Blackface in White Space: Using Admissions to Address Racism in Medical Education
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Given the long history and pervasive nature of racism in medical culture, this essay argues that diversifying efforts alone cannot address systemic racism in medical education. Positive affirmation of anti-racist values and racial consciousness in the admissions process is necessary to create a truly inclusive culture in medical education and begin to undo centuries of racial prejudice in medicine. Drawing from historic examples, scholarship on the sociology of racialized space, recent research on race and medical education, and personal experience, we propose that medical educational institutions make a more concerted effort to consider racial attitudes and awareness as part of the admissions process as well as curricular reform efforts. We also provide examples of potential ways to practically implement this proposal in the admissions process. J Gen Intern Med DOI: 10.1007/s11606-020-06079-4 © Society of General Internal Medicine 2020
BLACKFACE IN WHITE SPACE: ADDRESSING RACISM IN MEDICAL EDUCATION
Looking at yearbook pictures of medical students at Eastern Virginia Medical School wearing blackface and dressed like Ku Klux Klansmen and civil war confederates, we felt a complex and familiar mix of emotions: the dull ache of recognition of the hackneyed visual tropes of white supremacy, the sudden self-consciousness (for two of us) about our own brown skin, and a sad weariness that eventually morphed into anger. But none of us felt surprise or shock. The images of white medical students dressed in racist costumes merely affirmed what we already knew—that most medical schools are white spaces where explicit and implicit racism occurs constantly and often goes unmentioned and unpunished. What makes medicine a white space? As described by sociologist Elijah Anderson, white spaces are characterized by “their overwhelming presence of white people and their absence of black people.1” This is certainly true of medical education, where the number of Black medical students and faculty remains disproportionately low compared with Received March 31, 2020 Accepted July 17, 2020
whites.2, 3 A white space, in Anderson’s words, also requires that “prejudiced actors pervade the white space and are singly or collectively able and interested in marginalizing the black person, actively reminding him of his outsider status to put him in his place.1” Recent research and writing demonstrates that medical schools are replete with such actors.4 Medical schools grant white students membership to honor societies more frequently than Black or Asian students and promote white faculty more readily than Black faculty.5, 6 Medical school faculty often perpetuate false racist beliefs, enforce racial hierarchies in the hospital, and normalize racism by making racist remarks that go unchallenged.7, 8 A 2016 study by Hoffman et al. found that about 50% of white medical students and residents surveyed endorsed at least one false statement about biological race, such as “Black people’s nerve-endings are less sensitive than White people’s nerve-endi
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