A discussion on equity, diversity and inclusion in medical education featuring Nicolas Cadet, MDCM’12, an ophthalmologist and the first Black oculoplastic surgeon in Canada; MDCM & PhD student and Vanier Scholar Lashanda Skerritt; and, Iyman Ahmed of the Office of Social Accountability and Community Engagement.
The future is bright for Black excellence, says Nicolas Cadet, MDCM’12. Less than a decade since graduating from 91ÉçÇř, the ophthalmologist and oculoplastic surgeon is launching a bursary through the Cadet Foundation for Black students in healthcare fields who are also aspiring social entrepreneurs.
Growing up, Cadet followed his father, a Seventh Day Adventist pastor from Haiti to congregations across the island of Montreal where he saw from a young age the disparities in access to health care in Black communities. Cadet learned early on the importance of not only physical health, but also spiritual and mental health, from his father, as well as from his mother, a Québécoise doctor practicing on the South Shore. His foundation aims to empower Black students to maintain a balance between the rigorous academic demands of medical school, and the individual passions that can transform the profession into one that emphasizes compassion and fosters individual talents.
Cadet is an example himself as an organizer of health and education clinics in Montreal and Haiti and a founder of the Alliance of Black Healthcare Professionals of Quebec, which brings together doctors, nurses and other professionals from different Black communities to promote social change. 91ÉçÇř, says Cadet, has a role to play in ameliorating culturally sensitive community care by training more Black physicians and surgeons, but also by hiring Black health educators and administrators.
At 91ÉçÇř, the Office of Social Accountability and Community Engagement (SACE) is also taking steps to make its student body more representative of Montreal’s diversity through the Black Candidate Pathway, which will welcome top Black applicants to the Fall 2022 cohort. (This was developed in collaboration with Anita Brown-Johnson, MDCM’88, PGME’90, 2021 Haile T. Debas Prize laureate, 91ÉçÇř assistant professor and Chief of Family Medicine at the 91ÉçÇř Health Centre. Working with SACE and medical students such as Victoire KpadĂ© of the Class of ’22, Brown-Johnson helped to set in motion a program that would support the Black medical student experience from application to graduation.) SACE’s Community of Support program provides mentorship and resources for current students and Black youth considering a future in medicine and will offer free CASPer and MCAT prep courses for potential applicants.
Iyman Ahmed, who grew up in Toronto, worked for several years improving access to global education opportunities for students at the University of North Carolina at Chapel Hill. She recently returned to Canada to take a position at SACE, where she puts into practice her experience helping students thrive while administering both the Black Candidate Pathway and Community of Support. This brings her into contact with students such as Lashanda Skerritt, an MDCM & PhD student pursuing her PhD in Family Medicine and a Vanier Scholar researching health inequities and improving reproductive health care for women living with HIV in Canada.
In 2017, Skerritt co-founded the Supporting Young Black Students initiative with Clement Bélanger Bishinga, MDCM’21, to demystify med school for high school and CEGEP students. The mentorship program was the impetus for the Community of Support program.
The three joined FMHS Focus, the Faculty of Medicine and Health Sciences donor and alumni newsletter, for a discussion about equity and diversity in medicine. The interview has been edited for length and clarity.
What changes to medical education do you see as being necessary from where we are right now?
Iyman Ahmed: What we want to see is increasing the number of Black students in medicine in general. That is the ultimate goal of the Black Candidate Pathway, which is a newly launched initiative in the Faculty of Medicine and Health Sciences for applicants to the MDCM program to address the under-representation of Black students and practicing physicians.
Lashanda Skerritt: Once we’ve matriculated into the program, what we’d like to see is more baseline acknowledgement of the racial injustices and the history that has created a lot of the systemic problems within the healthcare system and the profession. I think 91ÉçÇř is working on acknowledging this. And then we need strategies to redress a lot of those inequities, removing some of those systemic barriers, supporting students who might not have equal social network or social capital to have access to or succeed in this profession.
Nicolas Cadet: It needs to be recognized that medicine was very monolithic and not very diverse to start with. One thing that needs to be changed also is the curriculum. For example, in the Bates’ Guide when you study for physical exams you shouldn’t only see pictures of Caucasian patients, you should also see pictures of how diseases present in patients of colour. You might be Black yourself as a physician or healthcare practitioner, but if you weren’t taught to recognize something, then you won’t.
LS: There’s often a mindset in institutions that we’re implementing equity, diversity, and inclusion initiatives as a type of charity to marginalized groups, which is wrong. When we have more diverse perspectives among faculty and students, it makes medicine more excellent. It’s not about making institutions diverse for the sake of diversity, but because that is how medicine becomes better and achieves its goals in a more intentional way. It means we’re going to be able to treat patients better and achieve education that is more inclusive of all the needs of the community.
IA: I totally agree. The reason that we talk about the numbers of students is because they are just shockingly low, not because we’re trying to meet a quota or checking a box. This is a holistic approach to make health care better for every Canadian. Especially in a multicultural place like Montreal, to not have representation of a community is a disadvantage to the whole medical community.
Speaking about the Black Candidate Pathway, how is it different from what’s been done before?
IA: The Pathway means that students who identify as Black on their application will have their application reviewed by a committee set up uniquely to take into account the systemic barriers and social realities of these applicants. While there are no official targets, we hope to have approximately 8-10 Black students admitted each year into the MDCM program.
