the opinion that racisim may not be as widespread as it once was as stated by some members here, I also think we should all do our best to further eliminate racism and implicity biases from medical training. Acknowledging that there is still work to be done is a bare minimum first step that I think all of us should be willing to take.

 

[Truthbetold123]

I'm not sure that I agree it is as simple as overt racism where faculty outright decides to get rid of a trainee solely based on their race. However, I do believe that implicit biases may exist and result in some faculty members giving the benefit of the doubt to trainees of a certain race/ethnicity while being overly critical of trainees of racial/ethnic minorities.

Bottom line, while I can respect the opinion that racisim may not be as widespread as it once was as stated by some members here, I also think we should all do our best to further eliminate racism and implicity biases from medical training. Acknowledging that there is still work to be done is a bare minimum first step that I think all of us should be willing to take.

I am just confused. isnt biases towards giving benefit of the doubt to trainees of a certain race or ethnicity equates to racism?? unequal treatment basing on RACE or ethnicity is RACISM. Didn't you just described racism on your first statement?

Racism meaning: unfair treatment of people of a particular race in a society especially to the benefit of people of another race.

So does having biases that results to giving the benefit of the doubt to other trainees of a certain race = RACISM?

On your first statement, you do. not agree because you have not heard of it? or it is spoken as taboo in the "Doctor" circle? Just because it is not spoken about because it is a "secret" or overt topic doesnt mean it does not exist.

 

[anonperson]

good sir. while I will try to agree to disagree with what you are saying. Racism is very wide spread. Did you hear the news where a white guy who lives in a fairly liberal state go and drive somewhere just to shoot people. Well, after 1 week in the news or even less story disappeared. If it was a colored individual the news would have lasted 1 month or 1 year.

No it wouldn't. It's just not interesting anymore. Why would it continue to be covered?

The Las Vegas shooter a few years back was a white guy and that was in the news for a long period of time.

 

[guytakingboards]

I am just confused. isnt biases towards giving benefit of the doubt to trainees of a certain race or ethnicity equates to racism?? unequal treatment basing on RACE or ethnicity is RACISM. Didn't you just described racism on your first statement?

Racism meaning: unfair treatment of people of a particular race in a society especially to the benefit of people of another race.

So does having biases that results to giving the benefit of the doubt to other trainees of a certain race = RACISM?

On your first statement, you do. not agree because you have not heard of it? or it is spoken as taboo in the "Doctor" circle? Just because it is not spoken about because it is a "secret" or overt topic doesnt mean it does not exist.

There's a lot of nuance to the concepts being discussed in this thread. It does no good to yell "THAT'S RACIST" every time someone isn't given the benefit of the doubt.

As a society, overt racism has really been stamped out of mainstream culture. If you get tagged as a racist these days, that's a speedy ticket to termination and other punitive repercussions.

Honestly, overt racism was low-hanging fruit compared to implicit bias. There's a ton of reasons why people of different cultures/backgrounds have awkward/sub-optimal interactions. Doesn't make them all racist. A white person getting suboptimal service at a Chinese restaurant is not racism. A black person feeling uncomfortable at Orange Theory.... also not racism. (kidding)

In my eyes, "racism" implies intentional undertones. "Implicit bias" is an awareness/educational problem.

 

[GoSpursGo]

I am just confused. isnt biases towards giving benefit of the doubt to trainees of a certain race or ethnicity equates to racism?? unequal treatment basing on RACE or ethnicity is RACISM. Didn't you just described racism on your first statement?

Racism meaning: unfair treatment of people of a particular race in a society especially to the benefit of people of another race.

So does having biases that results to giving the benefit of the doubt to other trainees of a certain race = RACISM?

On your first statement, you do. not agree because you have not heard of it? or it is spoken as taboo in the "Doctor" circle? Just because it is not spoken about because it is a "secret" or overt topic doesnt mean it does not exist.

I'm not sure why you're yelling at me when I'm fundamentally agreeing with most of what you're saying...

Implicit biases are racist. But you were not describing implicit biases, you were describing overt racisms, ie "I don't like your skin color so I'm going to invent a reason to end your career." I think very little of the overt racism actually occurs. Implicit biases are much more common, and more difficult to identify. I do think we need to do a better job to recognize our implicit biases and not allow them to lead to unfair treatment of trainees.

