Black in Medical Education

Aysha H Khoury, MD, MPH, FACP
5 min readDec 31, 2020
United against Racism March, 2020

As the year ends, my mind is a tangle of emotions on how to describe 2020. The pandemic continues to ravage the world, but this summer, we also witnessed a tremendous uprising against racism. People all over the world spoke out, companies boldly declared “Black Lives Matter”, health care professionals knelt for 8 minutes and 46 seconds, institutions published statements on improving diversity, equity, and inclusion. It felt like Black people were being seen and heard across industries for the first time in decades. Seeing “Black Lives Matter” stickers next to Pride flags on store fronts and church lawns gave me a sense of safety.

How is it possible in the same summer that racism is repeatedly confirmed as a public health issue, I was placed on a now 18 week suspension after facilitating a medical school class incorporating topics of bias and racial health disparities? How is it possible after we, as health care professionals, protested together and knelt together that I would feel so isolated and alone? I thought we implicitly and explicitly agreed that diversity, equity, and inclusion in medical education was necessary.

In November 2019, I moved from Atlanta, GA to Pasadena, CA to become a small group facilitator at Kaiser Permanente Bernard J Tyson School of Medicine (KPSOM). There would be focus on “achieving equity”, the “elimination of health disparities”, and the promotion of “inclusiveness and diversity”. The School and the Dean actively endorse these values on social media.

When facilitators were asked to incorporate topics on bias and racial health disparities into the August 28, 2020 class, I decided to show up fully as a Black woman and physician. That morning, I paired a t-shirt with the words “I can’t breathe” with my usual African print attire. Surely, my lived experience as a Black woman physician in America would be welcomed at this institution for this class.

August 28 was also the 57th anniversary of the March on Washington and the 65th anniversary of Emmet Till’s death. Both of these anniversaries reflect the consequences of bias and racism in America. That day in Washington, DC, thousands of people risked COVID-19 to speak out against bias and racism. That week, KPSOM students grappled with how to do the same in response to the shootings of Jacob Blake in Kenosha, WI and Anthony McClain in Pasadena, CA.

Medicine is a microcosm of society and a medical school class on bias and health disparities cannot be divorced from society. Bias and racism in society show up in medicine as racial health disparities. I started the class asking students to reflect on the day’s anniversaries and then on the Dean’s KPSOM wide email regarding the recent shootings. The ensuing discussion was authentic, honest, and moving. Many of us, including myself, were tearful. This kind of work is emotional and necessarily, uncomfortable. Discomfort is a small price to pay, if eliminating health disparities and thus. saving lives is the goal. To enrich the conversation, I shared personal stories and observations. In response to one student’s comments, I recommended “White Fragility: Why It’s Hard for White People to Talk about Racism” by Robin Di Angelo. Within nine hours of the class ending, I received a phone call that my teaching privileges were revoked pending an investigation into the class.

On August 31, I learned that my suspension would also extend to my clinical duties with my employer, Southern California Medical Group (SCPMG). For six weeks, I was removed from both the clinic and the classroom. In 5th grade I decided to become a doctor and in 11th grade, I knew I would also teach. As a teenager, like many of us, I worked in food service. I delivered boxed lunches to the Kaiser Permanente regional offices in Atlanta and told the Admins that one day, I was going to work for Kaiser Permanente too. This suspension is devastating. (Maybe one day I will share the extent of the emotional toll this has taken.)

On October 7, I was told by SCPMG leadership and HR that I could return to the clinic. I was told that I was “courageous”, that I “didn’t do anything”, that I spoke “from the heart” and that what was shared in the class was “consistent with the values of the School”. Naively, I thought I would be returning to the school and that I would finally receive the faculty rank increase with its associated 3 year appointment (my KPSOM department Chair decided to request in June). Instead, the school insisted on a retroactive 6 month contract followed by a 1 month contract so that their investigation could continue. If I did not accept this one month contract, an immediate non-renewal letter would be furnished. I accepted this contract, which ends January 31, 2021.

We know racial health disparities exist. We see it in the deaths related to police encounters. We see it in our hospitals. Dr. Susan Moore boldly shared this with the very breath she fought for. In November, an OBGYN friend posted on social media “I survived pregnancy as an older Black woman in the USA!” Just a month prior, Dr. Chaniece B Wallace, a Black Pediatric Chief Resident, died within days of giving birth. Pregnancy related deaths for Black women over 30 are 4–5 times higher than white women. Even Black newborns are not safe. They are three times more likely to die if their doctor is white. If we are going to achieve health equity, we must have difficult and uncomfortable conversations. Bias and racism have to be confronted. I am proud of the August 28, conversation I facilitated with students. However, the message from KPSOM seems clear. The school will count me among their diverse faculty, but only if I compartmentalize my blackness. My life in America is informed by my racialized identity, but my livelihood is dependent on the comfort of other people. Yet this was the summer that so many of us knelt together. This was the summer I thought I would be “permitted” to be Black in medical education.