Scenario:  A third-year student who identifies as a cis-gender Black woman (she/her) is on her OB/GYN Clerkship and hopes to one day complete a fellowship in Maternal-Fetal Medicine. She scrubs into a case alongside a student who identifies as a cis-gender White male (he/him). As the students scrub in, they are expected to wear generic surgical caps to cover their hair. The student has trouble placing the scrub cap over her passion twists and rushes to finish scrubbing before the residents/attendings. Her fellow student has no problem putting the scrub cap over his hair. Before the surgery starts, the attending reaches for the student’s hair and attempts to put it all under the scrub cap and says, “Sterility is of the utmost importance. Please take this seriously.”

Impact: Surgical wear was not designed for diverse racial and/or ethnic hairstyles. The attending failed to consider that the student’s trouble with scrubbing in was not due to a disregard for sterility; instead, it resulted from structural racism in healthcare. The student may now feel that the OR is an unfriendly space for those from non-White backgrounds, and this may impact their final career choice. 

Outcome: The student completes the surgical case, without interacting much with the attending. She fears that the team may not take her seriously if she speaks up, given the scrub cap incident. The student completes her rotation and scores a pass. She feels uncomfortable about her interaction with this attending but is unsure if it constitutes a microaggression. The student eventually decides to match into a non-surgical specialty. 

Takeaways:

• Medical educators are responsible for being aware of the far-reaching impacts of structural racism and how it may play out for learners in their teaching environments.

• Educators should be thoughtful about how students' identities may have tangible impacts on their ability to participate in the learning environment.

• This case demonstrates how a failure to consider structural racism within the medical context can lead to students feeling othered/unwelcomed/excluded from specialties they were initially excited to pursue.

Scenario: A second-year student who identifies as a cis-gender Afro-Latina (she/her/hers) joins her community mentor in the wards for Internal Medicine rounds. The student is excited that she will have the chance to observe rounds for the first time in her medical career. She is also nervous but feels reassured that another one of her classmates, who identifies as a non-binary white person (they/them), will be joining her as well. The two students introduce themselves to the inpatient team. As it is their first time working with this attending, they give a bit of background on themselves. The attending interrupts the second year and asks her if she is the first person in her family to become a doctor. The student was not expecting this question but responded that she was the first in her family to attend medical school. The attending nods and says, “I expected as much.” The attending does not ask the other student if they are the first in their family to complete medical training.

Impact: This student may now feel othered or singled out in this new learning environment. Given that the attending only asked the visibly non-White student about her family background, this may imply that non-White folx are less educated than their White counterparts. 

Outcome: The student felt uncomfortable about this comment and discussed it with a few of her peers at a Latino Medical Student Association meeting. Some folx told her that they had similar experiences with this particular attending. The student decides to report her concerns using the Learning Environment Survey anonymously. 

Takeaways:

• Displaying curiosity about your students’ lives is essential; it helps students feel welcome and valued and creates a positive learning environment. 

• Whether intentional or unintentional, racial bias can impact how welcome or safe students feel in the learning environment.

• As an alternative, ask both students the same question or ask something else: 

  • “How did you decide to become a doctor?”

  • “What was your favorite part of college?”

  • “What do your loved ones think about your decision to become a doctor?” 

Scenario: A fourth-year student who identifies as a cis-gender Indian male (he/him/his) is on a new inpatient team for his Internal Medicine sub-internship. The student introduces himself to this week’s attending on his first day. The attending chuckles and says, “There’s no way I’m going to be able to pronounce that. Is there a nickname you go by?” The student professionally explains that he would prefer to be called by the name he introduced himself, which is on his ID badge. The attending replies, “Well, I’ll try my best but no promises.” As the week goes on, the attending continues to mispronounce the student’s name despite being corrected by both the students and residents. 

Impact: The student feels less comfortable speaking up and asking questions during rounds given that the attending refuses to learn how to pronounce his name. The student tries his best to ignore the mispronunciation and wait it out until the attending is replaced with a different one the following week.

Outcome: The attending completes this student’s evaluation and the student receives a passing score for the sub-internship. The student wonders if he would have received better feedback had he felt more comfortable displaying his interests and skills around this specific attending. 

Takeaways:

• Repeatedly mispronouncing a student’s name constitutes microaggressions and shouldn’t occur. 

• Failure to respect a student's identity excludes students from the learning environment and may result in disengagement. 

• The instructor must respect a student’s chosen name regardless of the name's proximity to the English language. It’s inappropriate to ask if the student is willing to go by something else. 

• Here are some strategies you can use:

  • “Names are so important, and I’m worried I might mess up yours. I am determined to get your name right! Will you please correct me if I mispronounce your name?” 

  • Jot down a phonetic spelling of the person’s name and practice it

  • Use free websites like pronouncenames.com to hear a name several times

  • Be sure to share your attention (i.e. teaching, question-asking) among all students; skipping a student whose name you aren’t yet comfortable with is noticed by students and is exclusionary