The Black community makes up about 8.4 per cent of the GTA population but accounts for only one to two per cent of all medical students at the University of Toronto. This current paucity of Black students in medical school and in health care is alarming.
Chika Oriuwa is the only Black student in a class of 259 first-year medical students at the University of Toronto. She said that learning to adjust had been a process. “I think that there was a process where I was a little bit disillusioned in a sense… Getting through that process [was] realizing that it was a similar environment [to what I had experienced in my undergraduate years].”
Correcting the Issue
To increase the diversity of their medical program, U of T has announced an initiative called the Black Student Application Program (BSAP). Inspired by ISAP, U of T’s application stream for Indigenous applicants, BSAP seeks to attract more Black medical school applicants.
BSAP does not mean that spots are guaranteed or reserved for Black applicants. Black applicants must still meet the same rigorous academic and extracurricular requirements as students applying via the regular stream. This is the case despite studies having shown that the Medical College Admissions Test (MCAT) disadvantages ethnic minorities.
U of T requires all students to meet a score of at least 125 in each of the MCAT’s four sections. This admission process looks at MCAT scores differently from other schools in Ontario.
“U of T uses MCAT as a minimum threshold score; it is not looked at on a competitive scale,” said Dr. David Latter, Director of MD Admissions for the Faculty of Medicine.
What this means is that once BSAP applicants have met this minimum score, like all other applicants, their applications can move onto the next stages — file reviews and interviews.
One of the major differences between BSAP and the regular application stream is that these next stages are conducted by a team that includes members of the Black community. “In this way, there may be less room for unconscious or conscious bias,” said Latter.
But there still may be those who misunderstand the aim of the program. One of the challenges that the program may face, Oriuwa said, is that “other people may interpret and criticize the program for the work that it is trying to do… Maybe, people might have certain presumptions or assumptions about students who enter the program.”
Therefore, maintaining transparency and educating people is essential to increasing the success of the program.
Why is diversity in medicine important?
A lack of diversity in medical classrooms translates to a lack of diversity in health care. The cultural discordance between physician and patient means that this interaction does not always produce the best outcomes.
This is especially concerning because Black Canadians experience higher rates of certain afflictions, including HIV/AIDS, diabetes, sickle cell anemia, and strokes than their white counterparts.
Increasing diversity among health care professionals can provide underserved minorities with greater or improved access to healthcare, and potentially increase doctor-patient trust.
In the long-term, diversity in health care can improve and sustain patient-physician interactions, making them meaningful and positively impactful, not only for Black or First Nations individuals, but for other ethnic minorities as well.
“Greater diversity in medical classes leads to doctors with a greater ability and sensitivity to serving diverse communities,” said Latter, “Ensuring many different ethnic and racial groups within the profession also broadens the scope of care and concern for unique health conditions that affect specific populations.”
The American Journal of Public Health published a study that found that “implicit racial bias and stereotyping of patient compliance” were correlated with negative experiences for Black patients and positive experiences for their white counterparts.
In another study published by the Proceedings of the National Academy of Sciences, students at the University of Virginia, in believing that Black people had a higher tolerance for pain than white people, said that they would be less likely to prescribe painkillers to Black patients.
The University of Toronto understands that all students must have some level of cultural awareness if they are to be competent doctors. U of T is trying to incorporate more cultural awareness in its courses to better equip students with the tools they need to serve underserved minority communities.
“It can be frustrating… if you don’t see yourself reflected… in a lesson or [if] you don’t think that it translates necessarily to some minority groups,” Oriuwa pointed out.
At the same time, she said that the opportunity to increase cultural awareness can also be empowering for her: “There’s been a number of times where I’ve become acutely aware of my identity and that in and of itself can sometimes be empowering in a sense, when you have a lot to offer to [the] discussion.”
Creating a better sense of community, therefore, means that more dialogue can be generated among different people. For Oriuwa, who, as a member of the Black Medical Students Association, helped with the launch of BSAP, community and support networks have also been integral to her medical school experience. “There were some amazing mentors that I had in the program, like Ike Okafor… [and] I also joined the BMSA, which is a very good support system and network.”
She gives back to the community by doing outreach programs, observing that the social capital within the Black community “is currently at a deficit.”
Promoting medicine as a career path early on
U of T has also implemented outreach programs to recruit Black high school students and create a better sense of community.
The Summer Mentorship Program (SMP) provides high school students with Indigenous or African ancestry the opportunity to explore the field of health sciences at the University of Toronto. For a period of four weeks in July, high school students are mentored by professionals in the field and also get hands-on experience in the lab.
It is important to target students early on. Although it is now less than the former 40 per cent dropout rate, Toronto’s Black youth are still dropping out at a higher rate than other youth at roughly 23 per cent. This means that even before their undergraduate careers, some Black students have been eliminated from the potential pool of medical school applicants.
In the United States, studies have shown that the educational disparities between Black and white students are evident early in their academic careers. If this kind of data could be collected for black Canadian students, Toronto might be better equipped to address the lack of diversity in health care.
SMP has been around for over 20 years. While the initiative is implementing positive change, the paucity of Black students in medical school suggests that outreach programs can still be improved upon.
To create this sense of community, U of T has also implemented the Community of Support (CoS), which encourages more ethnic minorities to pursue a career in the health sciences. CoS offers advice and guidance throughout the medical school application process and events or programming so that students who want to pursue medicine do not feel alone or overwhelmed.
Supporting diversity throughout the degree
Latter also said that it is important to continue to support Black students even while they are in medical school. “We are working to develop a Diversity focused office. This will include programming for Black students. Our focus will be on offering mentorship opportunities and increased visibility of Black physician role models,” he said.
Part of this focus means that U of T is interested in working with Black student clubs and the Black community to accomplish this long-term goal of diversifying medicine and health care. As Oriuwa pointed out, “U of T is making great strides in its ability to be more accepting in how it’s teaching medicine.”
The university is working with the Black Physicians’ Association of Ontario, the Black Medical Students Association, UME Enrolment Services Office and other groups so that diversity in medicine can finally become a reality.