Authors’ Reply to “Minority Physicians are Not Protected by Their White Coats”

We thank Drs Amaechi and Rodríguez for their thoughtful comments in response to the implicit bias training program we recently described.1 We absolutely concur and affirm their message that the white coat does not provide immunity to bias among physicians, including the residents we teach.

As is common with qualitative research, the focus groups we conducted as part of our evaluation expanded into interesting areas beyond our specific training program. Some of our residents spontaneously described incidents of microaggressions they had experienced in the hospital due to the color of their skin. As this was not the central focus of our evaluation, we did not include these reflections in the original manuscript, but they apply directly to Drs Amaechi and Rodríguez’s comments. Specifically, two different residents shared the following:

I think a lot of our challenge is bringing up specific times when microaggressions happen or maltreatment of patients happen. A lot of the challenge of that is hierarchy, it’s true, but …there are a lot of times in my life that I’ve experienced treatment where I was like, “Did they do that because I was a woman? Did they do it because [of my race]? Did they do that because they perceive me as young? Or are they just like that to everybody?” And when you experience a lot of microaggressions, and maybe a higher volume because of how you look, it’s exhausting because you ask yourself that question all [the time].

When you’re in the hospital and you’re a resident…it’s the mixture of who do you tell, what do you tell them, and are you sure the thing actually happened.

Thus, we share Drs Amaechi and Rodríguez’s concern about the multiple impacts of unchecked discrimination on many levels, especially our patients and residents. As noted in our first quotation above, residents may experience discrimination due to many variables, certainly including the color of their skin but also their gender, age, and resident status. The impacts of these multiple layers of discrimination can accumulate and contribute to many adverse outcomes, including mental health problems and leaving the profession.

Therefore, as educators we see our mission as three-fold: (1) to advocate and affect systemic change to decrease implicit bias at our institutions, (2) to help our residents debrief individual episodes of either explicit or implicit bias, and (3) to empower residents with tools and support to advocate for themselves and for the communities they serve. As faculty, and as training programs, we must strive to be aware of our own blind spots, advocate for systemic change, and work to create safe work places for our residents and patients where discrimination is never tolerated and all feel safe to share their discomfort and experiences.