In early June, Columbia University Irving Medical Center held a vigil featuring nine minutes of silenceone for each minute that George Floyds life ebbed as a police officer kneeled on his neck in Minneapolis. The employees who gathered in front of university and hospital buildingsand others who paused in their work across campus or at their remote work locationsto stand or kneel were joining forces with tens of thousands of protesters who peacefully assembled across the United States and around the world to call for police reform and an end to systemic racism.
Like medical schools everywhere, VP&S felt the weight of respondingacknowledging the role of structural racism in health disparities and in patient care, education, research, and work- place environments. In the months since, VP&S and other medical schools have worked to find solutions unique to their missions: augmenting a diverse and inclusive environment for students, faculty, staff, and patients; conducting research that improves health care; combating health disparities; expanding community programs; and strengthening education and training. A task force with multiple working groups across Columbia University Irving Medical Center was formed in the summer.
The institutional reflection sparked by the summer protests coincided with the greatest public health crisis in modern history and heightened white Americans awareness of race-based health disparities. As COVID-19 affected Black Americans at more than twice the rate of white Americans, the social faults that give rise to disparities stood out in stark relief. Suddenly, the deaths of Black Americanseither at the hands of police or through a virus no one knew existed a few months earliercollided, and for many protesters, the hazard of coronavirus infection paled in comparison to the brutal consequences of systemic racism. As a Black physician, wrote emergency medicine physician Steven McDonald, MD, in a New York Times opinion piece, I understand that the protests are the necessary medicine for both ills.
The statistics of illness and death from the pandemic make clear that the virus and racial injustice are interwoven into the fabric of this part of our history, says Anil K. Rustgi, MD, now interim EVP and Dean of the Faculties of Health Sciences and Medicine. Just as we have learned much about COVID-19 this year, we also have acknowledged that we are in a unique position to have an impact on health care disparities. We can work toward health equality by examining the education of health care professionals, the way we care for patients, and how our research can improve health outcomes.
At VP&S, 13% of students in the entering Class of 2024 are Black (an additional 9% are Latino with a combined total of 22% for underrepresented students, above the national average), compared with 7% nationally. (Slightly more than 5% of all U.S. physicians are Black.)
Students are actively involved in the work toward change. Our VP&S students, led by our Black student leaders, brown students, and white allies and supported by faculty and administration, have catalyzed a process for effecting long overdue change, says Lisa Mellman, MD, interim co-vice dean for education. We are proud of our students, united in our commitment, and grateful to collaborate across the school, the campus, and with the community.
Adds Jonathan Amiel, MD, interim co-vice dean for education: Our responsibility to improving health care for all begins here at VP&S. We must enhance equity and justice within our own academic medical center and ensure that our training programs equip health care providers to advocate for equity and justice in their work. Our staff and faculty share this commitment with our students and are already hard at work moving ahead with curricular innovations.
As VP&S redoublesits efforts to promote racial justice, a few Black medical students and physicians at VP&SHilda Hutcherson, MD, Steven McDonald, MD'14,Taiwo Peter Alonge21,Ogoegbunam Brian Okolo23, andKeyanna Jackson23shared their thoughts on navigating this historical momentwhat one calls a perfect storm.
When Hutcherson arrived at VP&S, she became the first Black woman resident in the Department of Obstetrics & Gynecology. Those early days were really difficult because there were so few Black people among the residents or faculty; it was very isolating. Discussions about race, racism, equity, and inclusion didnt take place. As a minority physician, you learned to put your head down and forge ahead.
In the years that Hutcherson has led the Office of Diversity and Multicultural Affairs, the representation of students underrepresented in medicine has increased. For more than 10 years, Black, Hispanic, and Native American students have ranged from 20% to 24% of each entering class. Increasing the diversity of the health care workforce is an important first step to decrease health disparities in minority communities.
The combination of the COVID-19 pandemic and the murder of George Floyd and other African Americans by police caused us all to look squarely in the face of racism in our society and how our institution may have contributed to this social ill. As an adviser for students of color, I have heard, firsthand, the pain and anguish of implicit bias and racism. We are working hard to extinguish systemic racism at our institution and the community at large.
Structural change often comes slowly, says Hutcherson, and depends on the synergy of collective action and strong leadership. You need a critical mass of people getting togetherwhere all of us, putting our energy together, say The status quo is no longer acceptable. There is a need for change. And you have to have a leader who says, This is important, who takes those recommendations and makes them happen. I am confident that our current leadership, with Dean Rustgi at the helm, will make lasting systemic change that will make VP&S a place where everyone feels comfortable and supported.
As the son of a physician and a nursing school dean, Steven McDonald, MD, assistant professor of emergency medicine, has long believed that working in medicine was a way to be on the good side of injustice. He was running the Boston Marathon in 2013, the year a bomb went off at the finish line. He rushed to the scene to help. I wasnt needed, says McDonald, but that experience made me wish I knew a bit of emergency practice, so I went back and did a round of emergency medicine.
