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EQUITY AND SOCIAL JUSTICE

Let's Get Uncomfortable

McElroy, Imani MD

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doi: 10.1097/SLA.0000000000004603
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Recently I became a meme on Twitter for being the only Black resident pictured in a sea of white coats and white faces at one of the nation's top surgical training programs. The meme creator zoomed in on my face and added text that reads, “Please send help.” Many found it hilarious, and a Twitter storm ensued. Needless to say, this was not the kind of viral moment I had ever hoped for.

My initial reaction to the meme was mild amusement -- the picture was not an accurate representation of our program – but it also was not far off. I started to engage the criticisms of our program and the comments directed at me. But, as the day wore on, I found myself increasingly frustrated, exhausted, and at times humiliated by the attention.

I will be the third black woman ever to graduate from my surgical training program since its inception. That within itself is a bleak statistic. As I engaged with tweets where people called me “the diversity hire” and making statements suggesting that “there were not any qualified applicants,” I became increasingly frustrated by how these statements discredit the qualifications and perseverance needed to survive in training environments that systematically exclude people of color.

What started as a casual engagement of tweets ended up being quite disruptive. I found myself at the center of a conversation about race, diversity, and inequity at my institution, which I had not signed up for. Unfortunately, I do not have the luxury of ignoring it. Consumed by a dialogue calling me a diversity hire, I found myself unable to focus on my actual work and responsibilities. I was really disappointed to experience this personal attack in the context of current events in the US regarding racism. Furthermore, despite the plurality of conversations about allyship in medicine – I had never felt more alone.

In the months since George Floyd's murder, more Americans have begun to understand the urgency of the fight for racial justice. COVID-19 has only increased this urgency, killing people of color at such disproportionate rates. As we struggle to contain the pandemic, the social determinants of health and the disparities are glaring. As a Black woman in surgery, this fight is my life's mission. This Twitter experience, coupled with what is going on more globally in the US, underscores the need for academic surgery to (1) acknowledge the racism in our training environment and (2) mobilize active engagement for its eradication.

The relationship between White Supremacy and nonracism has been a recurring thorn in my academic and professional development. I can recall instances as far back as elementary school where I have been treated differently, including having opportunities taken away, been ignored, or even reprimanded more harshly than my classmates. Sometimes because I was a female student, sometimes because I was a Black student, but most likely because of both. There is a lot of discomfort with the concepts of “White supremacy” and being anti-racist. It is more comfortable to be “nonracist.” It is comfortable (even satisfying) to avoid racial slurs, treat people of color with common courtesy and respect, and acknowledge the existence of white privilege. It is incredibly uncomfortable to stand up and actively call out White supremacy – but as surgeons, this must be where we start. Our training paradigm already lends itself well to growth in times of discomfort. The same holds true in the fight for racial equality. Challenging the status quo is hard work. But it is time to get comfortable with being uncomfortable. Today, I am challenging the field of academic surgery to get uncomfortable alongside me – alongside all Black medical trainees that have been marginalized on their path to excellence.

While recruitment plays a large role in workplace diversity, it is just the beginning of the work. Creating an environment that is inclusive, anti-racist, and active in allyship must be a priority for surgical training programs if they are sincere in their efforts to foster a diverse workplace. Many under-represented (URiM) residents avoid coming forward to discuss racism or discrimination they experience out of fear of retribution or being labeled as overly sensitive. Their experiences are explained away as misunderstandings or chalked up to someone making a joke in poor taste.

Surgical residency is demanding on its own, and having to train in an environment that normalizes racism or tolerates willful ignorance places an unfair burden on URiM trainees. The same intensity and effort used to investigate sexual harassment claims or behavioral misconduct must be applied to reports of racism or discrimination.

Doubling down on a culture of nonracism instead of embracing anti-racism creates a hostile atmosphere and contributes to URiM trainees’ and staff's feelings of being unwelcome within academia. The unwillingness to lean into the discomfort and address racism head-on has consequences for trainees, staff, faculty, but, most importantly, for our patients. If leadership is willing to condone racism in the workplace, how can one ensure it does not influence patient care?

Formal teaching on explicit and implicit bias and cultural dexterity training needs to become an integral principle of surgical education. Training frames how we engage with patients; thus, if this generation of trainees does the hard work of recognizing their explicit and implicit biases, it will directly benefit patient care. If we continue to ignore the intersectionality between racial and social justice and a patient's health, we will continue to fail Black and Brown communities. Beyond these measures, we must be ultra-conscious of our language. Physicians are in the spotlight during this crisis, and we must be leaders in the fight to recognize and end racism as a public health crisis.

I do not want under-represented minority students to take this as an indictment of the field of surgery, my training program, or medicine as a whole. There is work to be done, but the change has already begun. I adore my program and am honored to be amongst the ranks of some of the best and the brightest our field has to offer. If I had to choose a program over again, I would pick my program a million times over, without hesitation. I am hopeful that the discourse that started on Twitter will also continue to hold programs and institutions accountable in acknowledging the root cause of disparities within our system. Anti-racism asks us to stand up and speak out, even when it is uncomfortable.

Keywords:

perspectives; surgery; public health

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