Medical researchers University of Saskatchewan School of Medicine Their latest study looks inward—trying to capture racism Issues facing black medical students.
The results of the study were published on Monday in Canadian Medical Association JournalA range of reported insults were documented, including a senior doctor defending her use of a racial slur, commenting on police violence against “dangerous” black people in the US, and censorship that made a student feel like she didn't belong.
Between May and July 2022, interviews were conducted with four Black residents and nine Black students at the University of Saskatoon.
Jacob Alhassan, the study’s lead author and an assistant professor of community health and epidemiology at the university, said it was important to document the experiences of Black students and residents completing their undergraduate training.
“Sometimes in the student training world, people assume things can’t be that bad because they’re dealing with professors,” said Alhassan, the only Black researcher on the study, which was co-authored by two others.
“We ultimately found that experiences of racial discrimination occurred not only between students and patients in clinical settings, but even between professors or clinicians who worked with them.”
One resident quoted in the study, without naming any of the commenters or alleged offenders, said the doctor who used the slur was in charge of supervising students and was also said to have said people from a certain African country were “blacker than blacks, blacker than coal.”
“She repeatedly uttered the word 'nigger' several times during the same session,” the resident said, adding that the doctor seemed to feel entitled to do so after mentioning that her parents, also a health care professional, had used the derogatory language in their home when she was growing up.
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“'Oh, that's OK. I'm not a racist,'” the resident remembered her saying.
Another student said they “felt vulnerable”.
“I just know that a lot of people don’t like my presence in the field because of my race, you know? So if there are systems in place to protect black medical students in the field, then I think that’s enough.”
While the study did not measure the mental health impact on students and residents, some said their confidence had been shaken, particularly Black women who were unsure whether the abuse was related to their gender, race or both.
Alhassan said that while some first-year students said they had not encountered any racial discrimination, as their studies progressed and with ongoing training outside the classroom, learners generally identified specific instances of increasing racial discrimination.
“They experience racial discrimination from their mentors, patients, faculty, courses and colleagues. When they become residents, the sources of discrimination increase further. They experience discrimination from hospital leadership, consulting physicians, attending physicians.”
He noted that while many workplaces have hierarchies, the hierarchy is particularly clear among medical juniors and seniors, residents and physicians, adding that Black people are often at the bottom because of racism.
Alhassan said some people are afraid to talk about their experiences.
“Of all the people I’ve interviewed, I’ve never had a single person who was so afraid that their answers would come back on them or hurt them in some way,” he said.
“I think it speaks to the deep insecurity and powerlessness that some students are experiencing because they’re worried that something they say might come back to hurt them as they try to get into residency.”
Marilyn Baetz, interim dean for a six-month term that expires at the end of June, said the school has made a number of changes since the study began two years ago, including working with the local chapter of the Black Medical Students Association of Canada.
Starting next spring, the admissions process will include Black representation on interview panels, similar to policies at some other medical schools, including the University of Toronto, the University of Alberta and the University of Calgary.
Bates said the curriculum will also continue to be more inclusive, including adding learning materials that show how different types of illnesses or skin conditions may appear differently depending on the skin tone.
Bates, who will return to her post as vice dean for academic affairs next month, said the college is using anti-racism programs at the Icahn School of Medicine at Mount Sinai in New York to help guide curricular changes and has developed equity, diversity and inclusion modules for students, faculty and staff.
Bates said the university does not collect racial data on students, faculty and staff but is working with various demographic groups to gather that information in a respectful manner.
The Saskatchewan study sheds new light on the barriers facing Black medical students.
Earlier this year, researchers from Toronto's St. Michael's Hospital and the University of Toronto's Faculty of Medicine conducted a qualitative study that found that few Black medical students pursue careers as surgeons in Canada due to factors such as a lack of mentoring, flawed admissions criteria and racist microaggressions during training.
Another qualitative CMAJ study published in 2022 described systemic anti-Black racism as “deeply embedded in every aspect of the health system and medical training.” The study looked at Black medical students and senior faculty’s perspectives on their schools’ efforts to address anti-Black racism in 2020 and found that in the absence of Black faculty, schools relied heavily on Black students to guide their responses.
Bates said the Saskatchewan study “highlights concerns that I think are probably not dissimilar to other organizations.”
“But we are committed to reconciliation in our universities and medical schools, in teaching our future health care providers, our physicians and others.”
