Addressing a Difficult Subject
Anti-Black Racism in Medicine
A mentoring relationship helps incorporate the voice of the patient in bedside care.
“Having a mentor is like having someone to take you up on an elevator,” says Matthew Burke, a third-year student at Meharry Medical College in Nashville, Tennessee. “Now I’m ready to go back to the lobby and help someone else up.”
Burke spent the summer of 2021 as a virtual participant in the Stanford–Historically Black Medical Colleges (HBMC) Summer Research Program, established by the Stanford Department of Medicine in 2017. He was matched with his mentor, Samantha Wang, MD, clinical assistant professor of medicine, through pure luck.
“When I was accepted into the program, I had to identify which area of research I was interested in. I knew I didn’t want to do laboratory research, but I had little experience with other areas that were considered research opportunities. Social issues? Healthcare policy? Community outreach? I had no idea that research was possible in those arenas, so I checked them all,” he explains. “That’s how I was matched with Dr. Wang!”
The relationship he established with Wang flourished because of the research project she was pursuing: understanding the difficulties of teaching students how structural racism affects clinical decisions and whether educators could teach that subject at the bedside.
“Many clinicians already knew health care was not always equitable or fair,” Wang says. “But it’s only recently that we’ve become willing to consider how we inadvertently contribute to those disparities.”
She wanted to incorporate the voices of patients who have experienced health care in a disadvantaged community. “But I wasn’t sure if talking about racism with one’s doctor, at the bedside, would make the patient uncomfortable or if it would enhance the patient’s trust in that doctor,” says Wang. “It’s such a sensitive topic.”
“I immediately identified with these concepts,” recalls Burke. “As a Black man, I have firsthand experience seeing the prevalence of hypertension, diabetes, obesity, and cardiovascular disease in our community. This, coupled with a lack of trust for health care providers, is common among the underserved,” he says.
“Dr. Wang opened the world of research to me... she fostered my curiosity by recognizing any question I asked as valid. Her support helped push me into considering public policy research as part of my career path.”
– Matthew Burke
“Many clinicians already knew health care was not always equitable or fair... But it’s only recently that we’ve become willing to consider how we inadvertently contribute to those disparities.”
– Samantha Wang, MD
The Five-Minute Moment for Racial Justice
Wang’s research stems from the foundation built by Stanford Medicine 25’s Five Minute Moment for teaching at the bedside. This Stanford Medicine education initiative focuses on teaching physical exam skills. She adapted a teaching framework for the physical exam to create the Five Minute Moment for Racial Justice. This is a curriculum designed to standardize discussing how racism affects the ways that physicians diagnose, evaluate, and treat patients, and how it contributes to health disparities especially among Black patients.
Understanding Patients’ Experiences with Anti-Black Racism in Health Care
“Once the framework and curriculum were completed, I wanted to determine how Black patients would feel about discussions around race during their interactions with physicians,” Wang notes. “That’s where Matthew’s project evolved.”
Mentee Burke’s assignment was to seek input from the Community Advisory Board (CAB), comprising minority patients and health care professionals from Oakland, California; Leeds, Alabama; Nashville, Tennessee; and Rochester, New York. With Wang serving as his guide, he sought to understand patient perceptions about how racial bias affects health care, including CAB members’ own experiences of health inequity with their doctors.
Burke created and led focus group discussions on this subject with CAB members. His findings concluded that relating personal stories of structural racism in health care not only was supported by most CAB members but could also increase trust in the physician who was asking those questions. One caveat: All CAB members agreed that they wanted to be asked first if having that conversation would be acceptable before launching into it.
Burke summarized the results in a poster and presented his findings at a meeting of the American Academy of Medical Colleges in Washington, D.C. “It was thrilling to see Matthew so excited about presenting his work to people outside of Stanford and to see people so interested in what he reported,” recalls Wang. “The experience boosted his confidence and empowered him to see that he is capable of achieving many great things in the future.”
About her role as a mentor to Burke and to other students, Wang comments, “It’s rejuvenating to share your work with fresh minds that are excited and interested in the project and the future of medicine.”
Mentoring Future Leaders
The foundation for creating a mentor-mentee relationship is often grounded in a specific project, such as an educational innovation, a research paper, or a poster. The end point in some minds is a tangible product or the answer to a specific research question.
But Wang feels the most important component of mentoring someone is the relationship itself, not the end product. “The mentor should serve in a nurturing role, independent of his or her own academic interests. My goal in working with Matthew was to create a good experience for him, giving him autonomy to develop his own skills — not just delegating tasks to him that would further my own research.”
When she was in medical school, Wang recalls, “no one talked about structural racism; we considered broad areas like social determinants of health and left it at that. But talking about it is the only way we can begin to move to increased equity.”
As for the research that Burke carried out, Wang says it was important to have someone leading the focus groups who shared a lived experience with the people in the room.
The mentor should serve in a nurturing role, independent of his or her own academic interests.
– Samantha Wang, MD
Big Dreams can Change the World
“Matthew Burke and Samantha Wang demonstrate the dynamic nature of the mentor-mentee relationship as it evolves into a collaboration supporting a common goal,” says Sonoo Thadaney Israni, MBA, executive director of Presence and its program in bedside medicine. “It helps both participants to view the world through a different, shared lens.”
The long-term goal of Presence, in collaboration with Stanford Medicine’s REACH (Racial Equity to Advance a Community of Health) Initiative, is to have a network with Stanford, Morehouse, Meharry, Howard, and Charles R. Drew University — all historically Black medical colleges — so that residency, education, clinical care, and community engagement can easily collaborate across all institutions.
“We envision a bidirectional faculty program that collaborates on all the issues related to justice, equity, diversity, and inclusion (JEDI),” says Israni. “In that world, for example, the Community Advisory Board would serve researchers on all five campuses and could be called upon to advise numerous racial justice research programs.” She believes this streamlining could create a more efficient approach to research, since the infrastructure would be in place and not a separate silo for each project.
Israni already sees progress. “When we meet with mentors and mentees, we hear discussions about research in new areas, with new perspectives informing the focus of that research.”
She feels that if we want our clinical world to be representative of the population it serves, we need to think bigger and broader. “Mentee Matthew Burke will change the world because he learned to think big from his mentor, Samantha Wang,” she says.
“Dr. Wang opened the world of research to me,” says Burke. “She fostered my curiosity by recognizing any question I asked as valid. Her support helped push me into considering public policy research as part of my career path.”