 

[guytakingboards]

Two reasons.
1. Residency evaluation, like most jobs, can be very subjective, and it is very easy to hide racial bias behind vague clinical critique (doesn't synthesize clinical information well, poor interpersonal skills, etc.).

2. The culture in medicine is very conservative and change is often resisted. Old attendings (and institutions) are usually stuck in their ways and don't have insight into their own biases.

Re: your 2nd point. Problems with implicit bias pervade most large, conservative institutions. There's plenty of examples in big law, politics, government, etc...

What gets me about this entire thread is how racism is specifically a healthcare problem. If anything I think healthcare is probably more on the progressive side of the spectrum relative to general society. If the OP is complaining about the idea of racism existing at all in medicine, I think that's naive to expect that implicit bias can completely be eliminated. If the OP is venting about something personal/in particular, I'd say: I'm sorry whatever happened happened. It sucks and maybe or may not have occured because of racism. Randomly complaining about the concept of racism in healthcare on an anonymous forum board ain't fixing anything.

 

[Apollyon]

I'm just a little amazed at 10 responses in a row by one person.

 

[Browns99]

good sir. while I will try to agree to disagree with what you are saying. Racism is very wide spread. Did you hear the news where a white guy who lives in a fairly liberal state go and drive somewhere just to shoot people. Well, after 1 week in the news or even less story disappeared. If it was a colored individual the news would have lasted 1 month or 1 year.

I assume you are not being serious, because if so, you sound very misinformed. One, racism it is not "very widespread" and 2, "whites" have been the topic of discussion for the last two years and not being cast in a positive light by the media, politicians , corporations, etc. Also, if the mainstream media had a story involving a white person driving around to shoot someone, trust me, it would have made headlines and stayed there.

 

[hallowmann]

This was my initial reaction, TBH. However, on the same day that the OP posted this, the following article was circulated by a very well-respected Black faculty member at my institution:

‘It was stolen from me’: Black doctors are forced out of training programs at far higher rates than white residents

A STAT investigation found that Black residents leave or are terminated from training programs at far higher rates than white residents.

www.statnews.com

No, I've never heard of statnews either, but they cite some solid peer-reviewed publications. It's difficult to come away any conclusion other than graduate medical education, on the national level, does have a race problem. Of course nobody ever thinks it is a problem at their own institution, but I think this is something we need to be cognizant of and vigilant to ensure that we are, in fact, affording the same opportunities to all trainees. Being aware there is a problem in the first place and acknowledging that it exists is the first step to fixing the problem. And we all should strive to do better.

I can say that I have absolutely both experienced and witnessed overt racism and implicit biases in the medical education system in at least 3 states (basically all that I have interacted with - including red and blue states in the northeast and midwest in case anyone wants to say "not I"). I have seen attendings completely rail against people of different religions and ethnic groups. I have watched some residents clearly get preferential treatment and the benefit of the doubt because of their skin tone and sex. I have seen even well-meaning attendings make obviously racist comments because it's so normalized to them that they have no concept of how racist the statements actually are.

This is excluding all the racism exhibited by patients on an almost daily basis (I'm sick of hearing that nurses have to reassure patients that I don't have an accent before meeting me, I'm sick of having other patients assume I was born out of the country and must be an immigrant based solely on my name even after they've met and asked "where are you from", I'm sick of patients railing against Mexicans seemingly out of nowhere, I'm sick of hearing from the black med students who get followed and stopped by security when they are on their way to a new rotation, I'm sick of having to excuse myself from a patient room when a patient calls people from my parent's country of origin savages, I'm sick of all of it).

I agree that generally, people in medicine are well meaning, typically exposed to more cultures, and generally better educated which often results in them being less likely to engage in overt racism (at least while sober). It is a huge part of this country, not to say it isn't in every country to varying degrees. We have plenty of work to do.

 

[GoSpursGo]

I can say that I have absolutely both experienced and witnessed overt racism and implicit biases in the medical education system in at least 3 states (basically all that I have interacted with - including red and blue states in the northeast and midwest in case anyone wants to say "not I"). I have seen attendings completely rail against people of different religions and ethnic groups. I have watched some residents clearly get preferential treatment and the benefit of the doubt because of their skin tone and sex. I have seen even well-meaning attendings make obviously racist comments because it's so normalized to them that they have no concept of how racist the statements actually are.

