Dr. Hardin’s Stories of Diversity

Amanda Chang shares her personal experience as a minority at a non diverse residency

Dr. Frances Mei Hardin: Welcome to this week’s episode of Promising Young Surgeon. I’m really excited to chat with you guys today about my personal experience as a minority at a non diverse residency training program. And so, again, these are just stories about training in a setting that’s not that diverse. For background and context, I am a 6ft tall half Asian woman. you know, I can no longer count on one hand the number of times where a patient or a patient’s family member has stopped me, like, in a hallway, to say, you are, wow, you are the biggest Asian I’ve ever seen. And so, as you can imagine, kind of an unusual claim to fame, not necessarily one that, like, young women are looking for, but. But that is what we’re dealing with. That. That’s what I have to work with. So unless I’m wearing sunglasses, I do not pass for a white person. And so I really stood out in a small, midwestern college town where there wasn’t a ton of diversity represented in that hospital work environment. And so, yes, sharing some stories today, you know, personal experiences, of course, all names in stories are changed. And, you know, let’s. Let’s dive right in. During my residency training, there were no other Asians in the program until I was a fourth year resident. And by the time that I became a PGY four, we actually had a young female Asian join as an intern or also aka a PGY one. And we’ll call her Amanda Chang, for the purposes of this story. So, as I mentioned, you know, just in terms of a little bit of context, not many Asians in this hospital, nor this town, certainly. It was a less diverse setting than other hospitals that I’d worked at at earlier levels of training as residents. We would cover cases at this outpatient surgery center that was kind of across the street from the main hospital. that was an addition that came on when I was about, like, a third year or so. So we hadn’t been operating there for years and years and years, but it was a beautiful new center, and we started doing outpatient cases there. There was a woman who was an or administrator, and we will call her Katie for the purposes of this story. So, again, Katie was admin. She was a petite, very friendly, middle aged white woman. And, you know, even in the years that I was occasionally covering cases over there and things like that, she’d say, hi. occasionally residents do need to go to or administration just to make requests about, like, case order, moving cases, adding cases on things like that. So certainly residents typically would have, like, a relationship of some nature with, surgery center administration, especially as you start to move up in the years and things like that. So, I was part of a relatively small, small to medium sized ENT department. But by the point that we’re getting into this story, there were eleven ent residents total spread across five years. And so, as I mentioned, I’m a fourth year. We do have a first year ENT resident, and we are really, like, the only two Asian residents that I knew of in the hospital at that time. And yes, we’re in the same department. What you really need to know about Amanda changing the first year resident in our department is that she was chinese. She looked absolutely nothing like me in any sense. you know, I don’t know how to say this in a way that’s even like, not cyberbullying myself, but I am the width of two amandas. Our silhouettes are very different. Like, our gates are different. hair color is different. And I have what people used to call swimmers shoulders back in the early two thousands. Amanda has normal shoulders. You know, again, I could just go on and on and on. We are really, not doppelgangers. Okay?

