... depict the crisis of racial prejudice in America.
J. B. Clemmons, MS iv.
The Medical Education System and the Third World Medical Student
The medical school is a massive organism which apperars omnipotent
and immortal. The great brontosori, however, did also. They succumbed
when they could not adapt to changes in the climate of their environment.
The medical school projects a monolith of tradition stabilized
and based in an ominous and unshakeable foundation. Rome, the
center of the world, fell when its traditions could not find sufficient
plasticity to incorporate the cultures of its' non-Roman citizens,
who were arbitrarily labeled barbarians.
Today, there's a changing climate in racial self-images and
mutual perceptions, concommitant with a shifting attitude in the
political traditions of America. Whites have gone through a period
ranging from pompous "White-man's burden" to a groveling, masochistic
liberalism in expiation of white man's guilt, to a present backlash
sentiment of If-ever-I-was-that-guilty-and-I-doubt- it-I-have-penanced-enough.
Blacks, in turn, have concurrently with the changes in self-appelation,
passed from "Sho'-nuff-boss" coloreds, to integrationist Negroes,
to self-determination Blacks. Since both races seem to be girding
their loins as if to war, Black students, as highly visible defenseless
targets in a bastion of institutionalized white power, easily
fall prey to onslaughts by manipulators in either camp.
First of all let me state that in a very real sense there
is no such thing as a Black student within the perceptions of
white faculties. Student implies a person at study, whose business
is study. Seldom, if ever, is the Black student viewed as a person.
Most often, he is an object, a symbol.
To the more malevolent whites, he is at best an object to
supplement income ... ... ... research grants. To moderate-liberal
whites, he is an object-tool for alternate behaviors of guilt-
expiation (masochistic liberalism) and racial chauvanism (sadistic
liberalism). To the more liberal racists, he is a dark-colored
white. The latter is especially difficult for the Black student
to effectively rebut because on the one hand, he must maintain
ties with those who can give him any aid, while on the other hand,
he is forced to reprimand friends who would deny basic cultural
and moral antagonisms between Blacks and whites.
It is the depersonalization and attempted albinizing of Black
students which is the crux of almost all problems Black students
have in white medical schools. Another important component is
long term exposure to white culture without reference to sufficient
Black culture i.e., a problem of cultural toxicity rather than
The decision to become a physician is not an easy one for
Black youth. Medicine, as with any managerial position, has been
racially- sexually stereotyped as a white male occupation.13Therefore,
there was some realism in the discouraging sentiments with which
Blacks, heretofore, used to pressure their peers who voiced a
preference for a doctorate, as fantasy. Even today, the change
in self-image of Black people is in such a recent past that most
of my contemporaries, and many who are younger, have not overcome
stereotypic imaginations - they can only dream dreams which they
have been allowed to dream.
From what roots then did those Black students who are now
in medical school come? A knowledge of their past could be used
in the present, to formulate approaches of medical education,
which will produce, in the future, sufficient competent health
manpower to close the gap between health care to whites and health
care to Blacks.
In 1970, the Student National Medical Association (SNMA),
and the Association of American Medical Colleges began to collect
data "designed to identify, characterize, and evaluate current
trends in the recruitment and retention of minority group students
as well as to analyze the socio-economic, academic, geographical,
personal, and institutional factors that affect the progress of
minority students in medicine.10
The researchers found much data which wrecked some basic
assumptions about Black students that white administrators had
long held as facts from which to develop policies.
Among white college freshmen, "doctor" is one of the most
common career choices 11; it was assumed that at least six percent
of Black college freshmen would also have medicine as their career
choice. These students would form the applicant pool for white
medical schools to select three-quaters of their number and thus
overnight bring the enrollment of Black students in medical school
to the 12% level.12The assumption considered neither the realities
that two t.v. ads and a college recruiter are insufficient to
overcome the entrenched wariness of Blacks toward whites bearing
gifts nor the fact that it's easier to put out a press release
endorsing 12% minority enrollment than to overcome the inertia
of admissions committees and the racism of public opinion. Thus,
the study found that among Black freshman entering college in
1966, only 5.6% were pursuing medicine and that by 1970 only 2.6%
of Black college freshmen were so inclined.13In addition, the
total number of Black college freshmen is significantly lower
than what the AAMC predicted.
Had the study delved deeper into what forces influenced those
students to desire to be physicians and its' temporality they
would have found little correlation between onset of the desire
and any recent advertising campaigns or p.r. releases genterated
by a new liberality in medical schools. What they would have found
was that Black students are drawn to medicine for quite same reasons
white students are; the use of medicine merely as a tool for upward
mobility is not significant.
What is significant is a spirit of service and a commitment
to pursue a career that will equip him to serve his people.15
Neither would the study have found that this decision to become
a physician was a lightly made one. Many students state that they
can remember desiring to become doctors in early high school or
even earlier. Therefore, by the time these students entered college
they had already run a severe guantlet of counter-pressure against
their goal of becoming physicians. They had already successfully
disregarded peer group pressure against their becoming physicians;
they had already successfully overcome the negative counseling
of high-school counselors; they had already begun to incorporate
behaviors which analogous to the white student are isolation,
intellectualization and counter-phobic.
While in college the student is faced with stresses which
will become more acute in medical school. As he encounters the
initial self-imposed isolation, mutual alienation from his community,
the pressure to abandon medicine becomes increased both by his
own community and by those designated pre-medical advisors by
his college, especially if the student attends a predominantly
white college. This may be he explanation of why 45% of Black
applicants were from predominantly Black colleges in 1971.16It
is also a partial explanation why two out of three Black freshman
college students withdraw themselves from the applicant pool before
they give the medical school a chance to evaluate them.17In the
Black schools there does exist the encouragement of a larger reference
group with which the pre-medical student can identify.
Those students who finally do submit their names do so with
the dual burden of tremendous anxiety, as a result of long years
violating the cultural morms of their peer group and with a certain
sense of defiant courage that those long years of study were not