This is excluding all the racism exhibited by patients on an almost daily basis (I'm sick of hearing that nurses have to reassure patients that I don't have an accent before meeting me, I'm sick of having other patients assume I was born out of the country and must be an immigrant based solely on my name even after they've met and asked "where are you from", I'm sick of patients railing against Mexicans seemingly out of nowhere, I'm sick of hearing from the black med students who get followed and stopped by security when they are on their way to a new rotation, I'm sick of having to excuse myself from a patient room when a patient calls people from my parent's country of origin savages, I'm sick of all of it).

I agree that generally, people in medicine are well meaning, typically exposed to more cultures, and generally better educated which often results in them being less likely to engage in overt racism (at least while sober). It is a huge part of this country, not to say it isn't in every country to varying degrees. We have plenty of work to do.

I also kind of think this whole distinction of implicit bias vs overt racism (which means different things to different people) probably is distracting by dividing people who fundamentally agree that there is work to be done.

 

[Goro]

I'm just a little amazed at 10 responses in a row by one person.

Some SDNers don't know how to use the quote function.

OP, did you get kicked out of a program?

 

[gutonc]

I am just confused. isnt biases towards giving benefit of the doubt to trainees of a certain race or ethnicity equates to racism?? unequal treatment basing on RACE or ethnicity is RACISM. Didn't you just described racism on your first statement?

Racism meaning: unfair treatment of people of a particular race in a society especially to the benefit of people of another race.

So does having biases that results to giving the benefit of the doubt to other trainees of a certain race = RACISM?

On your first statement, you do. not agree because you have not heard of it? or it is spoken as taboo in the "Doctor" circle? Just because it is not spoken about because it is a "secret" or overt topic doesnt mean it does not exist.

If you're here for a debate/discussion, welcome. If you're here for a fight, please go elsewhere (I hear Reddit's nice this time of year).

I'm not sure why you chose a person agreeing with you to argue most vehemently with, but, this discussion would gain a lot from some pertinent examples rather than continued polemics on your part.

 

[guytakingboards]

I can say that I have absolutely both experienced and witnessed overt racism and implicit biases in the medical education system in at least 3 states (basically all that I have interacted with - including red and blue states in the northeast and midwest in case anyone wants to say "not I"). I have seen attendings completely rail against people of different religions and ethnic groups. I have watched some residents clearly get preferential treatment and the benefit of the doubt because of their skin tone and sex. I have seen even well-meaning attendings make obviously racist comments because it's so normalized to them that they have no concept of how racist the statements actually are.

This is excluding all the racism exhibited by patients on an almost daily basis (I'm sick of hearing that nurses have to reassure patients that I don't have an accent before meeting me, I'm sick of having other patients assume I was born out of the country and must be an immigrant based solely on my name even after they've met and asked "where are you from", I'm sick of patients railing against Mexicans seemingly out of nowhere, I'm sick of hearing from the black med students who get followed and stopped by security when they are on their way to a new rotation, I'm sick of having to excuse myself from a patient room when a patient calls people from my parent's country of origin savages, I'm sick of all of it).

I agree that generally, people in medicine are well meaning, typically exposed to more cultures, and generally better educated which often results in them being less likely to engage in overt racism (at least while sober). It is a huge part of this country, not to say it isn't in every country to varying degrees. We have plenty of work to do.

Sorry that you've dealt with all of those things. Those examples are likely familiar to anyone who's not a white American with a generic American name.

When people talk about racism, I think scope and context makes a huge difference. As I've said above, a lot of those problems are more so societal problems. We live in an imperfect culture and work on getting better every day. As for scope, tackle the problems you can possibly fix. You're unlikely to fix the attitudes of your patients or the security guards working at the door. There's a chance implicit bias training works for your attendings, maybe not.

A ton of stuff will be (re)solved at the generational level. Back in the 70's the overwhelming majority of practicing physicians were white men. When I went through medical school 15 years ago, that generation was the full professors and senior associate professors. The assistant professors were overwhelming diverse with a heavy emphasis on FMG's at the particular place I trained. 15 years later, those assistants professors are now associate/full professors and 15 years worth of conservative white men have retired. (This is not me knocking white people, more observation than commentary). Time will affect as much change as anything.

