Diversity, Equity, Equality, and Inclusion in Medical School

Session 401

Dr. Tade Ayeni is the Director of Diversity and Equity at Hackensack School of Medicine and we talk about diversity and equity, why medical schools are doing this, why it’s important to them, and how you can help!

For more podcast resources to help you along your journey to medical school and beyond, check out Meded Media.

Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[02:35] A Little Background About Dr. Tade Ayeni

Prior to working at Hackensack School of Medicine, Tade’s background is teaching at the collegiate and at the graduate level about diversity, equity, social justice, and all those related things.

His real specialty is how that looks when you actually put it into practice. Those are easy concepts to get but once you try to actually apply them, it’s super messy.

[04:07] Why Schools Have Diversity and Equity Offices (or Diversity and Inclusion)

Right after the civil rights movement, the number of black male doctors has not increased, with the same rate of black male doctors in 2020. That implies a huge deficit in terms of practice.

“Having more diversity within a field really strengthens that field. It creates a diversity of thought.”Click To Tweet

There are people who have doubts or questions about affirmative action, about why medical schools want to reach out to minorities and they think that’s not fair. But the data shows that when there’s more diversity of thought and when we have voices representing different parts of our country and our world, we have better outcomes.

[06:40] What Does This Mean for Middle-Class White Males?

“If you want to differentiate yourself in terms of diversity, you just start working towards that now.”Click To Tweet

What medical schools are simultaneously looking for is not only doctors from all these types of backgrounds. They’re also looking for white male doctors who may have never interacted with anything related to diversity but they “get it.” And they will still have a huge impact within any community that you actually work towards.

So if you’re not from one of these underrepresented backgrounds and you have that concern, one thing you can do is start working towards diversity today. That’ll be a huge feather in your cap later on.

The core of the question is really going back to that thought diversity. What are your experiences? What are your skills? What are your traits? What are you bringing from that arena to the class and how are you going to add to the class. It’s not that you’re a black guy, so, therefore, you’re diverse.

[08:53] It’s Everyone’s Responsibility

Tade briefly shares this story of how his white female colleague touched his hair. Tade didn’t say anything to her. He knew she had no bad intention, but Tade felt uncomfortable. So when the girl tried to reach for his hair again, he leaned away. Then one of their white male colleagues looked at her to signal that it wasn’t okay to do that. And to Tade, that was very powerful.

The moral of the story: A black person can actually tell you that’s not okay. But if you’re looking to do more in the field of diversity, it is everyone’s responsibility.

'If you're human, then diversity matters to you.'Click To Tweet

You can be part of a group that is traditionally not considered a minority in any way, but you still have a very important role to play.

[10:58] The Different Determinants of Health

In April, people started looking at all the COVID-19 deaths in Chicago. And what they found was that black residents of Chicago made up 68%, so almost 70% of all the COVID-19 deaths. But black people only make up 30% of Chicago’s population. They make up less than half of the population but they’re still making up the majority of those deaths.

Way before COVID, if you’re black and you live in Chicago and everything is equal, you will die probably 9 to 10 years earlier than the person who lives in the same city in the same country, 45 minutes down the street. And it’s because of all these different social determinants of health. So you either just accept that if you’re part of a certain group, you’re going to have worse health. Or you should exercise harder and eat well.

“People are having drastically different results related to health.”Click To Tweet

[15:45] Does Systemic Racism Exist?

“Systemic racism is really hard to see. But what's easy to see are isolated happenings where racism happens.”Click To Tweet

In a 2002 study, researchers created 5,000 resumes all the same, and all they changed was the name and they sent it to 1,300 different companies. They purposely picked “black” sounding names and “white” sounding names. Then they sent out the same exact resumes to two companies and the result was a 50% callback rate for the white-sounding resumes.

Then they improved all of the resumes expecting a better turnout. The white-sounding names had a 30% increase while the resumes with the black-sounding names had zero percent increase.

That’s an example of systemic racism. But how could you see that without doing a full-on study, sending 5,000 resumes out?

A lot of people don’t believe that it’s a problem because it’s very hard to see. There are seemingly harmless things in our system that produce drastically different results. Just take that study and apply it to the medical world. Then you would start to see a lot of the same outcomes really quickly.

A study was done where they reviewed 10,000 hospital records to find out if patients receive the same amount of pain medication after the same surgical procedure. And they found that black patients, after getting the same exact surgical procedure done, were 40% less likely to receive enough pain medication.

And there’s still a large prevalence of active medical students who believe this myth that black people experience less pain than white people. It’s just ridiculous!

[19:18] Understanding the Concept of Implicit Bias

Tade points out the concept of implicit bias. The important thing to remember about implicit bias is that it’s delayed in many cases, which is directly opposite of our explicit beliefs.

For example, you believe that women are equal to men. And if you’d have taken an implicit bias test, it wouldn’t be shocking to find that your implicit bias is high in negativity towards women. Now, if there was a tire that had to be changed. Then the woman asked you for the wrench. You’d surely ask her if she’s strong enough to do it. Then an implicit bias would kick in and then you’d tell her that you’ll take care of it.

