Progress has been made, but work remains to address systemic racism in medicine
When Dr. Mojola Omole attended medical school at the University of Toronto, she was told by a clinical staff physician during a third-year diagnostic presentation that she wasn’t an eloquent speaker and did not understand the material.
Dr. Omole, a general surgeon and breast surgical oncologist with the Scarborough Health Network, felt singled out as a Black medical student.
"Anyone (who) knows me knows that I am a great speaker, and I can 100 per cent say that is something that I excel at," said Dr. Omole, who, as a board member of the Black Physicians’ Association of Ontario, is a regular guest speaker at events and co-host of the Canadian Medical Association Journal podcast.
This is just one example of the discrimination Dr. Omole said she faced as a Black student and as a physician since.
“We didn’t really talk openly about systemic racism,” said Dr. Omole, who graduated from medical school in 2007. “We didn’t talk about what microaggressions are.”
Following her supervisor’s comments, she remembers calling her father to try to make sense of what happened.
“Speaking to other people who’ve experienced microaggressions … you’re in tears and you feel vulnerable, but you don’t really know what’s happening.”
She said her experience reflects the systemic racism that persists within Ontario’s medical community, impacting Black representation in medical schools and the overall physician population.
“What I’m heartened by is the fact that we’re now having open conversations about what white supremacy in medicine looks like.”
According to a 2021 University of Toronto’s Temerty Faculty of Medicine Voices survey, the results outlined in its accountability report, 56 per cent of Black MD students, 65 per cent of Black residents and 39 per cent of Black clinical fellows reported experiencing discrimination at least once in the past academic year. Meanwhile, the same survey revealed that Black learners represent just six per cent of Temerty’s MD students, three per cent of residents and six per cent of clinical fellows.
Nationally, a 2018 study by researchers at Western University’s Schulich School of Medicine surveyed 1,338 medical students at 14 English-language Canadian medical schools and found that just 1.7 per cent of medical students identified as Black, compared to 6.4 per cent of the Canadian census population.
The impact is also felt within the medical profession. According to a 2016 Statistics Canada report, just 2.3 per cent of Ontario’s physician workforce is Black, compared to 4.7 per cent of the population.
Dr. Kwadwo Kyeremanteng said anti-Black racism is known to be embedded in Canadian institutions, including health care and education, which can directly impact each other. The ICU and palliative care physician, who is the head of critical care at the Ottawa Hospital, said Black high school students are sometimes streamed into the trades by their teachers and counsellors, even when they have other educational aspirations. This bias directly contributes to low Black representation in certain fields.
“A lot of people don’t realize their potential, that they can get a seat at the table, they can put on a white coat, they can help patients,” said Dr. Kyeremanteng, who hosts the podcast Solving Health Care. “Those barriers start at a young age, they’re systemic and prevent people from achieving their dreams.”
Research has shown that socioeconomic situations including the community you live in, schools you attend, parents’ occupation and income level can impact your future, including education level.
A 2012 national physicians survey by the CMA found that 52 per cent of medical students came from households earning more than $100,000 annually, while just 23 per cent of medical students came from households earning less than $60,000 annually.
“We often talk about inclusion and diversity, but what we always miss out is equity. And equity is basically saying ‘you know that your road to get here is different from X’s road to get here’, and (it’s about) trying to level that playing field,” Dr. Omole said.
“If you have affluency, you might have neighbours who are physicians. But if you’re someone who does not have that background, or if you and your family are new immigrants here, you don’t really know what that looks like.”
Data plays a critical role in revealing and repairing racial inequities, but there have been limited efforts to identify the ethnic, racial or socioeconomic backgrounds of Canadian medical students and physicians.
Schools, including U of T’s Temerty Faculty of Medicine and the University of Ottawa, have made some headway with data collection: Temerty with its accountability report and U of Ottawa with Canada’s first academic research centre studying the biological, social and cultural determinants of health of Black communities.
Meanwhile, in 2020, the Black Medical Students’ Association of Canada shared 10 recommendations for combatting anti-Black racism with the Association of Faculties of Medicine. These include evaluating data collection practices to ensure they align with national equity and diversity initiatives and policies.
If seeing is believing, then equity in medical schools requires changing the face of medicine. In other words, more Black physicians will inevitably lead to more Black medical students and vice versa.
