Reflecting and Progressing Forward: A Chat with Two Incoming Interns

27 Jul 2020

By Elisa Atamian, MD, MS, and Joy Ayemoba, MD, MSc

When I (Elisa) volunteered to write for the AWS blog over 7 months ago, I assumed I would submit a piece that reflected on my experience as an Integrated Plastic Surgery residency applicant. Over the course of the past month, with the uprising of the Black Lives Matter Movement, I realized that this space could and should be used differently.

In recent days I’ve seen the trending hashtag on our beloved Med Twitter, #ShareTheMicNowMed. I was inspired by this movement that was amplifying the voices of Black Women in medicine. I was also struck by the realization that we (White women) should not just be “sharing” the microphone on our own social media channels… Black men and women have been sharing their successes, joys, and hardships for years, and it is our duty to seek out their stories. The voices have always been there.

With that being said, I was honored to have my former classmate and now surgical colleague, Joy Ayemoba, join me in contributing to this blog post. We are both incoming surgical interns. Dr. Ayemoba will be starting her surgical career as a General Surgery Resident at the New York Presbyterian Brooklyn Methodist Hospital. I (Elisa) am heading to Zucker School of Medicine Hofstra/Northwell as an Integrated Plastic Surgery Resident. We discussed our paths to this point, and what our roles are as physicians in the midst of a historic movement and dismantling of systemic racism.

Reflecting on Our Paths 

Elisa: When asked about my interest in Plastic Surgery, I will always bring up my mentors. The moment I established a successful mentor relationship was the moment I felt comfortable and supported in pursuing my dream. So much of my path has been shaped by my mentors, including my interests, research endeavors, away rotations, and clinical experiences. Something that I have taken for granted is the opportunity to see myself in many of my mentors. We often shared the same hometowns, the same passions, and, the same skin color. Drawing attention to my privilege, and the privilege other white medical students and residents share, is vital in dismantling the systems that prevent my Black colleagues from finding mentors and role models that look like them.

Joy: My decision to pursue a career in General Surgery took much self-reflection in addition to trial and error. Like many individuals identifying as Black, Indigenous and/or People of Color (BIPOC), I stand as the first physician within my family. Finding mentorship has been a challenge I’ve endured long before entering medical school. Once I decided on a career in medicine, I remember being disappointed by the lack of Black physicians within my community. Although I had hoped to see improvement in medical school, the truth is I had more or less the same experience. In 2018 the AAMC reported that 5% of all active physicians self-identified as Black or African-American. Within surgery, these numbers were dismaying when focusing on Black women. A recent study found that less than 1% of all current academic surgical faculty are Black women.  Furthermore, Black women are less likely to receive NIH grants, tenure, and less likely to be made department chair. Understanding that pursuing a career in surgery as a Black woman meant becoming a minority within a minority, I realized that I had to readjust my expectations and try and find mentors who reflected some other characteristic or interest I possessed.  Although I navigate within this country as a Black woman, I could not and did not expect to find a mentor within my medical school who could completely understand the challenges I experienced. This is not to say that I had ‘bad mentors’. I have a wonderful support system, and I remain so immensely grateful and fortunate to have found a group of mentors who advocated for me and advised me to the best of their capabilities. What I mean is that as a Black woman interested in surgery, finding a Black female surgeon within my institution felt like an impossible task. As students, we long to see some future version of ourselves within our mentors. It gives us hope that we too can accomplish our goals. But what does it mean when you struggle to see yourself within the present structure of leadership? How does lack of diversity AND inclusion affect the goals that underrepresented students set for themselves?

Acknowledging the Landscape

As we enter a new chapter of our lives, we have an important role in bringing to light the practices that perpetuate health inequities based on race. At the most basic level, countless diagnostic algorithms and practice guidelines used in the medical field raise racial equity concerns. In Louisiana, 76.9% of patients hospitalized with Covid-19 and 70.6% of those who died were black, though Blacks comprise only 31% of the population of the largest health system in the state. In two of our nation’s largest cities—Chicago and NYC—a recent study found that Black and Latino residents had significantly increased odds of infection and death from COVID-19 compared to white residents. 

The AAMC found that 40% of first- and second-year medical students believed that Black skin is thicker than white skin. But these wrongly held beliefs don’t end in medical school. One study found that 50% of medical students and residents it surveyed held some false beliefs regarding biological differences in Black patients. These beliefs translate into continued poor practice, as we see that Black patients are less likely to receive analgesics in the ED (57% v 73% for whites).7 Moreover, even when dealing with children the disparity remains apparent.

Understanding the current landscape and the racial biases that are deep-rooted in medical culture is crucial in ensuring patients receive the best possible care. By increasing diversity within our medical schools and residency programs, our cycle of health inequity can be broken. Trainees today become the attendings of tomorrow.

Where do we go from here?

We want to shift the focus to actionable items: required historical readings, implicit bias training, diversification of leadership, mentorship programs for underrepresented minorities in medicine. Together we can create change and transformation in the world, especially in the medical field, but we must all put the work in! We must listen to our patients, educate our colleagues, study the history, understand the statistics, and have the difficult conversations that are necessary. We must support our Black colleagues and not only “share the microphone,” but also give them the entire stage.

Elisa K. Atamian, MD, MS, is originally from New York, NY. After receiving her undergraduate and graduate degrees in Human Physiology at Boston University, she spent a year in NYC completing a research thesis at NYU which discussed DNA damage leading to infertility. She recently graduated from Tulane University School of Medicine, where she developed her interest in Plastic Surgery. She is currently a first year Integrated Plastic Surgery Resident at Northwell Health. Elisa is also a former member of the AWS National Medical Student Committee, where she served as the South Regional Representative for two consecutive years. Follow her on Twitter at @elisaatamian and Instagram at @drelisaatamian.

Joy Ayemoba, MD, MSc, is originally from London, United Kingdom. She completed her undergraduate studies at the University of Chicago. After obtaining her BA, she returned to the United Kingdom to complete her graduate degree in Social Epidemiology at the University College London (UCL). She then worked as a research statistician/epidemiologist at UCL before enrolling at Tulane University School of Medicine. At Tulane, she developed an interest in General Surgery and further understanding the relationship between surgical outcomes and health care inequalities. She is a  first year General Surgery resident at New York Presbyterian Brooklyn Methodist Hospital.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

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