Dr Dixon’s essay in the July 2020 issue of the BCMJ[1] is a powerful reminder of our need to consistently reflect on our positionality in the field of medicine and, more importantly, as part of our overall moral compass. The challenges she discusses both as a Black physician and through witnessing the care of Black women in the Canadian health care system cannot be tolerated. 

A key point is the critical need for more Black physicians, so that Black patients feel that their physicians represent them and can understand their unique cultural values and experiences.[1] Recent research[2] highlights the enormous benefits of patient-physician concordance on health care outcomes for minority populations and shows that it can reduce widely held biases, boost effective communication, and increase trust. More importantly, this research found that when Black physicians cared for Black newborns, the newborn mortality rate can be reduced by half.[2]

While creating greater support for Black students to enter medical school is just a small part of our collective battle against racism, it is a clear step in the right direction. Thus, medical schools in Canada have a responsibility to ensure that Black students have the best opportunity to matriculate and be successful in medicine. It is important to recognize that the lack of equitable representation among medical trainees is a huge barrier to building an efficient and inclusive health care system in Canada.

We must acknowledge and reflect on previous barriers that have been set up by Canadian medical schools against Black students. An example of a direct barrier in Canadian history is Queen’s University’s official ban preventing the admission of Black students that was enforced from 1918 to 1965.[3] However, it was not until very recently, in autumn 2018, that this ban was officially revoked.[3] This example provides a sense of the discrimination that Black students have faced and continue to face when entering medical school. Additionally, some of the barriers described in the literature for Black applicants entering medicine include enormous financial difficulties, the complex nature of admissions, and unsupportive advisors.[4] Hence, we can understand that there are plenty of challenges that Black applicants face when applying to medical school. Moreover, evidence[5] from examining the bias of medical school admissions committees shows statistically significant (p < 0.05) race bias among admissions committee members favoring White applicants. Long-standing racism, significant barriers, and the bias of admissions committees underscore the need for alternative pathways that minimize negative biases to successfully admit Black students into medical school.

Of the 17 medical schools in Canada, only four have optional entry paths that separate Black medical students from the general stream [Table [12]]: the University of Toronto, the University of Western Ontario, the University of Calgary, and the University of Alberta. These separate entry pathways are important to ensure that Black students are evaluated in a holistic manner free from negative biases,[5] as evaluators are composed of Black community members and faculty. It is important for these pathways to be expanded to all 17 Canadian medical schools. Canadian medical schools should take a collaborative approach, developing programs among each other and in consultation with Black applicants, community members, and faculty, so that we can truly listen and support Black applicants in the best way possible. It should be a responsibility of all medical schools in Canada to ensure that they create and consistently evaluate programs that allow Black applicants to become successful in entering medicine.

Alternative entry pathways are important to support Black students matriculate into medical schools. However, we must remind ourselves that these pathways constitute only a small part of our overall approach in dismantling the systemic racism that is present in Canada; it is necessary to bring innovative and forward-thinking solutions to this long-neglected health care disparity. Much larger systems-level changes tackling racism are needed as well.[1]
—Nilanga Aki Bandara, BSc
Vancouver
—Vahid Mehrnoush, MD
Vancouver
—Ricky Jhauj, BKin
Vancouver

This letter was submitted in response to “Anti-Black racism in medicine and in our glorious and free nation.” [13]

References

1.    Dixon M. Anti-Black racism in medicine and in our glorious and free nation. BCMJ 2020;62:205.

2.    Greenwood BN, Hardeman RR, Huang L, Sojourner A. Physician-patient racial concordance and disparities in birthing mortality for newborns. Proc Natl Acad Sci USA 2020;117:21194-21200.

3.    Vogel L. Queen’s to redress harms of historic ban on black medical students. CMAJ 2019;191:E746.

4.    Hadinger MA. Underrepresented minorities in medical school admissions: A qualitative study. Teach Learn Med 2017;29:31-41.

5.    Capers Q, Clinchot D, McDougle L, Greenwald A. Implicit racial bias in medical school admissions. Aca Med 2017;92:365-369.