Approximately 75 % of Black patients receive treatment from non-Black healthcare providers,1 and communication in racially/ethnically discordant medical interactions is less positive, productive, and informative than in racially concordant ones.2–6
Negative perceptions by physicians and patients play important roles in the dynamics and outcomes of these interactions.7–10 One critical aspect of these perceptions is trust.11 Non-Black physicians see Blacks patients as less trustworthy and compliant than White patients.7,12 Black patients are less trusting of their non-Black physicians,13,14 more likely to believe they have been mistreated because of race,15 and show declines in trust following interactions with non-Black physicians.16
Black men make up less than 3% of physicians. That requires immediate action, say leaders in academic medicine. From systemic racism to economic disadvantage, Black men face numerous obstacles in their path to medicine. At the AAMC’s annual meeting, three who succeeded shared their stories and their insights on how best to pave the way for others.
By Stacy Weiner, Senior Staff Writer
November 23, 2020
Antwione Haywood, PhD, grew up as the son of an undocumented immigrant who had a sixth-grade education. Nathan Delafield, MD, survived the turmoil of life with a drug-addicted mother. And David Wilkes, MD, knew his family could never afford to pay for medical school. All three men, speakers at the AAMC’s annual meeting, Learn Serve Lead 2020: The Virtual Experience, have become models of great success for Black men in medicine.
Such inspiring stories are crucial given how few young Black men become physicians, said Norma Poll-Hunter, PhD, AAMC senior director of human capital initiatives and moderator of the Nov. 18 session titled “Black Men in Medicine: Stories Behind the CV.”
Poll-Hunter pointed to the AAMC’s 2015 report Altering the Course: Black Males in Medicine, which revealed that the number of Black men enrolled in medical school actually decreased between 1978 and 2014. More recent AAMC data show little improvement: The percentage of Black men in medical schools has increased only slightly since 2016.
Now, “with the two pandemics of COVID-19 and continued acts of anti-Black violence, we experience a strong call for solutions to advance change,” Poll-Hunter said.
Each of the speakers offered insights on how to promote positive change for Black men in medicine, told their own stories of setbacks and success, and answered questions from listeners seeking guidance. Here’s some of what they shared.
Antwione Haywood, PhD: Seeing beyond scores
Antwione Haywood, PhD, assistant dean of student affairs at Indiana University School of Medicine, speaks at Learn Serve Lead 2020. Photo by Sholape Oriola
One recent story lingers in the mind of Antwione Haywood, PhD, assistant dean of student affairs at Indiana University School of Medicine.
He described a promising fourth-year student who had no academic issues in medical school but then experienced a little trouble on the pivotal Step 2 board exam. Haywood sat with the young man as he nervously awaited his test results.
“I couldn’t help but notice that this person’s entire success had been boiled down to a three-digit score,” Haywood recalled. And when the man finally learned he passed the exam, got teary-eyed, and hugged Haywood, “it felt like we were brothers,” he said.
In fact, Haywood’s own story highlights that an individual’s potential is not captured solely by a set of numbers.
Haywood’s mother, an undocumented immigrant, escaped a dangerous marriage in Trinidad and Tobago, and his father died from gun violence. Still, Haywood was taught to work hard and take full advantage of all educational opportunities.
Haywood, who grew up in Los Angeles, told listeners of the uncomfortable experience of starting graduate school in Kansas, where he arrived with two suitcases and a clear sense that he was part of a tiny minority. “[The experience] taught me it’s so important to learn how to navigate any space you go into,” said Haywood.
Adaptability and perseverance are among the many “unmeasured forms of capital” that Black men offer medicine, he added. It therefore makes sense to reimagine how we assess students “to account for the entirety of what they bring to the table.”
Once students enroll in medical school, institutions ought to support them holistically, going well beyond academic advising, Haywood said. Doing so requires checking on several crucial areas, including “psychological safety, financial barriers, and whether or not they’re even eating a couple of meals a day,” he explained.
Nathan Delafield, MD: Reaching out a hand
Nathan Delafield, MD, assistant professor at Mayo Clinic and Creighton University School of Medicine in Arizona, presents at the AAMC’s annual meeting. Photo by Sholape Oriola
Nathan Delafield, MD, was born into turmoil. His mother was the victim of domestic violence and a substance use disorder. Delafield himself faced extreme poverty, experienced homelessness by age 4, and was shuffled through the Arizona foster care system beginning at age 8.