 

[VA Hopeful Dr]

I also kind of think this whole distinction of implicit bias vs overt racism (which means different things to different people) probably is distracting by dividing people who fundamentally agree that there is work to be done.

This is worth paying particular attention to. I think the vast majority of physicians aren't racist and, speaking for myself, when someone claims that medicine has a huge problem with race it does get my back up because the connotation to being racist is very negative and implies active effort to be so.

If, on the other hand, you have articles like what you posted and the discussion heads to the types of implicit biases that have been mentioned its an area that can be worked on without implying that anyone is a bad person.

 

[operaman]

So with respect to the dismissed ENT resident, as someone with a few close personal contacts in that program, racism had nothing to do with her getting canned. Like Eugene Gu before her and countless others, she appears to be playing the race card and leveraging a situation where the program can’t speak publicly to counter her narrative. If there are ever depositions in the public record, I have no doubt that most people will agree the appropriate decisions were made.

If we define racism in the Gen Z way of “anything I don’t like” or the similar “anything with disparate outcomes,” then it’s probably widespread. But thankfully most thoughtful intelligent people are more nuanced than that. I’d love to see some rigorous study on this. Most things quoted in the article were the typical “black people do worse at X so therefore racism” rubbish.

My suspicion is that implicit bias is far more problematic than overt racism. Coming back to the canned ENT resident, was it facing implicit bias that turned her into a resident that had to be fired? Would she have made it to graduation if only she had matched to a different program? Was it the environment that led to her behaviors that got her canned, or would she have responded to training that way regardless?

The article seems to argue that her academic pedigree rules out any chance that her competence was the issue, but that simply isn’t true. I’m thinking of other non-black residents I’ve seen get fired and they also seemed to have solid pedigree: Stanford, Duke, etc.

There are some people who are simply incapable of functioning well in a high stress fast paced training environment. Their poor coping strategies tend to be what ultimately get them canned, not their faculty burning crossed in the doctors lounge.

 

[hallowmann]

Sorry that you've dealt with all of those things. Those examples are likely familiar to anyone who's not a white American with a generic American name.

When people talk about racism, I think scope and context makes a huge difference. As I've said above, a lot of those problems are more so societal problems. We live in an imperfect culture and work on getting better every day. As for scope, tackle the problems you can possibly fix. You're unlikely to fix the attitudes of your patients or the security guards working at the door. There's a chance implicit bias training works for your attendings, maybe not.

A ton of stuff will be (re)solved at the generational level. Back in the 70's the overwhelming majority of practicing physicians were white men. When I went through medical school 15 years ago, that generation was the full professors and senior associate professors. The assistant professors were overwhelming diverse with a heavy emphasis on FMG's at the particular place I trained. 15 years later, those assistants professors are now associate professors and 15 years worth of conservative white men have retired. (This is not me knocking white people, more observation than commentary). Time will affect as much change as anything.

So I am not young, have worked in multiple different industries, and as you said, this is not unique, I've lived with this all my life. Over very long periods of time, it seems things improve, but honestly I've only seen and experienced people get more bold and brazen with racism over the last 8 yrs. People get more openly mad about it sure, but I've also seen a lot more hate and anger than I had before. It's hard to feel like things will move in a positive direction anytime soon in the face of that.

 

[NotAProgDirector]

This is an important discussion to have. Lots of emotion on all sides makes it difficult to look at data, come to our best conclusions, and try to address any issues found without labeling people as "racist" which only amps up the conversation and is unhelpful (and mostly untrue).

Certainly, there are overtly racist people in medicine. But I do hope that they are a very small minority. Is it possible that some programs / geographies have a higher prevalence? Of course. But I doubt this is the primary issue overall.

The interesting discussion here is around difference of outcomes. If we take the ACGME data at face value (there is no way to confirm it, I think it's unlikely that they have massaged it to fit a preferred narrative, and a selection bias is very unlikely as the ACGME collects data on all residents in training), we see that Black residents make up 5% of all residents but make up 20% of all residents dismissed from training. These numbers are in the article but it's all linked to primary data. The data vary by specialty but a larger proportion of Black residents are dismissed from training across all specialties. The data looks solid, I have no reason to think it's not accurate.

