Graduating from medical school during a pandemic has been a tumultuous experience. My colleagues and I sat modified exams, cancelled our electives, held our graduation ceremony on Zoom, and were fast tracked into interim foundation year (FiY1) posts. Some of the hurdles we faced were unavoidable in the face of a crisis while others revealed deeply entrenched systemic failures.

The news of our early recruitment into the NHS gained a lot of media attention. The new doctors were praised in articles and posts made by our university, local hospitals, and news outlets. Yet despite having over 50% of our medical school cohort to choose from, I did not see a single interview or photo of a black or ethnic minority doctor included in any news reports.

A few weeks earlier, our online graduation ceremony had been interrupted by an intruder who shouted racist and aggressive language—including the ‘n’ word—as students’ names were called. What was intended to be a beautiful celebration of the last six years quickly turned into an unsafe space for many Black students. 

These are not isolated cases. Across the UK there continue to be reports of black and ethnic minority medical students and doctors experiencing racism from patients, colleagues, and staff, most of which goes unacknowledged and unreported. [1] An investigation by The BMJ earlier this year reported that “only half of medical schools collect data on students’ complaints about racism and racial harassment […] and since 2010 they’ve recorded just 11 complaints.” [2] A few months previously the Equality and Human Rights Commission reported that a third of universities had received no complaints of racial harassment from students over a three year period. Only a minority of complaints that had been made were upheld and offered redress, and two thirds of students who had experienced racial harassment had not reported it. [3]

During this pandemic I have seen students from different ethnic backgrounds set up volunteering schemes from scratch, take up FiY1 posts, and give up their time to work for the NHS yet it seems to me that they have received less recognition compared to our white peers from the media. 

There have been many reports of black and ethnic minority doctors, healthcare professionals, and patients dying disproportionately and Public Health England have recognised racism as being a root cause. We are only now starting to see “beyond the data” into the personal stories that have remained largely unheard. [4,5]

For many years I have used the term imposter syndrome to describe the heartbreak I feel when I am reminded that I might not belong. Imposter syndrome refers to “The persistent inability to believe that one’s success is deserved or has been legitimately achieved as a result of one’s own efforts or skills.” [6] I realise now that labelling this as a syndrome internalised its root instead of identifying the cause as within my environment.

As someone who started their life as a refugee I have never questioned whether I deserved becoming a doctor. I know I worked hard to make the transition from “illegal immigrant” to “good immigrant” just like my parents taught me. [7] However, as an Asian doctor who has been working through the pandemic, I have felt as if it does not matter how hard people like me work, we seem to always be pushed into the shadows.

Universities have a responsibility to nurture and encourage black and ethnic minority voices. While it is important to increase representation with widening participation programmes and scholarships, it is crucial to ensure that when we arrive we are not forgotten, overlooked, or worse.

In February, the BMA launched a charter to prevent and address racial harassment, which some medical schools have signed up to and hopefully the rest will follow. [8] My own university, University College London, has committed to eliminating the awarding gap between undergraduate black and ethnic minority and white students by 2024. [8] In light of global pressure to address anti-blackness and racism, we have established a Race Equality Advisory Group and renewed support for existing Equality Diversity and Inclusion groups.

These are steps in the right direction, however much of this work is done by already overstretched staff and students who do not always receive the recognition they deserve. In the UK 40% of medical students but only 13% of medical school staff are from ethnic minority backgrounds. [2] This means that even when concerns are heard or constructive efforts are made the impact can be dampened by ignorance and systemic racism.

Many medical schools have released statements in support of Black Lives Matter, but they cannot stop there. Equality and inclusivity are not simply about ticking boxes. All medical schools need to look inwards at the structural anti-blackness and racism that dominates every aspect our culture. To make real change we need to stop proclaiming that we are “not racist” and start taking an anti-racist approach, which gives black and ethnic minority staff and students a voice and a seat at the table.

Nazanin Rassa is a Interim Foundation Year doctor at the Royal Free Hospital and graduate from University College London Medical School. 

Competing interests: none declared.

 

 

References:

1. Munn F. Reporting racism on the wards. BMJ 2017;359:j5178 doi:10.1136/sbmj.j5178
2. Kmietowicz Z. Are medical schools turning a blind eye to racism? BMJ 2020; 368, m420. doi:10.1136/bmj.m420
3. Tackling racial harassment: universities challenged. London: Equality and Human Rights Commission; 2019. Retrieved June 13, 2020 from https://www.equalityhumanrights.com/en/publication-download/tackling-racial-harassment-universities-challenged 
4. Cook T, Kursumovic E, Lennane S. Exclusive: deaths of NHS staff from covid-19 analysed, Health Service Journal, April 22 2020. Retrieved June 13, 2020, from https://www.hsj.co.uk/exclusive-deaths-of-nhs-staff-from-covid-19-analysed/7027471.article 
5. Public Health England. Beyond the data: understanding the impact of covid-19 on BAME groups. Jun 2020, from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/892376/COVID_stakeholder_engagement_synthesis_beyond_the_data.pdf
6. Imposter syndrome, n. OED Online, Oxford University Press (June 2020). Retrieved 13 June 2020 from www.oed.com/viewdictionaryentry/Entry/11125 . 
7. Shukla, N. The Good Immigrant. London: Unbound; 2017.
8. A charter for medical schools to prevent and address racial harassment. British Medical Association; 2020. Retrieved June 13, 2020 from https://www.bma.org.uk/advice-and-support/discrimination-and-harassment/racial-harassment-in-medical-schools/racial-harassment-charter-for-medical-schools.
9. BAME Awarding Gap: new staff toolkit, UCL; 2020. Retrieved June 13, 2020, from https://www.ucl.ac.uk/teaching-learning/news/2020/may/bame-awarding-gap-new-staff-toolkit