HOW TO FAIL WITH FLYING COLORS AND LOVE IT!

Purpose 1

I asked the simple question, what is the purpose of failure? Why do we have to fail? How come our instinct does not kick in innately to prevent us from undertaking these doomed activities anyway?  Well, I asked this question years ago, and of course, I had no answer for over a decade. A few years later I ran into Dr. Myles Munroe’s quote: “When purpose is unknown, abuse is inevitable”. Well that’s great I thought, now all I had to do was find the purpose for failure.

Failure dead

Well in order to do so, I had to start by defining failure. Merriam-Webster defines failure as “a lack of success”. They, in turn, define success as “the achievement of an aim or purpose”. A glaring omission in both those definitions in the lack of the concept of temporality. Unless you are dead, you cannot declare yourself a failure or a success.

success destination

SUCCESS IS NOT A DESTINATION, WELL NEITHER IS FAILURE

Success and failure are not destinations rather they are ongoing themes in life suggesting that are more likely a mindset or a world view.  These are not static concepts but they are dynamic concepts which are ever changing and need to be constantly put in context. You can fail in business but have a wonderful marriage. Would you in that instance consider yourself a failure or a success?

Well, the answer is neither, life is not that simple. Also, only time will tell.  Let me give you an example Oprah ended her show on a high, everyone adored her and gave her a wonderful going away party. A few months later everyone was calling her network a failure and suggesting she quit.

What about Bernie Madoff? He was extremely wealthy and well respected in his community for most of his life but we all know how his things evolved. He is currently incarcerated and one of his sons committed suicide in the aftermath of the scandal. Should he be considered a success or a failure? Well again, only time will tell although he likely needs a miracle to turn things around at this point.

maturity

YOUR LEVEL OF MATURITY MUST MATCH YOUR LEVEL OF SUCCESS

Consider this, even if you achieve “success” at a given time point in your life, failure is still nipping at your heels. Have you ever heard of the saying “more money more problems?” (RIP Biggie…). Well, the problem is the more you have, the more you have to lose. One thing I know for sure is, If your level of maturity does not match your level of success, there are 3 possible outcomes; you will either lose the success, lose yourself or much worse lose your life.

TIME IS YOUR FRIEND

The one thing that everyone in this world has an equal measure of is time. We all get 24 hours in a day and once we become adults we all can choose how to spend our time. My advice to you is to put everything you experience within the context of eternity and suddenly you realize that things are just not that serious. If eternity is too long for you, consider everything you experience within the context of the average life expectancy which is anywhere from 60-80 years depending on where you live. 365 days x 80 = 29200 days. That is a really long time.

I personally refuse to allow the decision I make in one day affect or determine my worldview it just doesn’t make any sense. I personally have a running counter on my phone of the number of days I have been married. And whenever my husband and I have a bad day, I literally just pull out the counter and consider the number of good days I have had with him. At the time I am writing this article, I have been married for exactly 3405 days and I can say I have honestly had less than 300 horrible days. Now, does that mean I have a perfect marriage? Absolutely not! Marriage is hard and anyone who knows me can attest to the fact that I am not easy to deal with at all. Just imagine being married to a know-it-all ENTJ, yikes!

From a pure numbers point of view, you cannot let a bad day, week, month, year or even a decade sum up your life. A bad decade is still only 1/8 of your life and there are a lot more days left to consider. That will be like a making a business decision or a legal decision with only 1/8th of the facts.

THE PURPOSE FOR FAILURE

Now that I have debunked the concept of a failed life. Let me focus on sharing the purpose of failure. What you perceive as failure is really just an opportunity to re-strategize. And if you do not understand the purpose for this perceived “failure” you will abuse it.

restrategizing

 

Do not allow yourself to be ransacked by your emotions or feelings. One thing I have learned about feelings is the fact that they always change and they change without giving you any advance notice. You just wake up one-morning thinking and feeling different.

feelings

THE TRUTH OF THE MATTER

I wrote the statement below over a decade ago and I still stand by it.

“I am always floored by how many people I meet who think successful people never fail. Truth be told, most successful people I know fail more times than they are successful. Personally, I have failed at most things I attempted. However, I have learned that success is not a destination rather it is a mindset, a way of life, a certain perspective, a prism through which I view life. When other people see setbacks I see an opportunity to re-strategize. I firmly believe that failing is not designed to stop you, it is designed to give you an opportunity to re-strategize. So please stop misusing and misinterpreting your failures and start re-strategizing.”