A resident’s phone rings during endoscopic sinus surgery

So I feel like I’ve set the scene one day. I had a couple cases that I was covering at that outpatient surgery center. You know, I’m fourth year and I’m in a sinus case. It’s like a very standard. This is endoscopic sinus surgery. It’s definitely part of the bread and butter, what we do. in general, ent and also certainly ent residents. And in this scenario, you know, by the time that somebody is a PGY four, it is very appropriate that the senior resident would be doing this case. You know, I was scrubbed in. I was the one handling all the instrumentation. it was, like I said, a very straightforward fest. So this is our bread and butter. The attending physician was present in the room, but, you know, not like at the patient’s bedside or anything. And the, nice thing about endoscopic surgery is that they can watch this little tv screen and, like, certainly, be following along at all times. Although again, as I mentioned, like, not in their hands. So halfway through the case, the phone rings in the operating room. This is something that happens not uncommonly. You know, it’s usually like an admin or clerically related phone call. Like, for instance, sometimes, like, post op will call and ask for an ETA or, you know, an estimate, things like that. some surgeons really do not like a huge volume of phone calls into the OR. And I get that because it can be distracting. You know, if there’s tons of phone calls or if people are calling for you when you’re operating, and, you know, there’s questions by phone or things like that, so. Didn’t think anything of it. The circulator picks up the phone, and there’s a brief combo, you know, that would not be audible to me, nor is it any of my business. And then she hangs up, and she yells across the room to me, hey, Katie wants to see you in her office right away after this case. She needs to talk to you. Okay. you have my attention immediately. You know, this has the extreme vibes of being called to the principal’s office. Even though I was, like, 28 years old, 29 years old at the time that this happened, the entire room immediately anesthesia, the scrub, the attending, even. Even my own ent attending, they all go, ooh, what did you do? I. Again, you have my attention. I have no idea what I did, so I don’t know the answer to that question, nor do I know what this is about. I was brought up as a real teacher’s pet through the catholic grade school system. So you also, like I said, you’ve scared me straight. Why am I being called into the principal’s office and things like that right in the middle of a case? I said to the circulator, none of that shows on the outside. And for those out there who know surgeons or are surgeons, like, we’re cool as a cucumber. So externally, my facial expression does not change at all. I do not stop operating in any way. I’m just letting you guys see, like, a little bit of. If we draw back the curtain. That’s what I was thinking. I was thinking five alarm fire. the principal wants to see me. For some reason, like, I thought that. I thought that I was an adult, but I don’t know. It does have a little bit of that vibe when you’re a resident or something unusual like this happens. So I just very calmly, I’m still working. I calmly say to the circulator, you know, do you know what this is about? She says, no, I continue working. Residents across the board, I think, are kings of compartmentalization. And so no problem. Like, continue working. Finish the case. I rolled the patient to the pacu, made sure that they were, you know, set there safely, signed them out to the pacu, made sure everything was good. And then I went directly from the Pacu to Katie’s office, because, you know, like I said, it would be a lie to say that I had a moment where that wasn’t on my mind, even for the remainder of this, like, straightforward sinus case and things like that. Yeah, I can hold two thoughts in my mind at once, and I’m just, like, racking my brain, like, man, what did I do to her? And, you know, it’s a very unusual type of phone call. I knock on the door and I say, hey, good morning. You wanted to see me? And she looked up from her desk, and, you know, she’s knee deep in paperwork and things, and she looks up, and she’s just like, yeah. Oh, good. Here. And she hands me a piece of paper. So I walk in. Like, I step forward, I take the paper from her, and I’m looking down at it, and I will tell you guys what I saw, in what order I saw it.

Informed consent is a document that is reviewed with every patient before surgery

