Opinion: In light of anti-Asian attacks, medicine needs to listen to Asian American trainees

The shocking shooting rampage in Atlanta targeting Asian spas, followed not long after by an attack on a 65-year-old Asian American woman in Midtown Manhattan this week, felt to us like the culmination of a year of increased hatred, a year of Asian American and Pacific Islander people clamoring for recognition when our suffering wasn’t believed.

As Asian American and Pacific Islander (AAPI) medical students, we have had front-row seats in seeing the hikes in anti-Asian racism this past year. While many health care workers across the country were being called “heroes” for treating people with Covid-19, AAPI health care workers were often vilified. Some of our classmates were told to “go back to China” when they walked outside. One student at Mt. Sinai School of Medicine was attacked and dragged after being called “Chinese virus” on her way to work.

Hate followed AAPI medical students into the hospitals where they train. They are told to wash their hands more often and blamed for the coronavirus by their own patients.

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To be sure, some AAPI medical students have received strong support from their institutions amid rising anti-Asian hate, especially those that publicly condemned anti-Asian racism, that encouraged all members in their institution to take action, and that offered AAPI-specific resources. The three of us in particular felt supported by our schools at Columbia University and the University of Michigan when they carved out time and space for our classmates to talk to one another to process our emotions and experiences. We felt supported. Temporarily.

But even before the Atlanta and Manhattan attacks, Asian American and Pacific Islander medical trainees have been struggling. In clinical settings, AAPI medical students are stereotyped as being quiet and over-reliant on books, which may introduce bias into evaluations. Indeed, students in this group are more likely than white students to receive a lower category summary (like “very good” instead of “outstanding”) in their Medical Student Performance Evaluation, an indicator of overall performance in medical school that is critical in determining residency placements. And even after controlling for scores on the mandatory standardized Step 1 test, research publications, and community service, AAPI students are less likely to be a part of their medical schools’ Alpha Omega Alpha academic honor societies than white students.

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When AAPI medical students become residents, microaggressions and biases follow them. In a survey of residents published in JAMA Network Open, AAPI residents were far more likely to report having experienced belittling and demeaning behavior: 100% of AAPI respondents said they were asked about their ethnic origin, 99% had been mistaken for a team member of the same race/ethnicity, and 93% were questioned by patients about their credentials.

Navigating these biases in a climate where racism against AAPIs often feels ignored isn’t new. AAPI medical students and residents are used to being seen as a model minority, viewed as successful and rule abiding, not people who speak up to express their fears or their anger. They aren’t used to seeing the AAPI community mentioned in lectures on health disparities, despite the vast disparities within these communities. They aren’t even a footnote in most research: only 0.01% of articles in the National Library of Medicine’s MEDLINE database mention AAPIs.

The carnage of the recent attacks made something break inside of us and many of our AAPI colleagues. We could no longer hold back our feelings back about the racism we experience both inside and outside of the clinic, and our desire to see that stop.

That desire for change has been buoyed by seeing how medical institutions such as the University of Utah and Kaiser Permanente have committed resources and attention to anti-racism efforts over the past year. Renewed attention to combating racism has led to the much-needed creation of task forces, financial pledges, and adjustments to curricula.

As AAPI medical students, we simply ask: include us.

Include AAPI voices in your task forces, and their experiences in your anti-racism initiatives. Listen to the Asian Pacific American Medical Student Association, which has listed actionable steps for medical education institutions to support AAPI trainees. Listen to AAPI medical students, some of whom feel isolated because no one on their clinical teams has acknowledged rising anti-Asian hate. Listen to AAPI medical residents, who are asking for support like bystander training so their colleagues can better recognize biases and microaggressions. Listen to AAPI faculty, some of whom yearn to break through the bamboo ceiling shutting them out of top leadership positions in health care.

By listening and acting, we can work together toward the day when AAPI medical students or residents or attending physicians won’t need to tell a co-worker why it’s wrong to ask us, “Where are you really from?” When we won’t need to see colleagues standing next to us in awkward silence after hearing a patient say they want an American medical student, not a foreign one. When we won’t need to ride the subway in fear, afraid that our white coat and scrubs won’t protect us from hate crimes.

But to reach this point, a dialogue needs to start. Not just about what can be done now in response to the Atlanta and Manhattan attacks, but about how to create a north star of anti-racism in health care that includes AAPI voices in addition to those of other people of color. Before another tragedy occurs, include us.

Jesper Ke is a medical student at the University of Michigan Medical School. Kate E. Lee and Hueyjong Shih are medical students at the Vagelos College of Physicians and Surgeons at Columbia University.

Source: STAT