Tipping the Scales Toward Equity Equilibrium

Abstract

A third year medical student shares his approach for translating personal experiences with racial bias into teaching moments that enrich the learning environment.

Infant mortality rate, percentage of children with asthma, prevalence of hypertension. What do these statistics have in common? If you’re a black medical student like me, you’re well aware that these numbers are often highest in our community. We hear it in lecture, read it in textbooks, and see it in chart after chart.

The constant barrage of these appalling health outcomes is inescapable in our modern society, and the sensations I’ve experienced in response to them are beyond exhaustion. For me, these outcomes have evolved beyond their numerical forms into invasive personifications—generating visceral reactions and consuming my mind each time I experience them. The conceptualization of race-related stress has been described as having adverse impacts across multiple domains of well-being ¹ , and my prolonged exposure to this stress has led to the development of adaptive strategies that have conditioned me to these feelings.

As I’ve progressed in my medical training, I’ve continuously reflected on how perceptions of poor patient outcomes in black communities may be unintentionally, and intentionally, attributed to black physicians solely because of the color of their skin. The resulting misperception has the potential to generate bias against black physicians and propagate unsubstantiated beliefs that these physicians are incapable of providing effective care. I began to wonder whether this thought process was a contributing factor in the many instances where patients refuse care from a physician exclusively based on their race ² .

What I was starting to conceptualize in my mind became all too real when a white standardized patient (SP) demanded I leave an exam room when I happened to sneeze during an encounter. I had never seen a SP explicitly break character so abruptly, and their quavering voice contained a sinister undertone I was all too familiar with. I froze. Thoughts overwhelmed my frontal cortex—What did they think of me? Would they have responded similarly to a student of another ethnicity? As my primitive fight or flight response kicked into hyperdrive, I fixated on the iceberg analogy—their overreaction reflected the tip of something that likely ran much deeper.

In the days that followed the event with the SP, I ignored the instinctual emotions until they faded away as they always did. Desensitization was complete.

But a few months later when I witnessed the senseless murder of George Floyd in my hometown, it broke me. Such a blatant display of oppression melted away the armor I had built against it. This single event exposed me for who I truly was, and the vulnerability I felt served as a tipping point that inspired me to do more.

I’m a Nigerian-American training to become a physician in what many are referring to as an unprecedented time. While the successes and struggles I experience may seem foreign to those that do not look like me, I have the power to bridge the gap by shaping their perspectives and moving them toward equity equilibrium. I define this term as a mindset in which we balance our inherent and indoctrinated identities in order to recognize how these varying aspects of self influence our behavior. Equity equilibrium serves as a lens through which we critically analyze health disparities, and this personalized approach enables us to recognize our contrasting identities, resolve cognitive dissonance, and ultimately develop behaviors that actively address health disparities.

I began seeking out innovative opportunities in medical education because I felt that incorporating my experiences into the learning environment would broaden the perspective of my peers and future generations of physicians. With the themes of anti-oppression and self-efficacy as my guiding principles, I applied my own unique perspective to critically assess the curricular format and to enrich the learning materials of one communication course at my institution. Collaborating with a diversity of stakeholders and implementing longitudinal threads were essential to creating content that was trauma-informed and aligned with the guiding themes. The end result was a series of recommendations and alternative approaches, such as reflective exercises, anti-racist terminology, and clinical cases centered on health disparities, with the goal of instilling students with compassion and an appetite for humility and growth. My hope is that students take these learnings with them as they care for others as well as themselves.

Infusing my experiences into the curriculum initially felt strange, as I grappled with persistent waves of imposter syndrome. But I’ve found significant solace in this work because it allows me to overcome adversity, promote equity equilibrium, and translate my experiences into meaningful change. While I did not choose this path, I choose to continue walking it for the betterment of my community and those around me.