The question is why there is this difference. The data only show us the issue, not the reason. Hopefully, we all start with agreement that the answer isn't that minority residents are somehow "worse" than white residents. If we can't agree on that, then any further discussion becomes difficult.

The primary other explanation is "systemic racism". This is a term that often evokes high emotional responses, because it's misunderstood. It's not "everyone is racist". It's that the system / culture we live in has ingrained issues / problems / rules / laws / traditions that impact minorities in a negative way. This includes:

Implicit bias - all of us have implicit biases. I don't like carrot cake. When I go to a celebration and discover that dessert is carrot cake, I get really grumpy. Afterwards if I'm asked how good the party was, I'm likely to give it a lower score. Perhaps a silly example, but we all do this. In Med Ed, the danger is that I may grade a student lower based upon some physical characteristic rather than on their performance -- even if I don't want to. A personal example is students with names I find difficult to pronounce. They tell me their name, it's something I'm not familiar with. In general, I'm not good with names so I find this particularly challenging. The next day, perhaps I can't rmember quite how to pronounce it correctly. So instead, I avoid using their name. There's another student named Steve and I use his name all the time. We work together for a week, and then I need to grade them. Studies show that, on average, I'm likely to grade the student with the name I find difficult to pronounce lower. This is all subconscious -- I'm not punishing them for having their name. It's that I'll think back on our week together and might feel less connected to them. We tend to like people more who are more similar to us, and then this tends to be reflected in subjective assessments. It's insidious and very difficult to account for.

Culture - if the culture of a workplace makes people feel like outsiders / undervalued, that can worsen their performance. In the example above, I could imagine that the student whom I don't use their name will see that, feel less valued than Steve. Their enthusiasm may suffer -- and then that's something that could affect their grade. Perhaps you think they should just power through and ignore this -- but if it's widespread and frequent, that's very difficult to do.

Co-factors / confounders - minority students often come from less affluent backgrounds. This can affect them in many ways -- perhaps they live farther away from the hospital to save money. That would mean a longer commute, which means less sleep / study / personal time. They may get pulled over by the police more frequently while commuting. They may have more trouble affording food and other necessities. They may have less external supports such that when something "goes wrong" in their personal / family life, they can't just have someone else address it and maintain their focus on work. And already mentioned are statements from patients that are interpreted as hurtful -- female residents being assumed to be the nurse, minority residents being told to go get the "real doctor", etc.

The bottom line here is that systemic issues (rather than overtly racist people) may make succeeding as a minority more difficult. Each systemic issue by itself may be relatively small, but they add up over time. And its very clear that once a resident starts to struggle, performance problems tend to mount. When a resident is struggling, programs need to apply more scrutiny to their work. This tends to find more errors, some/many of which they (and others) would have self corrected. This leads to more remediation and more scrutiny. This can create a positive feedback cycle, residents caught in it can become depressed which results in even worse performance, all leading to ultimate termination.

And that's the question raised by the data we see in Med Ed. Do we have an environment that increases the chances that minority residents fail? If so, what parts of that environment can we change to mitigate the issue? The main life lesson that my father repeated to me is that "Life isn't fair". And he's right -- there's no way we can make the world a completely fair place. But we can try to make it as fair as possible, especially the parts we have under our control.

We should definitely not get caught up in individual cases. I know nothing about this resident, her skills, the culture of the program she was in. It's quite possible that she was terminated because her performance was poor and it had nothing to do with her race. She might have been overly outspoken about injustices or had other interpersonal conflicts. She may have been great as an early PGY resident, and then run into performance issues as her responsibilities increased. Or, when her PD left she may have been subject to all of those issues listed above which impaired her ability to perform. I have no idea. But, no matter her story, this doesn't explain the differences we see in termination rates. That does seem to be a problem we should investigate and address.

 

[operaman]

This is an important discussion to have. Lots of emotion on all sides makes it difficult to look at data, come to our best conclusions, and try to address any issues found without labeling people as "racist" which only amps up the conversation and is unhelpful (and mostly untrue).

Certainly, there are overtly racist people in medicine. But I do hope that they are a very small minority. Is it possible that some programs / geographies have a higher prevalence? Of course. But I doubt this is the primary issue overall.