The training altered his professional trajectory; today in addition to teaching at VP&S, he treats patients in three New York City emergency departments. Emergency medicine is social justicea majority of the patients we serve are Black and Latinx, he says. People who are left disenfranchised by the system are ultimately cared for by emergency medicine.
Since the pandemic began, McDonald has expanded his focus. As COVID started to ramp up, I felt that I needed to amplify my voice as much as possible to communicate what I was seeing. He began speaking to the press about the intersection of his experiences as a Black man and a doctor and penned opinion pieces for the New York Times and Atlantic magazine.
At protests, McDonald has noticed more of his non-Black colleagues present, including hisformer educators. Theres been a real societal shift since the death of George Floyd, he notes. I cant tell you why it took his death over Trayvon Martins or Michael Browns, but theres a real change in public support for the Black Lives Matter movement. To the extent that medicine is lifelong learning, my white peers are seeing that it includes learning about anti-racism.
When fifth-year medical student Taiwo Alonge becomes a doctor, he plans to serve Black and brown communities. When Trayvon Martin was murdered while I was in high school, I knew that if I was going to be a doctor, I needed to serve people who looked like me, he says.
Since then, he has worked to understand our current health care system, especially the disparities between communities of color and white communities. Studying both medicine and public health (in the Mailman School MPH program) has allowed him to understand how to treat issues that plague Black and brown communities, while also working to find solutions that promote preventive care. Oftentimes, issues like hypertension and diabetes add up in patients,he explains. But if we could treat those smaller things before they get too big, we can make health care better and our patients healthier. To me, thats a doctors job.
Alonge says much of the work it takes to truly understand health disparities starts when students enter medical school. For a long time, he was skeptical whether the changes he wanted to see in his field would happen.
I think every medical institution is trying to figure out how to have these conversations, especially now. Theres this feeling that something has to shift, he says. But if students are going to be involved in lecture conversations about race, potentially re-traumatizing themselves to try and educate other people, there needs to be some sort of compensation. Because of what weve seen happen with George Floyd, Breonna Taylor, and Tony McDadeon top of being forced to stay inside for three monthsfuture doctors will have the opportunity to learn about systemic racism in their coursework. I hate that it took this awful perfect storm for it to happen, but this change could dramatically impact what its like to be a person of color in America, even outside of medicine.
When asked what it feels like to be Black in his program at Columbia, Okolo recounts a particular struggle at the intersection of his racial and professional identity. It is truly a privilege to be at Columbia, but as one of a few Black med students here, Im continuously reminded of the exclusivity associated with highly academic spaces, he says.
Born into a Nigerian immigrant family, Okolo aspires to uplift and advocate for Black and brown communities as a health care provider. Okolo chose to study at VP&S because of the sense of support he felt when visiting, especially within the BALSO (Black and Latino Student Organization) community. It is hard to imagine navigating medical school without the support of BALSO. It has been particularly valuable to me now, amidst the widespread anti-Black racism that we continue to face.
When he first heard about the murder of George Floyd, the news sat with him in a way he knew it did not for his white peers. The weight of realizing that could be me, and having to grapple with that realitywhile trying to study for an exam to maintain my status as a medical student, was something I was really struggling with, he recalls. The very next day, I had to go to class as if everything was normal. It was difficult for me to balance my identity as a Black student and a med student in a space where the guise of professionalism leaves little room for these important conversations to happen. It is vital for medical institutions to critically examine the practices that contribute to racial injustice that has been invisibilized for far too long.
Keyanna Jackson grew up in Wilson, North Carolina, a small town where local medical care was substandard. Her family drove to a hospital 30 minutes away, one with a better reputation. But that didnt always mean better care. My grandfather had an older white doctor who was dismissive, she explains. He had hypertension and the doctor would speak about it as if it were normal.
Eventually the family switched doctors. The new doctor, a woman, was attentive, explained complex issues, and even allowed Jackson to shadow her throughout high school. Having a woman pour so much into me and my family allowed me to see what was possible, says Jackson.
At VP&S, Jackson facilitates mutual support among fellow Black medical students. As president of the Black and Latino Student Organization (BALSO), the Columbia chapter of the Student National Medical Association, and the Latino Medical Student Association, she works to connect her peers and faculty to one another for academic support and mentorship. BALSO also partners with local schools to encourage children to pursue a career in medicine.
Yet Jackson laments that more robust structures were not already in place through VP&S to facilitate this work. There needs to be a better understanding of what the invisible labor looks like for Black faculty and students to show up as mentors, or explain health disparities in our communities to our white peers, she says. It can be hard to navigate white spaces, or sit in class and hear about how certain diseases affect my community without much context or explanation on why that might be.
In recent years, VP&S has revamped its curriculum to include more anti-racist content. Jackson says thats a start, and she would like to see more done within the curriculum to ensure that Black students alone are not forced to explain anti-racist concepts to their non-Black peers in discussions of race and medicine. People can do the reading and take what they want from it. There should be opportunities to have these types of conversations about race, she says. Maybe tap on those outside of the medical field to facilitate this. Students have been asking for it.
This article was originally published in the 2020 VP&S Annual Report.
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