Berthina Coleman

10 THINGS YOU NEED TO UNDERSTAND ABOUT MARRIAGE

I want to give you a few facts about marriage that you should understand before you engage in this institution. This article is broken into two parts; first, we will examine the evidence and review findings from recent research papers about marriage. Next, I will share a few pearls I have learned almost 10 years into my marriage.

marriage7

THE EVIDENCE SHOWS MARRIAGE IS GREATLY UNDERRATED

MARRIAGE WILL LIKELY INCREASE YOUR LIFESPAN:

Overall, there remains a positive relationship between being married and health, which is consistent across different cultures and countries, with poorer health being observed in those who are widowed, unmarried and single. One caveat, however, is the fact that you are more likely to gain weight as a married couple. (Tatagenlo et al, 2017). However, the age when men and women gain weight may be different. It may even occur in different decades. You have to decide whether or not you are willing to deal with it.

YOU ARE MORE LIKELY TO BE MENTALLY SOUND IF YOU ARE MARRIED:

Although the physical benefits to marriage are often touted, there is evidence that marriage also reduces the risk of poor mental health and thus all-cause mortality. In short, those who are married have been shown to have fewer hospital admissions, shorter hospital stays, and are less likely to move into a nursing home. You are less likely to die alone. (Tatagenlo et al, 2017)

MEN APPEAR TO BENEFIT MORE FROM MARRIAGE THAN WOMEN:

marriage

Now, this appears to be counter-intuitive given that women seem more eager to get married compared to men. Evidence shows that men appear to derive greater health benefits from marriage than women. This is likely related to gender roles which are implicit in our culture with women being the de-factor caregivers for the family.

Interestingly young men who suffered early life conditions experienced less mortality when married compared to their unmarried cohorts. However, young women who suffered those same conditions did not experience the same benefit of decreased mortality. I wondered why when I read this and the only reason I could come up with was the fact that women mature a lot earlier than men and are therefore just better equipped to deal with those “early life conditions”.

YOUR CHILDREN WILL EXPERIENCE BETTER HEALTH IF YOU ARE MARRIED:

Previous generations can have a significant impact on the health of future generations. Children of married couples appear to have better health than the children of unmarried couples. Likely because they see these healthy behaviors emulated in their homes at a young age. (Tatagenlo et al, 2017).

WOMEN, SPEAK YOUR MIND!

There is scientific evidence which shows that women who “self-silenced” during a conflict with their spouse have four times the risk of dying, compared with women who did not. (Tatagenlo et al, 2017).

marriage2

MARRIAGE PEARLS

YOUR SPOUSE WILL DISAPPOINT YOU AND YOU WILL DISAPPOINT THEM, GET OVER IT!:

You are not perfect, well neither is your spouse. Give each other room to make mistakes and grow. No one wants a perfect spouse but the beauty of marriage is the ability to grow and learn together.

DON’T TRY TO CHANGE YOUR SPOUSE, CHANGE HOW YOU RESPOND TO THEIR FLAWS:

The challenge with marriage is, the fact that it feels like you are trying to grow and mature under a microscope. The truth is, once you marry someone, they get to know all your insecurities, all your “tells”, all your weaknesses, your strengths, they witness all your screw ups and all your successes.

It is very difficult to trust one person with all that information. Consequently, some people try to withhold some of that information from their spouse in order to protect themselves. My advice to you is to pick someone that you can trust with all that information. Pick someone who accepts and covers your faults until you have matured enough to change them. For some people that takes a year for others, it takes 40 years. Are you willing to stay long enough to get a return on your investment?

YOU WILL BE CHANGED FOREVER:

Marriage is like no other contract because it is not a contract it is a covenant. Covenants are different because they are almost impossible to break. In marriage, I can guarantee that you will be challenged like never before even if you have been in a relationship with this person for a long time. I married my college sweetheart whom I had dated for over 4 years. And marriage was still a shock. “Who is this alien?” I thought. Funny thing is, he thought the same thing.

The premise of marriage is a game changer it because it changes your context. After marriage, you think everything will last forever including vices and weaknesses. One of the challenges I faced when I first got married was the “forever” problem. After I got married my spouse’s quirks which I tolerated before the wedding suddenly became unbearable because I feared I would have to deal with them “forever”. I made the mistake of trying to change these perceived faults as soon as possible. In an attempt to “whip us into shape” as they say. Well, let me tell you how terrible that was. It totally backfired and I ended up having some of my faults pointed out. It was a total waste of time.