The interesting discussion here is around difference of outcomes. If we take the ACGME data at face value (there is no way to confirm it, I think it's unlikely that they have massaged it to fit a preferred narrative, and a selection bias is very unlikely as the ACGME collects data on all residents in training), we see that Black residents make up 5% of all residents but make up 20% of all residents dismissed from training. These numbers are in the article but it's all linked to primary data. The data vary by specialty but a larger proportion of Black residents are dismissed from training across all specialties. The data looks solid, I have no reason to think it's not accurate.

The question is why there is this difference. The data only show us the issue, not the reason. Hopefully, we all start with agreement that the answer isn't that minority residents are somehow "worse" than white residents. If we can't agree on that, then any further discussion becomes difficult.

The primary other explanation is "systemic racism". This is a term that often evokes high emotional responses, because it's misunderstood. It's not "everyone is racist". It's that the system / culture we live in has ingrained issues / problems / rules / laws / traditions that impact minorities in a negative way. This includes:

Implicit bias - all of us have implicit biases. I don't like carrot cake. When I go to a celebration and discover that dessert is carrot cake, I get really grumpy. Afterwards if I'm asked how good the party was, I'm likely to give it a lower score. Perhaps a silly example, but we all do this. In Med Ed, the danger is that I may grade a student lower based upon some physical characteristic rather than on their performance -- even if I don't want to. A personal example is students with names I find difficult to pronounce. They tell me their name, it's something I'm not familiar with. In general, I'm not good with names so I find this particularly challenging. The next day, perhaps I can't rmember quite how to pronounce it correctly. So instead, I avoid using their name. There's another student named Steve and I use his name all the time. We work together for a week, and then I need to grade them. Studies show that, on average, I'm likely to grade the student with the name I find difficult to pronounce lower. This is all subconscious -- I'm not punishing them for having their name. It's that I'll think back on our week together and might feel less connected to them. We tend to like people more who are more similar to us, and then this tends to be reflected in subjective assessments. It's insidious and very difficult to account for.

Culture - if the culture of a workplace makes people feel like outsiders / undervalued, that can worsen their performance. In the example above, I could imagine that the student whom I don't use their name will see that, feel less valued than Steve. Their enthusiasm may suffer -- and then that's something that could affect their grade. Perhaps you think they should just power through and ignore this -- but if it's widespread and frequent, that's very difficult to do.

Co-factors / confounders - minority students often come from less affluent backgrounds. This can affect them in many ways -- perhaps they live farther away from the hospital to save money. That would mean a longer commute, which means less sleep / study / personal time. They may get pulled over by the police more frequently while commuting. They may have more trouble affording food and other necessities. They may have less external supports such that when something "goes wrong" in their personal / family life, they can't just have someone else address it and maintain their focus on work. And already mentioned are statements from patients that are interpreted as hurtful -- female residents being assumed to be the nurse, minority residents being told to go get the "real doctor", etc.

The bottom line here is that systemic issues (rather than overtly racist people) may make succeeding as a minority more difficult. Each systemic issue by itself may be relatively small, but they add up over time. And its very clear that once a resident starts to struggle, performance problems tend to mount. When a resident is struggling, programs need to apply more scrutiny to their work. This tends to find more errors, some/many of which they (and others) would have self corrected. This leads to more remediation and more scrutiny. This can create a positive feedback cycle, residents caught in it can become depressed which results in even worse performance, all leading to ultimate termination.

And that's the question raised by the data we see in Med Ed. Do we have an environment that increases the chances that minority residents fail? If so, what parts of that environment can we change to mitigate the issue? The main life lesson that my father repeated to me is that "Life isn't fair". And he's right -- there's no way we can make the world a completely fair place. But we can try to make it as fair as possible, especially the parts we have under our control.

We should definitely not get caught up in individual cases. I know nothing about this resident, her skills, the culture of the program she was in. It's quite possible that she was terminated because her performance was poor and it had nothing to do with her race. She might have been overly outspoken about injustices or had other interpersonal conflicts. She may have been great as an early PGY resident, and then run into performance issues as her responsibilities increased. Or, when her PD left she may have been subject to all of those issues listed above which impaired her ability to perform. I have no idea. But, no matter her story, this doesn't explain the differences we see in termination rates. That does seem to be a problem we should investigate and address.

Well put. I think you’re spot on.