It is an informed consent form for a procedure. for those of you who aren’t spending a ton of time in the operating room or anything like that, just for context, this is a piece of paper that is reviewed with every single patient before they go to surgery. Informed consent is a very deliberate, thoughtful, ideally thorough process where we go over the risks, benefits, and alternatives to surgery with the patient, and then they sign it. It is a legal document. Absolutely medical, legally. Like, this is. It’s an important thing. It is definitely, a run of the mill thing. Every surgery has this form. So, you know, I’m looking at it. I’m like, okay, a consent form. I see that it’s for a procedure that was done, like, the prior week. I’m looking at it. I’ve never seen this specific consent before, and I can see that the procedure is written in there. We do have to write on this empty line what the procedure is. And so it said something like, I’ll use the example of l fess and the left, or l indicating left, and then fess being, like, shorthand for functional endoscopic sinus surgery. So, you know, something like that. And, down at the bottom, I see a name has been signed, and it says amanda chang. The whole thing is also in purple ink, which, like, I love that. I love any way that somebody can, like, express themselves or bring a little bit of color to an otherwise kind of, like, monotonous job. But, you know, I do recognize that we can’t be doing consents in, like, these legal documents in bright, fun purples and pinks and things like that. So, regardless, I’m just looking at this, and I was like, okay, thank you for this sheet. And I’m looking at it. And she starts talking. Okay? So she opens this conversation. She says, there are multiple issues with this consent document. Okay? Number one, you cannot use colored ink. Number two, you cannot abbreviate left and right as l and R. You have to write out the word. And it did take me, like, one extra second to process what was going on, but I looked at it again, and then I put all the pieces together, right. She thought that this was me. So I said to her, why do you think this is me? You know, I’m wearing a name tag, actually, like, on, my scrubs. It says francis may Hardin. My last name is Hardin. This says amanda chang. If you looked at the or board from that morning, it would say that the surgeon resident in that or running those cases, like the sinus I had just done, it would say harden. So I truly, I said, why do you think this is me? And I wasn’t even sassing her. I actually was like, oh, I’m perplexed. You seem perplexed. I was like, why do you think this is me? And she says nothing. She just stares at me. Now she’s really doubly perplexed. I will say, as a quick aside, I think one of my superpowers is that I can sit in an awkward silence in perpetuity. It doesn’t bother me, as much as. As it bothers others, typically. And so we’re just standing there, kind of, like, peering at each other. And eventually I was like, okay, you know, I don’t have all day. So then I, out loud said, this is one of our first year ent residents. I will touch base with her to let her know about these items for future consent. And she was like, oh. And then I just turned and walked away. Like, we did not get into it. Obviously, I don’t want to get in the weeds about kind of all of the problems that I see with how this unfolded this morning. You know, like I said, what I’d like to do is just break down, you know, this situation. Katie made several missteps that morning. The pieces were incorrectly put together because she had a consent from the previous week for an ENT case that was not filled out properly. There was a chinese name signed at the bottom, you know, recognizably, pretty objectively. She had seen me walking through pre op earlier that day in the hallway. Like, again, we just greet each other in passing. She knew that only one entor was running that day. I was in it at the time. And that led to an intraoperative phone call. To tell me that I needed to go see her. But again, all this was able to be done based on kind of assumptions and not even cross checking the names because, like I said, when I kind of play it back, I think the most obvious way to know that you have the right Asian would be to look at the or board, and you would not see Chang on there. You know, you’d see the attending name. And mine, I don’t have a chinese last name. I’m half irish. And so it’s Hardin. You know, it’s like, a fairly irish, very white name. I had signed the pre op note from that day, so if anyone looked at, like, this patient who enrolled to the or, they’d see, like, again, I was all over their chart. It was me. And also, this is kind of the kicker. I was a fourth year resident at that time. I had been seeing this woman around for multiple years. You know, I guess one of my questions for her would be, how did you think I escaped detection for all these years using, like, pink and purple, like, highlighter ink for all my legal medical documentation? It just, like, multiple pieces didn’t fit together. And then, of course, like, one of my last pieces, just thinking about, like, ways that it could be different or ways that we could address the conversation differently. I think it would be helpful to not call into the or intraoperatively. Like, even if it’s true, even if the resident. The crime that they’ve committed is that they didn’t know about the ink thing, they’ve been abbreviating left and right. You know, I still don’t know that many people would. Would agree that that merits an intraoperative phone call, let alone when it happens to be a senior resident, because I’m doing the surgery in this scenario. So, you know, there were no adverse events or outcomes of any kind, other than maybe like, a month off of my life from kind of, you know, that shock of being called interop. Like, hey, the person in charge wants to see you in their office. And none of us knew what it was about. But I do think that it’s unlikely. It’s nearly unbelievable that a white male PGY four surgery resident would be mistaken for a white male PGY one surgery resident in the same department, despite the fact that there are a lot of them. And frankly, sometimes they do look the same. Not only that, but in my experience, if administrators do find that a PGY four white male surgery resident has made a clerical error, they don’t typically call into the OR to request an in person meeting about it. I could be totally wrong about this, and I would love to hear from you if this has happened to you. And, you know, this is just a residence wide, nationwide problem.

Maybe this is a way bigger problem than I realized

we’re going to start doing a segment called DM’s for FM. So again, tell me if I’m wrong. Tell me if you can relate. Maybe this is a way bigger problem than I realized. It had nothing to do with me being one of two chinese female surgery residents in the hospital. And the real issue is maybe that a ton of people are face blind. You know? Again, I’m always open to kicking these things around, but I think that this is an interesting story, that illustrates why I’m asking the question.

