Michael Williams, I am currently a neuropathology fellow at University of Alabama Birmingham Pathology Department. And I'm here on behalf of the Society of Black Pathologists to discuss my journey as a person of color through medicine. So just a bit of background for those who don't know me or my story. I graduated with a degree in chemical engineering. I pursued a master's degree afterwards and they advised humans to me after not getting into any MD or DO schools my first time applying for medical school. And finally achieved my dream of getting into med school, getting a medical degree and graduating. One of the purposes of this presentation is to give my perspective at least of my journey to medicine including my failures and obstacles and how I eventually became a pathologist. And I also wanted to let people know that I entered medical school as a non-traditional student. And so my presentation will be presented in a non-traditional way and hopefully it does have an impact on those who are currently listening. And I have no disclosures to report. And so this first picture is me at graduation. I remember talking to other students of color in a class that I also pictured that we were done, that we did it. We graduated medical school and we were able to add joy and praise to our respective families and close friends. And it was such a proud moment for me and for them and especially for me, because as a black kid from the Bronx who was not exposed to any physicians of color growing up, who would have actually thought or me be that I would be a doctor or a physician. So after all these sleepless nights in college, in graduate school and medical school, I was proud to get to that point of being able to graduate. And yet when I think about it more, it was really just us. You know, a handful of black newly minted physicians leaving the graduation ceremony. And so this next picture is also another photo of me during graduation. And this is my good friend and colleague, Dr. Owate, who is taking a selfie, which, you know, honestly, something in hindsight that probably defines my particular taking skills today. But back then I was just happy to graduate and get the medical degree in general. But looking back again at the fact that there was just a few of us that graduated, I was just wondering, was this the norm to have such few black or African-American students graduating in a professional degree? So that is to say in terms of giving numbers that there was at least eight of us black medical students who graduated that year. The year prior, there was about probably four or five. And then the year before that it was probably the same or probably less. And now looking back retrospectively, you know, as a physician and pathologist, I see something that doesn't make sense. What we do is we try to gather data to figure out, you know, why things are happening and try to explain, you know, what is going on based on whatever available data is afforded to us. So I decided to get a better sense of what was happening in medical schools in general and try to see if there was any data about the amount of black graduates that are being produced. So this next slide is taking from the WAMC, looking at the current trends in medical education, and this is from 2015. And so when we look at what is the acceptance rates of different racial and ethnic groups, we see that the black or African-Americans are still applicants that had the lower acceptance rate compared to other groups. And when we look at this second figure, looking at the 2015 medical school graduates, we see that it comprises about 6% of black or African-Americans, where Hispanic or Latino were 5%. And what was sort of interesting was that for the blacks that were 6% of graduates, they said that that was about the same percentage of blacks or African-Americans that actually matriculated into medical school. When we look further, this is another figure from the 2015 report from the WAMC or AAMC. And so 39% of full-time faculty are female. And when we look at the percentage of those who identify as black, African-American, Hispanic or Latino, Native American, Native Hawaiian or Pacific Islander females, we see that only 3%, I'm sorry, 4% were identified as people of color. And yet only 3% of department chairs at that time in academic medicine were women of color. And I bring that up because it was just interesting to see these statistics and can't help but recalling the remarks that I heard made by people about getting into med school, or even the whispers that came to me at the end about like how lucky I was to get into med school or I probably got in because I was black. And it really puts this into perspective when I think about when I graduated medical school. But let's go back in time after I graduated. So this is me in my long white coat and my pocket. I was, again, so happy and proud. At this time, this was where I was starting intern year. And this was a ceremony for incoming residence fellows to actually get us acquainted with each other in part, but also to help with the transition from medical school into residency. But even at this point, I continue to feel like an imposter. And I say that because for those who don't know, I didn't match into residency my first time around. I initially applied for surgical residency. I sent out 70 applications initially. Only got a handful of interviews. And when I called various programs, I fought to at least get one more interview. So even with all the continued calling throughout the interview season and the interviews that I got, I ultimately didn't match. So I didn't get a match day. Instead, I actually got the email on that Monday, around 1145, that the medical school wanted to see me to help with the SOAP process. So I wanted to, of course, being retrospective, go back and get a sense of actually what the SOAP process was in terms of numbers. And so in this figure, we're looking at going from bottom up. And I marked 2016, because that was the year that I actually entered the SOAP, that the lime green is the number of applicants who were in SOAP that accepted a spot in unfilled categories in all medical fields. The dark blue were the positions that expired and the light blue on top of it represents the number of rejected positions that the applicants rejected from the SOAP. And there was a total of 1,097 positions in general. So Kara was looking at and feeling that after all that hard work and even graduating that I still felt like I wasn't made for doing medicine, because it was just a continuous failure in my head after another. And I wish