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The Impacts of Anti-Black Racism in Mentorship

Mentorship has played a key role in the journeys of Black students and professionals. In a discussion facilitated by Joan Y. Reede, M.D., M.P.H. (Harvard Medical School), five professionals shared their experiences as mentees, mentors, sponsors, and program developers. The panelists were Hannah Valantine, M.D. (Stanford University), MaCalus V. Hogan, M.D. (University of Pittsburgh School of Medicine), J. Nwando Olayiwola, M.D., M.P.H. (Humana), Alden M. Landry, M.D., M.P.H. (Harvard Medical School), and Valerae O. Lewis, M.D. (University of Texas MD Anderson Cancer Center).

PERSONAL EXPERIENCES

Dr. Valantine related that she was born in The Gambia and moved to England when she was 13. It was a shock, she recalled, from being part of the majority group to a minority in a high school of 500 students in London. Her academics plummeted amidst an intense feeling of not belonging, and it took time to get back on track. That feeling of not belonging is a huge part of anti-Black racism, both explicit and implicit, she continued, and it has followed her throughout her career. The root cause of the imposter syndrome is racism, she added. She identified the ways she has combatted it. The first is “to wear blinders, which is bad for one’s health.” When she began to push back, she discovered the way she had learned to behave in the United Kingdom did not work in the United States. For example, she was told not to seem so aggressive in the United States. She said she wants conditions to be better for trainees.

Dr. Hogan related that he grew up in rural Alabama and attended the two Historically Black Colleges and Universities (HBCUs) that he considers highlights of his journey to becoming a physician: Xavier as an undergraduate and Howard as a medical student. Mentors have helped him deal with anti-Black racism, including Dr. Laurencin, who helped him enter the field of orthopedic surgery at the University of Virginia. He stressed the importance of having sponsors of all backgrounds at a majority institution, where, he said, he learned what true allyship really means.

Dr. Olayiwola grew up in Columbus, Ohio, as the child of Nigerian immigrants, and she was always one of very few Black children in school: in high school, one of five Black students out of 1,200. She said her experience with racism started early and explicitly when she was told she would not be successful when she declared an interest in medicine. She attended the Ohio State University (OSU) for her undergraduate and medical education.

She and her brother decided to start a group when they realized there was no space at OSU for Black students interested in the health professions. The administration resisted their efforts, but a Black physician helped them succeed. Dr. Olayiwola also commented on the structural challenge caused by a very limited number of Black mentors. She expressed guilt because the very few who are on the faculty are asked by so many students. She said what has been important for her is “networking across institutions and organizations for kindred spirits, and making sure I am visible for people coming behind me.”

Dr. Landry described himself as a country boy from East Texas. His family worked in farming and the military, which he assumed he would do as well. As a child, he traveled because his father was in the military, and his family chose the schools and communities they moved to carefully. He said he benefited from great mentors along the way. Dr. Landry attended Prairie View A&M University, which exposed him to pipeline programs and a sense of community. These opportunities included the Health Careers Opportunity Program, or HCOP, through which he formed a cohort with other students. He said his residency, which he did in Boston, was another important piece of his pipeline. “Pipeline programs work, I am an example,” Dr. Landry stated. “Students need them to open the door because there are gatekeepers along the way; you cannot do it alone.” Students of color also are discouraged to hear that their experiences and capability do not matter, he said. He added that he feels he is in a position now to serve as an example, be visible, and make opportunities for others.

Dr. Lewis grew up in a family of physicians in New York City and was expected to continue this tradition. When she attended medical school with the plan to go into orthopedic surgery, she said, her Blackness and gender stood out, and she had to overcome a feeling of marginalization and the imposter syndrome. Being the “first and the only” provides grit and perseverance, but it is tiring. She did have a “posse” early in her career, although they were all African American men. She had no African American mentors, she related, men or women. “The onus for us in specialties is to be more welcoming and look for people like us to help them be comfortable and excel.”

MENTORS ALONG THE WAY

Dr. Reede commented on the variety of backgrounds and journeys they traveled and the variety of mentors they had within leadership and among their peers. Dr. Lewis said she held mentors precious, especially those in

her residency, but has found them hard to come by as a Black woman in orthopedics. She also clarified between mentors and sponsors. While both are valuable, she noted that mentors serve to advise and suggest, and may not be within one’s specialty or even profession. Sponsors “put forward” the person they are helping to propel the person’s career forward. As she observed, “Women are overmentored and undersponsored. And women plateau in midcareer.”