Jama open: There have been studies about differences for minorities in training

So let’s talk a little bit about the evidence. You know, a lot of us are academicians or have a history. Academics totally get that. So it’s kind of like, show me a little bit of data. There have been a couple studies about differences for minorities in training, and one article that, I’d love to highlight today, and we can talk a little bit about is from jama open. It came out in 2022. And the title of this article is racial and ethnic differences in internal medicine residency assessments. One thing I want to just open with is how they define, you know, underrepresented in medicine. So I’d love to start off with some definitions. It’s, important it’s defined in this article as well as I’ve seen this defined elsewhere as well. But underrepresented in medicine are black, hispanic, american indian, and alaskan native physicians. While Asian physicians are not underrepresented, Asian medical students are less likely to be selected for prestigious honor societies. And as they progress in their careers, Asian faculty members are less likely to hold departmental leadership positions. And so Asian physicians are actually not included in the underrepresented in medicine terminology. However, in this study, they do include them, together for looking at, like, these specific assessments because of that other difference for the Asian physicians when they were studied. So, this is a cross sectional study that examines whether race and ethnicity are associated with performance evaluation ratings of internal medicine residents. And they looked at 9026 internal medicine residents. Asian residents and residents, historically underrepresented in medicine by race and ethnicity, received lower ratings on assessments than their white peers during the first and second years of training. These differences abated by the final assessment in year three of training. So this is very interesting. I would love to highlight the fact that by year three, those differences had resolved, and I’m, not really surprised by that. Even in my own experience, I would say as an ent surgery resident, I had to prove myself doubly, in my opinion, as a female. And certainly women in surgery, you know, might have something to say about all this, as a female, and then also as a minority. But honestly, by the time that I was a chief resident, I’d been there for several years. I had proven myself. I don’t feel that, you know, again, from a resident evaluation standpoint, there were any of those discrepancies, as opposed to in some of the earlier years, what happens? And I know there’s a lot of great literature out there on this, but, for instance, quote unquote, professionalism is one of the metrics that were measured on. And it’s a little slippery. It’s a little slippery, and it’s quite subjective. And minorities, you know, often have reported lower professionalism scores based on, like, kind of an assortment of factors. None are, none of which are relative to the practice of medicine, nor, like, clinical competency, things like that. So what this makes me think of is even things like unconscious bias, you know, where have you witnessed it? In the hospital or ever experienced it. But I have attended morbidity and mortality conferences, you know, m m and m m. For those who are listening, who haven’t been in training or done a, morbidity and mortality conference, that’s where the whole department piles into a room, and we go over cases from the past, you know, say, month, if it’s held monthly, where a, you know, quick turnaround, readmission, you know, an undesired outcome, or a mortality, which is a death occurs for one of our patients that, you know, the department has provided care for over that timeline. And so this is, of course, like, it’s a fair. You know, it’s a high stakes. It’s a sensitive topic, of course, like, we all care enormously. And so m and m, can be this, like, stressful type of environment. And definitely residents present the cases. At least that’s how it went, you know, in my training experience. But residents will present the case as it happened. You know, they’ll present the outcome, everything like that. And then often, a lot of the department will engage in discussion about it. The whole point of this is to say, okay, well, was it preventable? If so, what was missed? If it wasn’t, how can we, you know, try to look out for this sooner in the future? You know, come at it from many different angles? But, of course, sometimes it gets a little heated if the resident involved in the case is like a minority or a female resident or a resident where the department has just, like, decided that they’re incompetent or they’re lacking in some way, then it can. It can get vicious. I’ve seen that. For sure, it can. But I’ve also seen cases where a white male resident is presenting a case. People start to grill him a little bit. And attendings, even very high ranking attendings, have jumped in to say, this is why they’re training. This is what residency is for, to make mistakes, like, drop it, move on. And it’s just funny, because obviously, it’s all anecdotal, but I have read many different op eds and things like that from people who have noticed similar differences in their training experience. So sometimes for whether it be women in surgery or minorities who are underrepresented, if they say that they feel like they’re not being held to the same standards nor that they can make the same mistakes, then a white male resident can get away with, then, you know, I think that that’s something that we should be tuned into, and we should be open to that conversation and actually engaging with it. There’s also a really interesting stat news article from June of 2022. The title is, it was stolen from me. Black doctors are forced out of training programs at far higher rates than white residents. And so while black residents account for about 5% of all residents in the study that was published with these numbers, in the STat news article, they accounted for nearly 20% of those who were dismissed in the year 2015. This is cited as being, according to an unpublished analysis by the ACGME. And so another way that they chop up the statistics they talk about within the field of surgery, specifically, that year 2015, 2% of white residents were dismissed and 12% of black residents were dismissed. In a 2020 survey of 7000 residents, nearly 25% experienced discrimination based on race, ethnicity, or religion, with the highest rates for black physicians. And that study did find that discrimination led to higher rates of burning out and not completing residency training. So, certainly, I think that these are really important topics for more of us to talk about and educate ourselves about. We’ll definitely dive deeper into some of these discrepancies and training in additional episodes this spring. But for today, you know, I’m going to go back to just some personal anecdotes and stories that are mine to tell from my residency training experience.