“We all have very different experiences, but there is no genetic Black race — that’s a social construct. But what we can say is that the majority of Black Ontarians don’t have a Black physician. And so, the importance of seeing someone that represents what you want to achieve just helps push you further along,” said Dr. Omole, who was a mentor in medical school and whose physician father mentored her as well.
Mentorship and other support programs offered to Black youths, as early as high school, can help them realize a future career they likely hadn’t considered, by encouraging their interest in the health sciences, assisting with application processes, even offering emotional support.
“If you have a certain level of guidance and someone to lean on, it could it take a huge weight off your shoulders,” said Dr. Kyeremanteng. “I would have loved to have had that in the earlier stages of my career.”
“A lot of people don’t realize their potential, that they can get a seat at the table, they can put on a white coat, they can help patients.” — Dr. Kwadwo Kyeremanteng
U of T’s Temerty’s summer mentorship program is one successful example. It offers Black and Indigenous Grade 11 students the opportunity to be immersed in health sciences for the month of July. Enrolment has increased from seven to more than 100 students a year, with a total of 1,370 students participating since 1994. Temerty also offers support services to Black medical students through its Diversity Mentorship Program, Community of Support network and a Black Student Application Program.
Meanwhile, reports from the Black at Temerty Medicine community consultation provide insight that supports Black learners, faculty and staff, and guide improvements. Notably, Temerty admitted 24 Black students, the largest cohort of any medical school in Canadian history at the time, for the class of 2024.
Dr. Clover Hemans, a family physician in Halton Region who has guided Black students through U of T programs, commends the school’s structured, long-term approach to supporting Black medical students.
“They recognized that getting into med school isn’t only about being smart,” said Dr. Hemans, who recalls there being just two Black students when she attended McMaster University’s medical school in the 1980s. “It’s about having support financially … It’s about being able to have those experiences where you can have those conversations: How do I get in in the first place? What kind of stuff do I need to do? What kind of placements might I need to have?”
More Ontario medical schools and student groups are taking action.
The uOttawa Black Medical Students Association provides group mentoring sessions for Black medical students and residents and one-to-one pairing with Black physician mentors. And, after issuing an official apology in 2018 for a ban on admitting students of African descent to its medical school from 1918 to 1965, Queen’s University in Kingston, Ont., is implementing initiatives to support Black medical students, including curricular changes, a mentorship program and admission awards. McMaster and Western universities also provide support networks for Black medical students.
Additionally, in 2020, more than 40 Canadian colleges and universities signed the Scarborough Charter on Anti-Black Racism and Black Inclusion in Canadian Higher Education, committing to taking concrete action to address anti-Black racism, promoting Black inclusion and excellence.
While these programs aim to increase Black representation in medical schools, the bias and discrimination that exists amongst faculty, administration, the student body and in the curriculum must also be confronted. It begins, doctors agree, with education and a willingness among all participants to learn, be humbled and acknowledge inherent beliefs and mistakes.
Dr. Omole suggested hiring physician experts to discuss the impact of implicit bias, how it manifests in medicine and how faculty and the student body contribute to it. Practical aspects include self-evaluation, confronting biases and becoming a better ally to the Black student body, faculty and physician colleagues.
The Black Physicians’ Association of Ontario and Black Physicians of Canada offer resources and services that medical schools can tap into.
Medical school curriculum must be more inclusive, notes Dr. Hemans, accurately presenting the Black patient experience, now and in the past, to increase understanding of the health-care inequities they face and the roots of their distrust. Students “need to have people outside of medicine tell their stories so you get a real understanding about how it feels.”
Though she’s encouraged by the progress being made, Dr. Hemans said the road to equity, diversity and inclusion remains a long one.
“I am enthusiastic, and I am encouraged, but I’m also very much aware that physicians and faculty come from the same society as everyone else and have similar biases that are not necessarily diminished or removed by education (in medicine).”
Meantime, Dr. Kyeremanteng said lasting change will only occur with acknowledgment from the broader medical community that systemic racism persists and is a problem to continuously prioritize and act upon.
“We need buy-in from everyone. It’s about action and believing it matters,” he said. “To be able to talk to a broad level of physicians to illustrate why this matters, why systemic racism is a concern, hopefully it creates that drive to want to make a difference.”