Yet Delafield went on to become an assistant professor at Mayo Clinic and Creighton University School of Medicine because he had “an unwillingness to be defeated” and “people that wanted to see my success,” he said.
Often, he added, Black men bring tremendous resilience and grit to medicine, having overcome systemic racism and unequal educational opportunities, among other challenges. But they also need the right supports and opportunities.
He told listeners of his experiences being helped by caring educators. One suggested medicine to Delafield during his freshman year of college, when he had “no idea what I would do with my life.” Another supported his candidacy after interviewing Delafield for medical school, recognizing his talent despite a disappointing MCAT® score.
Now, Delafield said, he strives to give back. “I serve in a medically disadvantaged community where I can serve as an example to my community members, to [those] who struggle with the same obstacles that I had as a young child.”
As he ended his remarks, Delafield asked listeners to consider a key question: “Are you doing enough to advocate for students that bring diversity, grit, and resilience to medicine?”
David Wilkes, MD: Avoiding the minority tax
David Wilkes, MD, dean of the University of Virginia School of Medicine, addresses Learn Serve Lead 2020 participants. Photo by Sholape Oriola
David Wilkes, MD, grew up in a home dedicated to education. In fact, he, his sisters, and his mother all attended college at virtually the same time.
But Wilkes knew he couldn’t afford to pay for his medical education. He therefore accepted a scholarship from the U.S. Air Force, where he served as a physician for three years. He went on to become a prominent leader in lung transplantation and was selected to serve as dean of the University of Virginia School of Medicine five years ago.
Wilkes shared a few key pieces of advice that helped him in his professional path.
For one, “success is unlikely without the appropriate mentors” — even for the most talented individuals, he said. What’s more, a person needs numerous mentors over the course of their career as their professional needs change. And, he noted, it’s not necessary to seek mentors only among African American men.
Also essential is guarding time to focus on pursuits that help win promotion and tenure. For example, researchers must set aside “protected time” to work intensively on their research and not stray too far into clinical tasks.
But protecting one’s time requires a related skill: learning to say no. Wilkes acknowledged that saying no can be tough at times, but a mentor can help identify which requests to turn away.
“All of you listening today, particularly if you’re a person of color, are being asked to do so many different things that can spread you very thin” and undermine your chances of advancement, he cautioned.
“The group we’re discussing today, African American males in medicine, is a very limited pool of individuals but critically needed,” Wilkes added. That means the minority tax of supporting institutional efforts such as increasing diversity can weigh heavily on them.
He therefore issued a plea to leaders: “Remember, when you’re asking an individual to engage [in a project for the institution], think about what it might mean to their career … so they’re able to pursue their activities that allow success for them.”
Moving forward, Haywood advised looking at the recently released AAMC Framework for Addressing and Eliminating Racism at the AAMC, in Academic Medicine, and Beyond for guidance.
The document’s first pillar, self-reflection, is essential because most medical educators haven’t studied how to teach diverse populations, he noted. “As a result, they enter the classroom and clinic with unconscious biases concerning Black men” and others.
Pillar number two, becoming an anti-racist, means shifting from deficit-oriented questions — such as “Why are so few black men in medicine?”— to constructive ones like, “What cultivates success?”
Collaborating with communities, the third pillar, involves activities such as working to remove financial barriers to educational advancement and supporting minority organizations, Wilkes said.
The final pillar urges speaking out about systemic racism, including updating policies to make stakeholders accountable for bigotry. Regarding such moves, Haywood quoted anti-racism activist Ibram X. Kendi, PhD, who gave a presentation on Nov. 16 at the AAMC’s annual meeting. “Intellectual activism is not enough,” he said. “An anti-racist activist produces power and policy change, not just mental change.”
Asked for his final thoughts on how to help Black men succeed in medicine, Wilkes emphasized that they first must find their way into the field.
“This process starts before college, it actually goes back to middle school,” he said. Wilkes then issued a challenge to leaders to reach out and build robust pipeline programs. “Become the role models for [those] students who can see medicine as a pathway to go forward,” he urged. “I would ask all of you to work in your communities in order to effect that change.”
More information about efforts to increase the representation of Black men in medicine is available from the Action Collaborative for Black Men in Medicine.
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