A great example of something that happened during residency that was quite upsetting

All right, so, you know, we’re warmed up. We’ll move on to kind of my next anecdote. And this story is. It’s tough. It’s a little personal. It’s a great example of something that happened during residency that was quite upsetting and completely unnecessary. And I think it really illustrates how difficult certain environments would be to learn in, not because of the material to learn itself, the patient care, the hours, the demanding call, but because of just interpersonal dynamics and challenging personalities that are so potent. I was a second year resident at the VA hospital when crazy rich Asians came out. This was a huge deal. Like, I legitimately think I saw it in theaters ultimately a total of four times or something like that. And I just say that because I grew up in a really very white suburb close to Chicago, and there were no other Asian people in town. My mom, who immigrated from Shanghai in her late thirties, definitely, like, found it to be a culture adjustment, living, you know, in a white suburb of Chicago and things like that. And so definitely, I can just tell you that it meant so much to me from day one to see this movie that was, like, a leading rom.com, a blockbuster hit. And when the movie starts, they open with this soundtrack. The first song is in Mandarin. And I’m just telling you, you know, it meant a lot, even though I was an adult when this came out, 100%. And it made me feel like I am, like, so happy for the next generation of, you know, Asians or mixed race Asians who don’t feel like they are very represented in their town or in media and entertainment and things like that. So just very meaningful. So on that va rotation, I was with a white male from the Midwest who was a PGy three, and another white male from the Midwest who was a PGy five. That fifth year was the chief on service. And, you know, this was shortly after the movie had come out. We just had Wednesday or days, and that’s what the whole team was working on that day. The attending who was covering for that day was a white woman from the Midwest in her late thirties. So that was the crew. No problem. Basically, you know, you just show up to work and you mind your business, and we get through the or day and things like that, and kind of move on. But something actually very unusual happened that day, which is that we had a bit of a longer break, like a lengthier turnover between a couple of the cases. And so around 11:00 a.m. We were coming into this break, and the attending was like, I will buy you guys lunch at the cafeteria. Very unusual. I honestly actually think that this is the only time in five years that this had ever happened, which, you know, I’m, not eager to do it again or anything, but we, as a foursome, you know, walked over to the cafeteria, and I definitely remember picking up a zebra cake, if that. And that was my lunch. So if that does tell the listeners anything about, like, my mental health state, I was like, oh, wonderful. Like a lunch with the team, and, you know, it’s on somebody else’s dime. And I just literally picked a zebra cake, and so sat down there, were quietly eating together. I’m just enjoying my zebra cake again. I don’t think I ate another one of those in my five years of training, but, you know, the vibes were weird. It’s kind of like if you see your second grade teacher at the grocery store when you’re a kid, you’re like, this is weird. This is a lot of context, but everyone’s just sitting there quietly eating, and, you know, we’re making small talk the best that we could. You know, people who don’t necessarily relate very strongly, to each other, but that’s okay that you still coexist and get things done. The attending was like, you guys seen any good? Anything good lately? You know, what’s everyone up to? And the third year said that he had just seen the newest, you know, Marvel movie, whatever it was, superhero action film the past weekend, and he’d absolutely loved it. So he’s raving. I said I had just seen crazy rich Asians, and that I really loved it, and it was awesome to see Asian representation in film. That’s it. I said my whole piece. Back to the zebra cake. I’m, like, just killing the zebra cake. I love it. The five or the fifth year resident, the chief resident, who was a huge bully in every sense of the word. Other than that he was a fairly petite guy, physically. Immediately responded by saying that there was already a ton of Asian representation in film. M enough. In his opinion, which I was not looking for, the third year resident agreed with him. He was like, yeah, agreed. And I, you know, again, slow on the uptake, because obviously, this is the part where you’re, like, yelling at the girl in the horror movie. Like, just. Just get out. Just turn around, man. Like, it’s not worth it. Definitely don’t go into this house. I just kind of nervously replied. Well, specifically in terms of rom coms and things like that, I disagree. There’s not a lot of mainstream films with Asian romantic leads. You know, usually they’re relegated to being the nerdy roommate. Like, think of, like, mindy, Kaling, in no strings attached or something like that. Like, they’re watching white women find the loves of their life while they’re, like, studying for the SAT or the MCAT or whatever is age appropriate. So, you know, their comments had stung. I just kind of gently said, you know, I definitely don’t think with rom coms like, this has really been done before. Definitely not of this scale or magnitude. And the, attending did not interject at all. She didn’t say anything. She did try to change the subject, but the chief resident would not bite. She was trying to change the subject. He was like, no. He said, what about all the Jackie Chan movies? I stared at him blankly. The three excitedly jumped back into the conversation. He was like, what about Bruce Lee? That guy’s incredible. He was like, I love Bruce Lee. Come on. They both were like, have you not. Are you not aware, like, those are, like, huge movie enterprises? Like, it’s enough. Like, you’re fine, you know? And like I said, the attending who’s just sitting at this table with us, she was like, we should head back to the ors. I did hold my tears until we got back to the OR, and then I went to the restroom to cry. Like I said, crazy rich Asians had meant a huge amount to me. I think even by the time we’d had this conversation, I’d seen it twice in theaters, and I wasn’t trying to change their minds about it, nor would I recommend this film to any of them. You know, I can read a room usually. So, I just thought that by participating in this, like, very benign, small talk conversation about cool movies that we’d enjoyed recently, I could have never predicted that it would cause, like, consternation nor all this pushback.

