This is the second voice from #BlackWomenInMedicine we are highlighting. To learn more about our mission to support black women in medicine and help bring more voices to light, we encourage you to read our first blog post in the series. #PathTwitter has a strong presence on the web and we hope you will take this opportunity to share this blog post and amplify these voices while reflecting on how you can bring equality to medicine.
We’d like to introduce you to Dr. Nicole Jackson (@NicoleJacksonMD), a Medical Examiner in Chicago, who talked to us in length about her experiences as a Black female pursuing a medical degree, beginning from high school and into her Fellowship. This is her story.
“Most people in my personal life - friends, relatives, educators, my own doctors - were neither surprised by nor doubted my future success in choosing a career in medicine. Like many other physicians, I was good at almost everything I did back in grade school - top scores on exams, leadership roles on multiple sports teams, competed musically and in the fine arts, and held long term leadership roles in community outreach volunteering,” Dr. Jackson said. She had all the right credentials, support from her inner circle and held leadership roles since grade school. Wouldn’t she be a shining star in high school, known to be destined for greatness in undergrad and postgrad? She continued, “Interestingly, the only doubt that was ever introduced to me was done so from guidance counselors and advisors. Since high school, they were the only ones that repeatedly questioned my ability to succeed in medicine. Think about that. These are non-medical people that serve as gatekeepers for passing from one phase of training into the next who, for whatever reason (not grades, not extracurriculars, not letters of recommendation), tried to dissuade me (and probably others that look like me) from pursuing medicine time and time again. It’s exhausting. It breeds unnecessary self-doubt. It helps create an Imposter Syndrome. These are things many minorities already fight coming into a predominantly White training environment. I would like to think that my experience is isolated, but numerous conversations with other underrepresented minorities lead me to believe it is not.
Fortunately, I have always been a bit headstrong - charging straight through any walls standing in my way. But that’s not everyone’s predisposition and this systemic problem is hampering the progress of underrepresented communities. Do we only want underrepresented minority physicians that are bull-ish like me or do we want a wide range of personalities and temperaments? Consider how many fantastic physicians and healers in their communities have been deterred by those in positions who chose to be a deterrent and give alternatives instead of support and resources.
I am in a transition point right now having recently completed Fellowship and about to start my career as a Medical Examiner. As such, I have been doing much reflecting on what and who it took to get me here - done with training, mentally intact, and ready to keep going. For many reasons I feel blessed to have made it to where I am today; there were so many unnecessary obstacles thrown at someone that came from a relatively disadvantaged background. Without delving too much into my family history, it is a near miracle I am here today - slavery to sharecropping to poor suburbs of Detroit to me. And not just me, this is the common trajectory of most Black doctors in America, still comprising around 5% of all U.S. physicians. As a first-generation college graduate I feel fortunate that I had an utterly supportive mother that was always there to lift me back up when others tore me down and who, despite not having higher education herself, believed in the importance of it. The positive voices of my mom and my community drowned out the negative ones. For this, I am blessed. There are others just as good and deserving, if not more so, that might only be hearing negative voices coming from within their training environment and give up. This needs to change.
In regards to stereotypes, I will say that aside from a few voices in undergrad and medical school, I never had any real issues. I have struggled with much internal conflict about not wanting to fulfill any stereotypes, which has pushed me to work harder so no one can call me lazy - ‘you will not outwork me’ is my personal mantra and even my biggest critic can’t deny my work ethic. Similarly, I have also given particular consideration to my appearance, timeliness, etc. so as not to appear “stereotypical,” which is perhaps consuming an unnecessary amount of energy in my life. I have absolutely been given unfair marks in training and have had very hateful comments made here and there based on biases from a few, but standing here at the end of my training I can say that while painful at the time they didn’t amount to much. I am fortunate for some were so pointed and cruel they could have ruined my career before it began.