I can just kind of go back in time and tell myself that that doesn't define who I am or who I will be. And I feel like at that point, it would have gave me a little coin of happiness and confidence actually prior to studying or in starting that surgical intern year. But I don't think anything could have really prepared me for what happened when I started my surgical year. So after starting at this point, I was so happy at least to say I can finally prove to somebody, maybe myself or to a patient that I was meant to be there having a medical degree and helping them in some aspect. But I wanted to show this. Now, this is definitely not a picture of me. This is a stock photo I found because there are times during when we are feeling less confident or just not all there in terms of confidence wise that we don't want to see ourselves in that aspect. And part of me wishes I did take more pictures of that, those areas of my life when I started residency so that I can kind of look back retrospectively and say, but what I meant by the preparedness of starting residency was I was getting comments like, you don't have the skillset of a third year medical student. And I say my inner dialogue because I thought to myself with each, I guess, quote unquote failure, not getting into medical school the first time, not matching at all into a categorical position, like why was I such a horrible doctor for somebody telling me that I had a skillset of a third year medical student? And then also I had this said to me by the same senior resident who told me that I should count myself lucky because I decided to get another senior resident to teach me how to be an intern. My inner dialogue, of course, was going along saying, how am I so behind everyone else? Like, how am I doing so horribly? Now, mind you, this is only three weeks into residency. Three weeks into residency, I had somebody telling me that I didn't have what it took to be a intern, that they needed somebody to teach me to be an intern while they weren't really teaching me anything about being a physician. And so it really makes me look back and say that even though I started off with their brightest intentions on my own and thinking that I would kind of roll throughout that year, really two people could make such an experience so, so horrible. So even thinking about it now, it's just interesting that it was myself judging myself through the perspective of two people who were later told to me that everybody knew that they were a malignant set of residents. But after I was done with my six-week rotation with them, I was still hearing things such as, regardless of what everyone is saying, you did fine. And I'm like, what are people saying? What else is going on that I wasn't aware of? So I looked up a journal called Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training. This study sought to characterize the frequency and sources of mistreatment, the examination of prevalence of burnout, and also the association of mistreatment with burnout and mental health. And it was a survey-based study that was given to surgical residents of all years during their in-service examination. But this study published in 2019. So as a non-surgical resident looking at this paper, I realized that surgery, just like other fields of medicine, are trying to identify the factors so that they can graduate successful surgeons and increase the wellbeing of residents and even attending physicians. Because this burnout and harassment abuse can literally lead to people being just stressed out and not wanting to continue further. And I always wondered just myself, like looking this up, why was I treated that way during the first six weeks of training? And is there a way I can either understand and cope with what occurred? So this is my little mini journal club. And I just wanted to give you the results of what I read. And so they surveyed a total of 7,409 residents. And they found that the verbal or emotional abuse was reported in a little more than 30% of all residents. They found that from the different sources that were identified for this abuse, that 22% of those sources were actually from other residents. They also reported about the racial discrimination that occurred from the residents who answered the survey, which was a mixture of coming from those in medicine and also from, unfortunately, the patients and their families who the residents were treating. And so what they concluded was that this provides insights in how we may build some safer, more equitable, and more effective educational environments for residents so that, again, they can be successful. And for me, I took from that that this was something, it's surgery at the time, but maybe in medicine where we realized that stuff like this is happening and hopefully we can have some sort of voice that allows people to be much more braver, I guess, is the way of reporting what's going on. But I kind of looked at this because I always just want to get an understanding of what was really happening. But I wanted to share a quote with one of my favorite characters, who is the 11th doctor in Doctor Who. So for those who don't know me, I'm such a huge Doctor Who fan, and 11th was my very favorite. And so here he says a quote, the way I see it, every life is a pile of good things and bad things. The good things don't always soften the bad things, but vice versa, the bad things don't always spoil the good things or make them unimportant. And he's just saying that even though bad things occurred and happened, it doesn't mean it cancels out the good things that also occurred. And that's what happened. So when I got away from these residents who made me feel so horrible about myself, I was able to work with other residents who made me feel less afraid to speak up, made me more encouraged to say and do what's right for patients and not feel like I was a horrible doctor. And of course I included their teachers. And these are people I still talk to to this day. And so these are where they are at, either currently in fellowship or in practice with the respective fields stated above them. And so with this, working with them, feeling much more confident, I'm having a clear mind that I was able to do a rotation in pathology. Because the thing is, I wanted to make sure that when I was really switching fields, I wasn't doing it to run away from a difficult situation, but I was honestly going into a diagnostic portion of medicine that I would be truly happy with, without regrets. So again, like I said, as I stated earlier, I did a rotation in the pathology department. I