Dr. Reede observed the existence of “de-mentors” and “tor-mentors” who can derail a mentee, noting that mentorship is not always positive. Dr. Hogan commented that while he has had an array of mentors, he has experienced both unconscious and deliberate bias. He was fortunate that the orthopedic program at the University of Virginia was relatively diverse, with one-third of the 27 residents minority or female. Conversations among them and with the majority residents were helpful, he related. However, he also learned about the tormentors, as Dr. Reede termed them. In addition, most environments are not diverse, and it is important to learn from mentors and sponsors and to call out bias where it occurs. Agreeing with Dr. Lewis, he described sponsors “as willing to make the phone call,” adding that sponsorship capital must be used wisely but is meant to be spent.

Dr. Valantine related that she had mentors who were protectors but none of them addressed issues of racism until she started to go into cardiology. Male white peers told her “you must be crazy,” she recalled. She also noted that some people have gone from mentorship to sponsorship without realizing it. She recounted that she was among six people shortlisted for a fellowship, the rest being white men. When the top choice could not begin immediately, the administrator called to ask if she wanted to come in ad locum. She grabbed it as the beginning of her trajectory. She noted opportunities are partly serendipitous but also about “pushing myself, being feisty, and not taking no,” even when she receives an admonition to tone herself down. Dr. Reede reflected that she was hearing talk about bias and structural components, but also about taking action, being intentional, and not sitting back but instead reaching out.

Dr. Landon shared his experience as he finished his residency and was looking to move from Boston, where he also participated in The Commonwealth Fund Fellowship in Minority Health Policy at Harvard University.¹

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¹ For more information on The Commonwealth Fund Fellowship in Minority Health Policy at Harvard University, see www.commonwealthfund.org/grants/commonwealth-fund-fellowship-minority-health-policy-harvard-university-2022-2023.

He related that many people assumed he should become a community doctor, although a white physician encouraged him to join an academic department. Afterwards, Dr. Landry learned that there was some pushback because he was perceived by some as not a “good fit” for the group. He commented:

Dr. Olayiwola reflected on another experience that may be a challenge for other Black leaders. “You are overmentored until you potentially grow past that person [the mentor],” she described. “It was fine when I was junior, but when I excelled beyond what was thought that a Black woman should excel, it got very difficult.” She assumed she was in a supportive environment until she performed well, then there was an attempt to undo her success. She commented that this was a very difficult experience to share and call out, and having someone with whom to unpack it was essential. “When you are the victim, you question if that is happening,” she said. “You need to have an outlet because you can be gaslighted.” She also called for better skills and tools related to equity around pay, promotion, and growth. She was accidentally sent a contract intended for a white male at her level and saw firsthand the larger pay and other benefits he was offered. “It stunned me, but what it told me is that I need to get the skills and tools to negotiate contracts and get promotions,” she said.

Dr. Reede asked about the issues that Black and Brown students and trainees may face today, and if they are similar to or different from those faced in the past. Dr. Lewis commented that although she and the other presenters are at different ages and had different backgrounds, they faced similar issues. “The same story has not changed, at least in our specialty for the students who I work with,” she said. “What has changed is they are less tolerant than I was 20 or 25 years ago. I am encouraged that it will change a bit, but it is still relevant.”

Dr. Landry commented that racism is present, and many of those who perpetuate it now hold more senior positions, although they know they cannot verbalize their feelings openly. He also commented that COVID-19 has

affected the ability of premed and med students to network, and he urged finding virtual ways for them to have access to opportunities.

INSTITUTIONAL ROLE

Dr. Valantine underscored that anti-Black racism has not changed, but the response has. She welcomes that the current generation of Black students are more vocal. However, she also cautioned that a flip side is students and trainees can derail Black faculty by writing poor reviews, which she said is an institutional problem. Dr. Reede asked the panelists what institutions should be doing to move beyond awareness that racism exists to action.

In her previous position as an OSU department chair, Dr. Oliwayola observed students struggling with repetitive trauma when they had to watch the murder of Black men in the media, then have to study, a trauma that their peers did not have to deal with. She noted students’ isolation but pointed out that they can be provided the conditions to thrive. Institutions can support them by providing them a mentor from day one and building in resources to prepare them to succeed. She continued that institutions can create safe spaces and proactively plan. “It has to be done before people ask for it, before the damage has been done,” she said. “Institutions can preemptively address what we know will happen.”

Dr. Valantine commented that even when creating an inclusive environment, bad actors will surface. Robust policies and practices are needed for this type of harassment, which requires strong leaders who will take action, she asserted. She noted that there is often hesitancy to do this. Going forward, she urged a huge push on hiring Black faculty as part of the solution.