I felt like it was so unnecessary and personal to attack crazy rich Asians

So, all right, I’m in the restroom near the ors. This is, you know, on, my top 20 places to cry from residency. Like, I could give you guys a whole list that would be its own episode. I’d be like, I found the best spots. Like, one for, you know, multiple for every building. But I’m just in there. I’m trying to collect myself. I just. I felt like it was so unnecessary and kind of, like, personal to attack crazy rich Asians or, you know, my interpretation of it, which is that it was so awesome to see Asians in rom coms on the big screen. So I’m just in there. I call my other chief resident. She was fifth year, a black surgeon making up the part of less than 1% of otolaryngologists that are black and I’m just crying. She was the best, so I felt comfortable calling her. And I was like, hey, hey, you know, this happened. I was like, this happened at lunch. It was awful. I was like, oh, my God. Like, this broke my heart. Like, why? It was just so horrible, the direction that the conversation had taken and everything like that. I was shocked by, like, the vitriol towards all of it and, like, the lack of understanding and the desire to, like, antagonize me about it. And the first words out of her mouth were, sadly, I am not surprised at all. She had obviously worked with these men as long as. If not longer than I had. And she just said, you know, I’m sorry that that happened, but not surprised at all. Similar things have happened to me over the years here. And she was like, I even get what you’re saying, because Black Panther meant a great deal to me when it had come out. And again, like, I’m sure would have been received pretty similarly by these men. So, you know, I do get even a little emotional thinking about it because it’s such a good illustration of what the daily milieu was. Like. This is kind of why we didn’t have, a ton of, like, favorable or affectionate small talk between trainees. But bigger picture, when people claim that there’s, like, a level field for all residents. That third year resident didn’t have his Marvel movies attacked to his face, you know, like, a prolonged double down, triple down attack of, like, superhero movies with an attending present. it definitely. It just made a difference in terms of, like, quality of learning and also overall wellness when you just work with, like, mean spirited people and there are no protections. So, yes, I think that those men could really not imagine what it would be like to grow up in a world where there isn’t a lot of representation for people who look like them. And that’s fine. That’s totally understandable. And there’s all sorts of diverse experiences that we don’t understand because we haven’t lived. But I do think that kind of, like, this response and this approach to those differences is harmful, to the workplace environment.