decided that this was, and decided that this was the field for me. I absolutely loved it. So I applied, I suddenly got more interviews than I did with the surgery residency. When I applied to surgery, initially I should say, and I got my own match day party because I was so happy that I matched into a field that I felt like was truly for me. And again, these were some of the residents that I was able to also celebrate my own match day party with. And so for those who don't know, like I, cause I even asked the medical school, like, do I get a match day? Do I show up? And because I was a resident or I was a part of the medical class that year, like I had to find my own way of having a match day. And so I did. And so I matched and I put this picture up because even though I did the first prelim year in surgery, I have to thank the nurses, the social workers, those all throughout the medical field who helped me become at least a better version of myself and a little more braver as well. And who really helped take care of patients alongside with me. And, you know, I carry that to this day where regardless of what people do, where they are at, if they work in a hospital, their main goal is to help patients and help the patients get home. So I really smile and look back at the amazing people that I got to work with. So let's transition. I got into residency and I got into SUNY Upstate Medical University. And here I go with another selfie with part of the department that was there to celebrate a colleague's birthday. And this is where I actually learned more about being a pathologist. I was a APCP resident and I really got to experience what pathology and laboratory medicine does with inside the hospital and how we were able to help patients along the way. Of course, I have to show more pictures of my journey along the way with pathology. And so here on the left, we have my program director, Dr. Shanley. This was Halloween. So that's why he has the mask on during one of our residency meetings. We have him again being sneaky and getting a fork to eat something he said he wasn't supposed to eat. And this bottom picture here is just when I first started in residency in pathology. And just a little background for the selfies that I take. When I started the journey for switching fields, ending surgery and going into pathology, I literally just wanted to have some sort of visual record of where I have been. So that even at times where I feel like I'm stepping back or getting backwards, either professionally or personally, I get to look back and say, I've been through so much and I'm actually able to step forward. I just take time to really see how I progressed and the friendships that I made along the way. And I'm continuing along with this barrage of pictures showing, of course, this is all during Halloween. And so one of my attendings, she wanted to be Batman for Halloween, so she got herself a Batman mask. And then we went up and seen a Star Trooper when I was getting coffee. So they had this awesome helmet. And so it just goes to show about the cool personalities and just a different environment that I was in and how I just was able to feel like I can succeed in where I was going and this was the right field for me. Of course, showing more pictures of just the residents and attendings that I had the opportunity to work with. And even seeing the different classes that came up after me and seeing how they succeeded as well, going to different fellowships and going off to do what they were meant to do. So my next couple of slides talks about Path Twitter. And so I started Path Twitter when I started residency. This was something that was encouraged from my senior residents. And so I got on there, put on the selfies that I took with my co-residents and attendings and laboratory technologists in the hospital. And it became sort of its own thing. And so I posted the pictures of those that I eventually became friends with through Twitter and was able to network and see a lot of people. So it was just kind of the cherry on top, I guess is the way I'm saying it. Because I was able to make friends and to connect with people virtually through this app of Twitter. And through Path Twitter, especially like being able to be part of this Path family for those who I talked to and was able to make friends with. And it was interesting because I would go to national meetings and people didn't even know who I am, what my name was, but they knew I was that guy that took pictures and took lots of selfies. And so I was pretty happy. I was able to, I guess, connect with people in that aspect. But yeah, we know that there was a tragedy that occurred and I put a trigger warning on here because this is something that may have triggered negative emotions for some of you who remembered as to what happened. And what I meant was, when I talked about the trigger warning was the fact of George Floyd's murder. The fact that there was a murder is a black man, which led to national and international protests. And I remember seeing on the news and seeing through social media and seeing and hearing through different outlets about the protests, about the kneeling, the white culture, black lives and the statements that were put out by professional medical societies with the statement that racism is a public health crisis. But internally, I was feeling such a mixed variety of emotions. I mean, first of all, it was the feeling of fear. And I don't know if anybody's really had time to have a conversation with their black colleagues, but when we see this, the next thought is, how safe are we? Personally, I didn't drive for several days. I Ubered back and forth because I didn't feel safe driving. And I had this feeling and thought, or fear, I should say, wondering if I'm gonna be the next name that has to be remembered. I also was wondering, who do I talk to about this? Because there was these feelings of fear, of exhaustion, of feeling unsafe, especially being a medical doctor where I'm going out to help people and feeling unsafe that if I go out, can I first do what my degree is telling me to do and to help people, but also, am I gonna be targeted in some way or another just because of the color of my skin? And of course, talking to the residents and other friends during these times, were programs ready to have these open discussions about people of color and their attitudes towards working in healthcare or whatever respective field that they work in? So all these emotions were coming up and through all this, especially through our residency, was a feeling of isolation, a feeling