Implicit bias itself is not actually bad. It’s just a description of how our brain processes information. But the problem is how our brain creates these mental links being born into a society where we’re constantly exposed to images of minorities doing negative things and images of people in the majority group doing positive things.

“The problem is not implicit bias. It's how our brain creates mental links just by virtue of being born into the society that we've been born into.”Click To Tweet

Another example is when Google had gotten a lot of trouble in 2016. If you typed three black teenagers, mug shots came up. And if you typed in three white teenagers, it showed pictures of people doing normal stuff.

What happens is you say you have no problem with black people and you believe they’re equal to you. But you’re constantly seeing those that it causes your implicit bias to unintentionally help maintain a structure of oppression.

[23:34] Race as a Social Construct

As a society, we have this notion that white is good and black is bad. Tade was born in Nigeria and raised in the United States. The interesting thing about being in Nigeria is that there’s no such thing as black. You’re in a society where all the police, judges, lawyers, and doctors are all black. All criminals are black people.

“A lot of people born and raised on the African continent discover that they're black when they get to the United States.” Click To Tweet

A lot of people born and raised on the African continent discover that they’re black when they get to the United States. That’s because they’ve never thought of associating anything good or bad with being black because everyone’s black. And for Tade to say that he’s black in Nigeria is like standing up in a medical school classroom saying he’s a med student.

[26:16] Why African-Americans Score 10 points Lower on Average on the MCAT

“AAMC data shows that African American students score almost 10 points lower on the MCAT, on average.”Click To Tweet

Tade recommends reading the book Whistling Vivaldi by Claude Steele. And the author brings up the term, stereotype threat. It’s when we talk about stereotypes, people always talk about it as how we view others.

So we say things like men stereotype women. But the people who are being stereotyped are not unaware of their stereotype. When we’re put into situations where there might be a danger of us fulfilling that stereotype, that becomes a huge instruction to us to accomplish what we’re set out to do.

There’s this study where everyone was made to take the same test. In one group, they were told they were going to do great. And so they did great on the test. But in the tested group, they were told that knowing their specific stereotype, they were going to do worse. The result was they got worse.

[30:48] When Things in Medicine were Formalized

What we’re realizing is that the way we think about medicine is that medicine is for objective researchers.

“If you want to be a doctor, you need to be objective and you need to be a researcher. You present symptoms and you diagnose. That's how we like to think about medicine.”Click To Tweet

But we have to remember that a lot of our medical practices today were not created in this objective bubble. They were really cemented, created, and formalized in the 20th century. If you are anywhere from 15 to 20 years older, or if you’re at least 15 years older, your parents were probably born into a world where there were still black only signs and white only signs. That’s how recent it was. And so that’s where a lot of things related to medicine today were actually formalized.

Tade mentions this article written by LaShyra Nolen that talks about how only mostly white people are being represented which results in different health care outcomes. She also brought up how our plastic mannequins for CPR are only white male bodies. So what safety precautions do we have to take for females or pregnant women?

And these seemingly harmless little things just they add up over time that now, we have a healthcare system or an educational system that’s failing African Americans. Some things weren’t done on purpose, but a lot of things are just small little things that just have added up.

[39:00] How to Be an Antiracist

Tade recommends another book called How to Be an Antiracist by Ibram X. Kendi. There’s a difference between not being racist and between being anti-racist. Even though you know you may not be racist, we were born into a society that that had its structure created when racism was completely legal. So it’s not enough to just not do “something.” We need to be anti “that thing.”

“There's a difference between not being racist and between being anti-racist.”Click To Tweet

Tade says increasing your knowledge is not bad. But you could also track your nontransactional intergroup contact. Although we are born into a society that’s not legally segregated, most of us still live in a very segregated way. It means that if you’re white, you come from a community that’s a predominantly white, good, clean neighborhood. And if you’re bilingual, everyone in your community is probably bilingual. Or if you’re black, you come from a community that’s predominantly black. When we interact with other groups, most of our interaction is transactional. For example, you have a Black or a Chinese American coworker.

Now, think about growing up and your own household. How many people who don’t look like you actually came into your house and had dinner when you were growing up?

Tade mentioned implicit bias above and one really interesting thing about implicit bias is that increasing our knowledge has a huge impact. And one thing you can do to just tie that whole thought together is track it.

When we want to see progress in medicine, we always track it. So for example, if you want to lose weight, you don’t just start eating healthy but you also track it. And it’s the same thing for this.

Tade recommends that you set a goal of having nontransactional intergroup contact at the beginning of a month. Then track it every month. Nontransactional means that there’s not an outward factor that’s forcing you to have that particular transaction. When you begin to have a real dialogue, even if you never fully agree with a different human being, your view of that particular group will become layered as opposed to one dimensional. And that’s something that you can start doing today.