When I switched into Pathology from General Surgery, I was fortunate to have two great mentors in medical school, both minorities. They were wonderful surgeons that helped me build my research experience and tried to throw my name in for consideration for Departmental happenings. Unfortunately, I trained at an institution that had a very stereotypical surgical department where women and minorities were not well-supported, so their voices weighed less than their majority counterparts. This shows that diversity is not enough. There needs to be a spirit of inclusivity and having all equally valued. Without that, there is no change, the status quo persists, and mentoring only goes so far as to steer others away to safer workspaces.
I was the first Black female graduate of my Pathology Residency and did not have any role models in Pathology until this past year, my Fellowship Year, where I considered all my Attendings role models and mentors. I spent a lot of time in Fellowship reflecting on why this tangible difference existed and on how, in the middle of the desert where there are hardly any Black people, I finally felt welcomed, included, and valued like the rest of my peers. Something I saw repeatedly throughout medical school and residency is not so much outright discrimination, but ‘people looking out for people who look like them.’ White men looking out for white men, foreign medical graduates looking out for foreign medical graduates, etc. - people making sure trainees that they identify with always have a piece of the pie. Likely done with a pure heart, this becomes problematic for underrepresented minorities because there is rarely anyone in leadership positions able to extend them the same courtesy, which then makes us a constant afterthought. I have found this particularly common in Pathology, which is probably one of the most diverse specialties in medicine. I did not find this in my Fellowship though. Everyone was addressed the same, presented with the same opportunities, and engaged on the same level. It was also during my Fellowship year that I found #MedTwitter and was surprised to be able to find physicians I consider role models across multiple disciplines.”
We asked, “What can we do to bring diversity into medicine? What needs to happen?” Dr. Jackson replied, “My story highlights how we can do better. A lack of role models and mentors stemming from a combination of lack of representation and inclusion, coupled with deterrents throughout training. So, how do we diversify and include? I think that the diversification of medicine and Pathology starts early - get them when they are young! I am a strong advocate of community outreach programs, making sure we are reaching out to diverse grade schools, undergraduate institutions, and medical schools. The main reason I am a doctor is that my local medical school reached out its surrounding public high schools (diverse schools!), sought out high performers, and invited them for a mini-medical school experience. That needs to be happening more and Pathology needs to be an integral part. I remember seeing the inside of the human body and instantly becoming obsessed. That is the perfect space for Pathology to insert itself - autopsy, forensics, microscopy. Specifically going into communities of color and schools of color is necessary. Pipeline programs are needed. Nothing exists in a vacuum, so part of this effort needs to involve addressing the things that keep underrepresented minority communities in America impoverished and enslaved. Do I necessarily think that’s the role of the physician or medical community? No, that’s not practical. But, all efforts at diversity will be harder until these things are addressed, which speaks to the role of the physician as an advocate.
Once we have diverse trainees, how do we keep them? They need role models and mentors of all kinds but until we reach a critical mass, they aren’t going to have that from people that look like them, so we need others to step up. We need people to give all trainees the same chance at opportunities for personal and professional development. I have no idea how you enforce that, nor do I have any idea how we rid the system of problematic advisors and educators. I think we have all sat through enough diversity trainings to know while good, they are not the answer.
I am not quite there yet but faculty support is needed. I keep seeing people of color thrust into roles to promote diversity and inclusion atop their baseline responsibilities without increased pay or shifting of other responsibilities. I don’t think it’s fair to say ‘Hey, we as a community have excluded you and yours for centuries and now that you’re here, go solve it. Oh, and do so without the appropriate time and financial support. K, thanx, bye.’ That’s what I keep seeing and it is not the answer. For there to be change in any minority community there needs to buy-in from the majority. I have seen people stepping up and stepping out in the wake of COVID-19, George Floyd, et al and entering strong advocacy roles for others, clearing space for minorities’ voices to be heard and talents to be seen. That is an excellent start and I hope that the momentum of this movement carries forward for a long time.”
We’d like to extend our sincerest gratitude to Dr. Jackson for talking with us and congratulate her on graduating Fellowship and beginning her new role as Medical Examiner. To other Black women in medicine, we’d like to share your story in our Voices from #BlackWomenInMedicine series. Please email me directly at email@example.com or message us on Twitter at @instapathbio. Stay tuned as we continue this series in the coming weeks.
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