of, again, who do I talk to about this? And one of the things that came out of me personally was talking to a attending, a white attending who grew up in the suburbs, really didn't have interaction with a lot of people of color during his medical education training of all aspects. And we had a three-hour conversation about race, about what it's like being black in medicine. And I felt that I had somebody I could talk to about all this, even though they were, they didn't grow up with a lot of people of color. I moved to this next statement by the ASCP, where basically the bottom line is, we must speak out against systemic racism discrimination. We are complicit in perpetuating it. And it's something that I keep and carry along with me, regardless of where I'm at. This is something that if we see something, we should say something because if we don't, it continues on not being stopped. So this also encouraged me to start my own podcast. So the Diversifying Path podcast, basically it's about pathology and the diversity that encompasses it. Completely independent project, entirely funded by myself. And I guess in a way it speaks to the entrepreneurial and artistic spirit that resides within everyone, especially me. And it's been such a fun experience because I've used what I have went through and what I've heard other people of color have gone through in their professional careers. And we talk about the different intersections of ethnicity, nationality, religion, sexuality, et cetera. Especially how these intersections affect how we navigate through life and also to decrease whatever sort of stereotypes that we may have. Because at the end, if this allows a one-on-one conversation between people about any of these intersections, I feel like the podcast has done its job. So with that being started, I had to move on and go on my next educational journey within pathology. So I go up to fellowship at UAB, which is where I'm at right now. This picture was taken after I landed from the plane. So I'm sorry for the picture quality, but I was just so happy to be able to say I'm starting a new chapter in my life after successfully finishing pathology residency and being in a residency that allowed me to grow and be as independent as I can be. And so here at UAB, I started this hashtag, hashtag UAB Neuropath. And along with the different attendings that I get to work with as well, we're a small nurturing department and I love it. I feel like my voice is heard and I get to learn along the way. So this is continuing the fact that I'm able to be in places that don't hinder my progress, but allow me to explore my potential. And I also wanted to show the different residents and staff that I get to work with. And they're getting used to me and my pictures because everywhere I go, I just start doing selfies and I guess everybody is okay with it. But they have been very kind and very welcoming for me to come here and being able to work here and learn here. And so what are pros that I would hope somebody can get out of this conversation? First of all, every journey is unique. And this, for me, I think speaks to people of color, especially going through professional fields in life in general. What I've always appreciated is that there is a common thread, at least being black in the medical field, that at times makes one feel like they are the only one. But when we do interact with another black professional, it's such a joyous event because we get to see somebody else who looks like us and we get to have that discussion and know that we have that commonality. But even though we do have the commonality, I have to say that not all journeys are the same. And I want the audience to go away with the fact that, yes, we have that commonality, but again, the journeys are different. And so what I went through may not be what somebody else has necessarily went through. And I don't want it to be pigeonholed that every black person or person of color goes through one experience when we all have diverse experiences. The second thing is I just want to encourage conversation and encourage conversations in a safe space. I think that, like I said earlier about my podcast, so we get to the point where we can have conversations about the different aspects of being a person, you know, in America, I should say, that, and learn about the differences that we have with another person, that we are able to encourage the one-on-one perspectives and have people go away from these conversations, learning something that they didn't know or a misconception that was ultimately defeated because they had the conversation with that person to defeat that misconception. And the third is what are ways we can diversify a path? And that leads me to this slide. So in my podcast, this is always something I ask my guests. I always ask this question, and I get excited when I hear their responses. And they also range from initiating pipeline strategies to having more people of color reaching out to younger generations to let them know that people in medicine can look like them. So being respective, I went back to the AAMC, and I'm sorry for how grainy it is, but they, in 2015, had published what is called Altering the Chorus, Black Males in Medicine. This was published in 2015. And one of the reasons why they did publish it was even though now we're talking about diversity, they wanted to understand why diversity efforts that were put in place have not been more successful in recruiting black males. And they stated that the number of black or African-American male medical school applicants and matriculants have actually decreased since 1978. How crazy is that, that we have this country that's growing, we have people who want to get into medicine, and yet we have such a decrease for decades. Again, going back to the earlier question I had in my earlier slides, when people said, wow, you're so lucky for getting into medical school, and I wonder if they meant because I was lucky to get in with such a decrease in the amount of matriculants who are black males, or because of being black that I was lucky, or the horrible alternative, I got in just because I was black. So I asked this question, I leave this here, because for those who are listening, I want you to think, what are ways we can diversify in path and medicine in general? With that, I leave my references here, and I want to thank you for listening with my Twitter contact and handles placed on the screen before you. Thank you all again.

Michael Williams

neuropathology

medical education

underrepresentation

racism

Diversifying Path

advocacy