It does seem that the increased scrutiny becomes a self fulfilling prophecy. I’ve seen this in troubled residents of all races, and sometimes I wonder how even the best residents would fare under intense scrutiny. If someone is already feeling marginalized and unsupported, it’s probably much worse.

It’s definitely a topic that needs some good research. So far we seem to just get the disparate numbers and everyone applies their preconceived notions to them. I suspect the truth is nuanced and multi factorial. Better data could also help us find feasible solutions.

Are the fired residents ones who had below average mcat and usmle scores? ITE scores? Does presence of a black faculty member increase or decrease chances of dismissing a black resident? If we compare white and black residents put on probation, are the rates of termination significantly different? Questions like those would be worth knowing and it seems like the data are out there to start chipping away at this.

 

[anonperson]

So if I'm understanding your argument correctly - as above we know that black residents are dismissed at a rate disproportionate to white residents. You're saying it's because black residents are just more likely to be bad at their jobs? Or am I misinterpreting your argument?

In the name of improving "diversity" medical schools routinely admit non Asian and White students with lower MCAT scores and GPA. This is pretty clearly illustrated with AAMC data. They publish this yearly.

These scores correlate with performance on USMLEs which then correlate pretty well with in service exams (this has been studied in OBGYN). Residents who do poorly on in service exams are generally weaker and probably more likely to be fired/ resign. I saw this in residency and fellowship.

So yes, if I filled a residency class with residents who had lower Step 1 scores, I wouldn't be surprised if they had a higher rate of attrition because of underperforming.

Why is this even remotely controversial? If I filled a bunch of residency classes with Asian residents who scored in the 30th percentile on the MCATs, I wouldn't be surprised if they similarly did poorly on their USMLEs and activities beyond.

I'm irritated that this doctor got fired from her residency and starts screaming racism and helps publish this article that is lacking basic common sense.

There are a lot of minorities in medicine who succeed and thrive. I'm one of them.

Shockingly, most of my mentors have been White people who took me under their wing and helped me out. I know this goes against the narrative out there.

 

[operaman]

In the name of improving "diversity" medical schools routinely admit non Asian and White students with lower MCAT scores and GPA. This is pretty clearly illustrated with AAMC data. They publish this yearly.

These scores correlate with performance on USMLEs which then correlate pretty well with in service exams (this has been studied in OBGYN). Residents who do poorly on in service exams are generally weaker and probably more likely to be fired/ resign. I saw this in residency and fellowship.

So yes, if I filled a residency class with residents who had lower Step 1 scores, I wouldn't be surprised if they had a higher rate of attrition because of underperforming.

Why is this even remotely controversial? If I filled a bunch of residency classes with Asian residents who scored in the 30th percentile on the MCATs, I wouldn't be surprised if they similarly did poorly on their USMLEs and activities beyond.

I'm irritated that this doctor got fired from her residency and starts screaming racism and helps publish this article that is lacking basic common sense.

There are a lot of minorities in medicine who succeed and thrive. I'm one of them.

Shockingly, most of my mentors have been White people who took me under their wing and helped me out. I know this goes against the narrative out there.

Agreed - I think there is a selection bias at play that probably explains some of the differences. Since the AAMC and acgme have access to most everyone’s scores, it would be pretty easy to study if the dismissed residents skewed heavily toward the lower end of scores and other objective measures. It should also be fairly simple to compare how influential prior scores are on attrition when compared across groups.

My suspicion is that knowledge deficits probably play more powerfully into our implicit biases as faculty when we see them in trainees who are different than us.

 

[wholeheartedly]

Isn’t it also true that medical school is getting more competitive with time? So people who would’ve been given acceptances 10 years ago and been successful might not even get in today?

So even if ppl have lower scores than the current numbers. it doesn’t necessarily mean they aren’t capable of being trained to be competent physicians. so I don’t think that’s it.

I think @NotAProgDirector nailed it.

 

[anonperson]

Isn’t it also true that medical school is getting more competitive with time? So people who would’ve been given acceptances 10 years ago and been successful might not even get in today?

So even if ppl have lower scores than the current numbers. it doesn’t necessarily mean they aren’t capable of being trained to be competent physicians. so I don’t think that’s it.

I think @NotAProgDirector nailed it.

Not necessarily.

If you are underperforming compared to your peers that can put you in the crosshairs.

In service exams (at least for OBGYN) are essentially graded on a curve.