Racial 'Self-segregation' in Med Ed Is Not Discrimination

The COVID-19 pandemic has inspired more students to consider careers in healthcare. According to new data from the Association of American Medical Colleges, more people are now entering medical school than at any time in the last two decades. Although administrators are excited at the increase in applications for allied health, nursing, and medical programs, this surge has also led to discussions about the "new" university.

Pre-pandemic, such discussions centered around improving the college experience for current students. Post-pandemic, these discussions now revolve around the quality of programs that have converted to remote or distance learning seemingly overnight. At the same time, ongoing incidents of racism and violence have many students and faculty asking how the "new" university will address racial inequality and social injustice for students of color at time when enrollment is increasing. According to the National Science Foundation 2000-2018 survey, the number of students of color enrolled in health science programs has increased. Latino/Hispanic student enrollment has increased from 5.6% to 11.2%, whereas Black/African American student enrollment has increased from 6.9% to 10.9%.

At Rush University in Chicago, where I serve on the department admissions committee and interview prospective students for the medical laboratory science program, video interviews have replaced campus visits for prospective students. For fall 2021, there have been 25 applicants; 23 have been accepted, all interviewed virtually. To date, 19 of these applicants have confirmed a spot in the class of 2023, compared with fewer than 10 this same time last year. In these virtual interviews (similar to meeting applicants in person), we discuss curriculum, tuition rates, and postgraduation job prospects. Over the past year, I've also begun concluding the interview by bringing up the subject of racism and identity, especially with prospective students of color.

Students of color are often hesitant to reach out or to show vulnerability. They often seem relieved when they see me appear on their screen: an African American female faculty member at a predominately White, urban university. Some are even comfortable enough to ask me about my experience. I have been part of Rush since 1999, and I am also an alumna. Others just want to talk about the climate in general. I reassure them that the Rush community often engages in conversations surrounding White privilege, racism, and social justice and is always ready to have difficult conversations. Still, once they get here, many students of color feel their White, upper-middle-class professors do not understand or relate to what they are going through during times of racial unrest.

For all the institution's best intentions and efforts, the students' instinct is to find solace and comfort among others who also identify as racial minorities. This is especially true at institutions of higher education, because racial inequality gets worse at the master's and professional degree levels. Asian persons are five times more likely to hold an advanced degree than Latinx/Hispanic persons, whereas White persons are 44% more likely to hold advanced degrees than Black persons.

Some of my colleagues bemoan students' self-segregation (a loaded term), especially in an institution that is working hard to promote the values of diversity and to launch inclusion initiatives and social justice programs. "Why do students of color only want to interact with other students of color?" they ask. I gently suggest that a better question would be, "During these extraordinary times, is it wrong to seek out those we feel most connected with, just because they happen to share the same skin color?"

Outside of education, individuals freely socialize with people of a similar ethnic background, culture, religion, political affiliation, and occupation without a lot of hand-wringing. This is deemed acceptable because those aspects of identity are seemingly not as loaded with power, status, and privilege as race. And yet those very issues of power, status, and privilege explain why some minorities are drawn who are similar to them.

This type of self-segregation, also known as racial balkanization (another loaded term), has been going on for years. Yet only now is it getting more attention, as the national conversation on race gives rise to diversity and inclusion initiatives and institutional soul-searching. Efforts to avoid the kind of segregation that has plagued society for much of its history have led many to try to exclude race from influencing group formation. This simply doesn't reflect reality. Ignoring the fact that racism exists in health care creates a bigger problem than just acknowledging the lack of diversity in medicine.

The kind of racial balkanization that happens when people of color seek each other out to commiserate over a shared experience is not discriminatory and should not be perceived negatively or as a form of prejudice. In fact, one proposed solution to reduce racial and ethnic health disparities is to create a healthcare workforce that actually looks like the population it serves. This illustrates that self-segregation is not always a bad thing.

Students of color are often merely looking for support from those who are like-minded and culturally similar in an environment that is not always considered safe, especially at predominantly White institutions. "Safe" means having a space where students feel they can express their concerns or worries and be accepted and heard without fear of retaliation and judgment. When diverse students don't get the support they need, it can lead to rising attrition rates for diverse students or a lack of diverse student applicants.

In 2017, the Journal of Higher Education published a study on college diversity experiences, defined as interactions with those of a different racial, gender, and ethnic group. This study concluded that students who engaged in positive diversity experiences had more constructive conversations and shared similar experiences that led to new friendships. Students felt inspired to challenge their previous viewpoints and were open to discussing complex or sensitive issues. On the other hand, students who engaged in negative diversity experiences were less likely to develop critical thinking skills, impairing cognitive development and learning.

The most obvious solution to this problem would be to admit more diverse students; however, this alone is not enough. I have served on multicultural committees, a diversity task force, and focus groups since 2006. They have all had the same mission: diversifying the student body and faculty while celebrating our differences and uniqueness. More than once, when inquiring why a student may not choose this institution, they have answered, "There isn't anyone who looks like me." Students need to understand the benefits of diversity and embrace their differences; therefore, self-segregation can be a starting point to give students of color the courage and confidence to address negative diversity experiences.

Of course, antiracism and social justice need to be concerns for all persons, not just candidates searching for medical, nursing, or health science school admission. In this "new" normal, I have recently made yet one more change. Instead of concluding my interviews by discussing racism with just prospective students of color, I now conclude all my interviews this way.

LaDonna M. Moreland, MS, MLS(ASCP)CM, is the director of clinical education and an instructor in the Department of Medical Laboratory Science at Rush University College of Health Sciences. She is a Public Voices Fellow of the OpEd Project.

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