The SACE office has been collecting racial demographic data from students who are admitted into medicine and other health sciences programs, but it’s all voluntary. We need a better system of data collection to better evaluate needs and outcomes. This is an issue tied to the absence of reliable demographic data at the national and provincial level.
The admissions process is quite involved. What are some of the other barriers to applying to medical school?
LS: There are a lot of financial barriers and constraints that make this a difficult profession to take the plunge to commit to doing. Also, it’s challenging when you don’t see or know anyone who has gone down this path. I always saw medicine as something that other people do and I wasn’t sure I’d fit into the profession, I think that is the experience for a lot of students. What’s great about the Black Candidate Pathway is that it tells students “We really want you here, you belong here.”
IA: There is also a cultural barrier. If you don’t have anyone in your family or know anyone that practices medicine, you have no idea what it entails. Experiential programs that allow you to see what it’s like to pursue medicine make it more real and achievable.
NC: There is also a need for greater organization and unity among healthcare workers. For me, I’m the first Black oculoplastic surgeon in Canada. There is often no one pulling you forward, but you have to make it through the wall and pull others forward with you.
On the issue of financial barriers, what is the Cadet Foundation’s aim?
NC: The Cadet Foundation’s objective is to promote holistic health with a special focus on Black communities in Montreal, Haiti and internationally. The Cadet Foundation is a continuity of what my parents were doing before, being involved in community services, being interested in people’s health and seeing people holistically.
Growing up I could see there were a lot of needs. Our communities are in areas where hospitals are far apart, without many clinics or physicians. Oftentimes physicians working are not people who understand the cultural or linguistic aspects, though we do have physicians from the Haitian communities. We saw also through the pandemic the many challenges Black communities were facing. We heard a lot about Montréal-Nord, but it was the case in all other Black neighbourhoods as well.
We want to help build the network of Black medical leaders, people who truly care about their communities and want to give back. We want them also to see themselves as a whole. Through my own experience, I learned that medical school is unidimensional and so intense that it’s hard to pursue other interests that make you a better physician. It’s easy to lose yourself as a person and only see yourself as a physician.
What were your experiences in medical school?
NC: Because we rarely see Black physicians training us, we might ask: “Is it because we’re not good enough, or there aren’t any of us?” One thing I realize is quite common is the whole problem with imposter syndrome any time you face a challenge—and throughout your medical career it’s impossible you won’t be challenged because it is so demanding. You are always asking, “Did this happen because I’m Black, or did a person treat me this way because I’m Black?” or sometimes you might ask, “Should I even be here as a Black person?”
Before my medical studies it was smooth sailing, and then you get into medicine. It was a completely new league. Let’s say if you are great at NCAA basketball, medical school and residency is the NBA. Everyone is bigger, faster, stronger and smarter. That’s when you start questioning yourself and realize, “I’m average at best,” and that can be scary. There is always so much more to learn than what you could reasonably master. Fast-forward into specialty training, you think “I’m going to be a master in this field,” but let me tell you, there is always so much more that you need to learn, there are new studies coming out every day, and even something as small as the eyelid, you would be surprised how complex it can be. These are all challenges that fit with the imposter syndrome and the lack of networking and the Black experience as it relates to perceived or real racism.
IA: The sense of isolation and imposter syndrome exist even for those not in medicine, it is prevalent in the humanities and social sciences as well. The magnitude increases once you enter the hard sciences. There is also this misconception that these fields of medicine are somehow immune to racism and inequality because they are neutral and fact-based. But there is a lot of inequality baked into these so-called neutral “objective” sciences.
NC: We don’t need to go far, the example of Joyce Echaquan and examples in Black communities, that make us realize that systemic racism is alive and well. It affects practitioners, trainees, and in every direction. Our patients fall prey to racism. It’s important for universities like 91ÉçÇř and my colleagues to take action. Universities must engage in meaningful consultation with Black faculty, staff, healthcare practitioners and local Black communities to develop comprehensive solutions to address systemic anti-Black racism.
LS: These are not issues for just the Black community to solve. We need other people to be involved. People with the ability to make change, people in positions who can donate to help address financial barriers and help facilitate networks and connections.
Why do you do this work?
NC: When it comes to social entrepreneurship, it’s one thing to be trained as a physician in the classical sense in how to care for your patients, but it’s also important for the new generation of physicians to realize that there are so many ways you can contribute to people’s health. It doesn’t only mean sitting one-on-one with a patient. One dream I’m working on right now, I believe we need to have Black community health centres in the Greater Montreal. I’m working with leaders in our Black communities to make that happen. Culturally sensitive health care… it’s coming to a neighbourhood close to you very soon.
IA: I am also a graduate student at 91ÉçÇř studying anti-Black racism in the Middle East through the Institute of Islamic Studies. But my passion for this work comes from how pervasive anti-Blackness is globally, and how personally I take that and want to change it at the institutional and structural levels. I believe in community and grassroots work, but also that change at the top tiers of structures has an impact.
LS: There is so much excellence in the Black community that medicine is missing out on. I see these issues as I’m navigating different parts of my education and I feel like I have a lot of privilege as a medical student to support other Black students navigating this training path. I want to see people have opportunities to enter medicine and do amazing things in this field.