We must create a safer and more equitable training environment for clinicians

During intern year I introduced myself to Mr. Smith (name changed), an older white man.

“Hello I am Dr. Adetoye. I will be taking care of you during this hospital admission.”

When the attending led us back to the room for team rounds, Mr. Smith addressed me as a nurse.  The word hung in the air, but no one, including the white attending physician, addressed it. The intersectionality of being a woman and a woman of color meant that I was unsure which had triggered this comment, but I was uncomfortable either way.

I wanted to talk with someone who would understand. But in my large department, there were only two Black female physicians. I was a new intern, and I hesitated to burden them. I did not want to add to their ‘minority tax’ burden as the only Black woman on faculty. So, I kept it to myself.

In my last year of residency, I was working in a hospital in a predominantly white rural community. While writing patient notes, I overheard two men and a woman outside the room discussing whether it was appropriate for police to kneel on George Floyd’s neck when he was resisting arrest. They agreed it was, though the woman felt he should not have been allowed to die. When I stepped into the hallway, the two white security guards and white nurse that had been conversing stopped abruptly and watched me pass. I kept walking.

Down the hall, I passed a Black security guard and impulsively thanked him for being there. He said, “You are welcome, Doctor. Things are crazy out there. I will be here all night. If you need anything, do not hesitate to ask.” I thanked him again, slipped into my call room, and began to cry.

As the sole Black resident in this hospital, I was afraid and stunned. How could the staff that I relied on discuss the merits of murder? This time, I talked to my residency leadership. To my surprise and pleasure, they were concerned and responsive, and we worked on ways to improve the climate at the hospital.

We cannot assume that the day-to-day experience of seeing patients is uniform for all. We know there are better patient outcomes and patient satisfaction with racial/ethnic congruence between patients and clinicians. The programs that train young physicians must take the lead to create a safer and more equitable environment for all. This can be done by taking several steps:

1. Understand the communities where trainees work, identify potential challenges, and communicate these with trainees.
2. Make clear that discrimination will not be tolerated by the program.
3. Educate staff and faculty about these experiences and teach them to recognize and address microaggressions and support trainees.
4. Provide time for faculty of color to serve as mentors so minority trainees need not seek this on their own.
5. Institutionalize these policies so they are not dependent on the good will of one individual.

We can do better. Increasing medicine’s physician diversity and supporting trainees with these difficult experiences will prepare us all to better care for the world’s diverse patient population.

Dr. Adetoye is a Clinical Lecturer in the Department of Family Medicine at the University of Michigan. She attended medical school at Michigan State University and completed a residency in Family Medicine at the University of Michigan.