Free: Residents are experts at compartmentalizing and pushing through difficult situations

So, for the last fun anecdote of the day, this is about a time when I was a second year resident on the peds ent rotation, and that is actually considered, like, kind of a lit time. Like, the kids are cute. Bread and butter is a lot of, like, ear tubes and tonsils and things like that. And we had one pediatric ent attending, so it was kind of like a, one on one apprenticeship and all second years, spent a couple months in his clinic. And the clinic environment, like, overall, it was really great. Obviously very cute. Tons of, like, animals plastered on the walls and things like that. And there was a big nurses swamp in the corner. And so patient rooms lined one side of that square swamp. And the physician workroom, you know, dictation room was orthogonal to that wall. And the Pz and T nurses were. Were great. They were really friendly, good with kids. Super nice. Like, bubbly, middle aged white women, and honestly, always very nice to the residents. Like, it was a generally welcoming environment. So one day, I was a second year resident. You know, you’re taking junior call at this point, which means that for those who haven’t taken call, you are the first phone call. If a nurse has a question about a, medication overnight or, you know, a new symptom that the patient has all new consults from the hospital and the emergency room, things like that, they all come through you. So it can be. It can be pretty demanding in this situation. Like I said, residents are just professional experts at compartmentalizing and pushing through. Like, I’ve never met a resident where I would levy against them that they’re not resilient, because you can just kind of look at everything that they’ve done to get to this point. And, you know, I think 99% of the general population would be like, okay, all right, you’ve convinced me. Like, that’s a resilient person. Doesn’t mean that they don’t have, like, a variety of flaws or x or Y or z, like we all do. But, yeah, not. Not typically a lack of resilience. And so it’s 10:00 a.m. On a Tuesday. I’m knocking out patients in clinic as efficiently as possible. I honestly really like clinic. So, you know, we’re moving. I looked up the next patient to see, and then I walked over to the patient door, where we would put some of the intake forms and paperwork in the door, in the door slot. And so, like, just pull it out, of course, review it to make sure that you have the whole picture before you knock and walk into the room. And so I’m just standing there, like, skimming this intake sheet, and the group of nurses behind me at the swamp, there’s three women who are just, like, talking and joking around. And they were very excited because somebody was describing, like, a new eye makeup technique. And one of them exclaims, I cannot do that. It makes me look chinese. And my back was to them. You know, I’m about to go into a patient encounter in this scenario, but I heard that, and I froze because I wasn’t born yesterday. I know what she meant by that. And it took me like 3 seconds to process it and compartmentalize it, stuff it way down. And then I confidently knocked on the door and entered the room. Did the patient visit? So no problem. But over time, this is the type of thing, you know, that haunted me, because part of my traumatic residency experience was also like the betrayal of self that occurs over and over again in a million different ways. And this story also proves how subtle that can be, too. Because it wouldn’t have been professional to say anything I didn’t. And because it didn’t serve the clinic or serve the patients, certainly it wouldn’t serve the little kiddo, waiting in that room to get his tonsils out. You know, I did not say anything, but obviously, you know, some days later, I was like, okay, now I know what I would say if something like this happened again. I just kind of wish that I’d turn around and been like, you know what? There are worse things than looking Chinese. And of course, of course, like, I digress. I’m glad I didn’t say that. And I wouldn’t today. But, like, can you imagine? Okay, so what’s the point of me sharing all this with you? Free therapy for me? Yes. I mean, no, but seriously, here’s the deal. About 60% of practicing physicians right now are white. Of course, studies vary, but let’s say ballpark, that number is likely going to decrease moving forward. The population of the US is rapidly becoming more diverse, and our physician cohort should accurately represent these changing demographics. But if we continue to ostracize and treat minority trainees differently, we will risk losing the next generation of doctors. And of course, for those who have experienced anything similar to my own stories and experience, you know you’re not alone out there. Next week, we will have doctor Courtney Barrows McEwen on the podcast to discuss her journey overcoming substance use in residency and fellowship training, and her experience with the PHP or the physician health program. Follow me on Instagram rancismay, MD and rethinkingresidency. Visit my website, rethinkingresidency.com, to learn more about resident physician stories and ways that residents can most effectively navigate the game of residency. I cannot wait to connect with you on the next episode of promising young Surgeon.