Dr. Landry added that academic medicine can discourage Black trainees who experience negative interactions and micro- and macroaggressions. He shared his own initial hesitation about entering academic medicine. As one example, there are so few Black faculty that when he completes a supposedly anonymous survey, it is easy to figure out who filled it out. As more Black faculty enter an institution, trainees will be more comfortable, he posited. He also warned about pigeon-holing Black faculty with the “Black tax,” in which they are weighed down by doing the diversity work that the entire faculty should be doing.

Dr. Hogan said it is important to consider which long-term strategies will be successful to achieve the cultural evolution of organizations. Relationships have to occur across all of the academic disciplines and professions

until the numbers increase. He noted that most institutions will claim “there are only so many minorities they can hire. We have to be honest and not send people to places where they will not have the strength to succeed.”

Dr. Reede suggested the need not just to talk about mentoring, but to train mentors and have accountability. Dr. Lewis said mentoring programs can flounder without pressure to succeed. She agreed that mentors should be trained, and that majority mentors need to be trained how to relate to minority candidates. Diversity comes from the top down, and some will misbehave unless they are held accountable. “We have to work with institutions to do appropriate and effective training and to hold people accountable. If we only concentrate on ourselves, we will not excel,” she said.

PANELISTS’ RECOMMENDATIONS TO MOVE FORWARD

Transparency and data are needed, said Dr. Reede, and she asked the presenters for their ideas to improve mentorship and sponsorship. Dr. Oliwayola noted the current opportunity because conversations are occurring in a more direct way. She urged creation of a culture of inquiry and inclusive conversation. Holding leaders accountable is very important—as she said, “This is on your scorecard as a requirement for promotion. We have to help define the metrics to make it a priority, not just words.”

Dr. Valantine commented that the strategy has been to fix individuals, not institutions. She agreed with the need for accountability and metrics, and to tie performance to reward systems. “We do that for everything else that matters,” she said. “We won’t achieve behavior change without it. That is where I would be pushing.” She agreed that more Black faculty would help, but she said to do so, diversity and inclusion have to be pushed up to the level of importance of other pillars of academic medicine. Dr. Lewis noted that institutions must acknowledge the role of working with students and trainees in promotions and tenure. Dr. Landry added that what individuals are doing toward social justice and mentorship must also be recognized. He pointed out that Dr. Reede has helped do that at Harvard through meaningful mentor and diversity awards.

Dr. Landry also called for longitudinal support for programs, not just quick fixes. A lot has emerged in the last 2 years, he remarked, but it will take decades of unpacking the trauma on Black communities. Projects are funded for 3 to 5 years, for example, to increase the number of Black men in medicine, but they must be longer term to expect results with “real money

for support and research.” Otherwise, he noted the program makes for a great press release for starting it, but there is no follow-up.

Dr. Hogan shared that Dr. Camara Jones spoke to the leadership at his institution. He said updates about inclusion must occur at every leadership meeting, not just twice a year or after the next crisis. “Will we change adults?” he queried. “At least it makes the room smaller for those on the wrong side of history, and broader and brighter for those who want to make it more open.” He added that in a capitalist health-care system, “people believe you are serious when you are putting money toward it. I did not write the rules but that is the way it is.” Dr. Lewis added, “You have to be in the room where it happens.” Greater representation in decision-making changes the outcome. Dr. Valantine questioned whether partnerships between majority institutions and HBCUs could move the needle more rapidly. For example, she said, they could work together to improve mentoring as they carry out grants and programs together.

Several of the concepts raised by the presenters were further explored in a short discussion with workshop participants. One participant commented that “fit,” as mentioned by Dr. Landry, interferes with innovation. Another noted the tendency to develop a liability versus an investment mindset. A more inclusive environment is a benefit not only to individuals but also to institutions. Dr. Landry concurred with the value in diversity to think about and solve problems differently and to bring in lived experience from complex angles.

In response to a question about the difference between a mentor and sponsor, Dr. Valantine commented that “a mentor tells you and advises you what to do; a sponsor goes the extra mile to clear the path and get you in the networks where things happen. Sponsors open doors. They may deter you from giving up. They are willing to use their name and connections to make a difference.” Another participant asked about allyship and working to be inclusive and not a white savior. Dr. Valantine suggested people from a majority group who are committed can help sponsor change. The onus should not be on the mentee and on Black faculty alone, Dr. Reede said. It has to include funders, leaders, community organizations, and regulatory organizations. It has to be about accountability and sustained action, and include the voices of racialized and minoritized students and faculty. Everyone is needed to create meaningful change, not just for a few but for all, and beyond entry to advancement and retention, she concluded.