Now almost 10 years into our marriage, I can honestly say it just doesn’t matter as much. Some of these faults have changed, some haven’t, others I totally forgot about. Frankly, I just stopped caring about changing him and just focused on changing my reaction to these perceived faults. Truth be told I have more faults than he does and I have been so busy working on my own faults that I stopped obsessing about his.

NEVER COMPARE YOUR MARRIAGE TO ANYONE ELSE’S:

No two marriages or relationships are the same. Never compare your relationship to someone else’s because you just don’t know enough even if you think you do. Perception and reality are usually completely different. Instead, focus on the things about your relationship that you want to change and work on them together (but you both have to agree it’s a problem). Otherwise, just work on you. The better you get at interpersonal relationships the more your marriage appreciates in value.

marriage1

BE COMMITTED:

Marriage is not for wimps, it is hard and it takes some time to find your rhythm. Confounded by this is the fact that life happens in seasons. Some seasons are just more challenging than others. Although you are married, there is no guarantee that you will experience life in the same seasons. Sometimes my husband’s best seasons in his business are my toughest seasons at work but I must have the capacity to be happy for him and support him through that season.

Some people are more committed to their cell phone providers than their spouses. You may know that Sprint sucks but you are willing to tolerate them much more than you are willing to tolerate your spouse. You cannot be more committed to your 401k investment portfolio than you are to your marriage. Sometimes you are up other times you are down. The point is to put everything in context. Some tough seasons last for a month, others last for 10 years. The question is, how committed are you? Sometimes life will throw you some curveballs such as cancer, the death of a parent, depression, joblessness, infidelity, financial challenges, the death of a child etc, etc, etc. Hard times are a guarantee but whether or not your marriage will stand is not.

marriage3

MARRIAGE IS NEVER 50–50:

This is one of the greatest misconceptions about marriage. Sometimes you will give 20%, other times you will give 70%. All that matters is that your marriage benefits from each spouse’s investment. Personally, my husband has given up so much to support my dream of becoming a physician. He has given up job opportunities, turned down business and deferred certain dreams to make my dream a possibility. Now as I near the completion of my training, we are making adjustments to maximize his opportunities.

marriage4

LOVE ENTERS THROUGH THE EYES AND LEAVES THROUGH THE EYES:

I once heard this line in a movie “Love enters through the eyes and leaves through the eyes”. I thought it was really interesting. The challenge is finding someone who looks physically attractive and also looks good on paper. My advice is to focus on values more than looks. Yes, I know that you have heard this before but it bears repeating. Love is what remains after emotions associated with lust have worn out.

It is easier to change your looks than it is to change your character. Poor character will wreak your life and that of your children. Pick a spouse that will build you up, that will invest in your children and your family, pick a spouse who loves your parents, one who will stay even if you lost your job.

marriage6

You need to pick someone with staying power. Staying power is hard to assess when dating casually but you need to ask specific questions about their lives. Ask to meet their friends, meet their parents. Watch how they interact with people less fortunate than them. How do they treat the homeless? , how do they deal with deficiencies? How do they deal with failure? At the end of the day, you cannot build your life with materials or equipment that have been untested. You need to make sure that they can withstand the storm before you use them as an anchor in your life.

marriage5

HOW TO CHOOSE THE BEST COLLEGE MAJOR AND CAREER

Choosing a major in college can be nerve racking and even intimidating for high school seniors. I would argue that this can even be more challenging for non traditional students. Non traditional students have to make this decision while keeping multiple other mitigating factors in life such as; a spouse or significant other, children, aging parents or even debt. At the end of the day the decision process should be the same. I would like to start by dispelling some myths about college and schooling in general.

YOU DON’T GO TO SCHOOL TO LEARN

I wrote an article about this not too long ago which you can read here. In general, school does not exist to really educate you and turn you into a well rounded individual, you will have to do that on your own with the help of your parents and a few mentors. So start by forgetting this common myth because if you do not, you will be disappoint and this will in turn make you less likely to thrive in college.

YOU DON’T GO TO COLLEGE TO FIND YOURSELF

Okay, I am so sick of people saying they are going to college to find themselves. YOU are NOT missing! My personal theory is people who are so hellbent on finding themselves especially under the age of 25 are just afraid to go out and start living life. Just speaking from a logical perspective, you are less likely to find yourself 1000 miles away from where you grew with no family and friends around. I do however think that having a college experience away from family and friends is a good way to know yourself better. It is important that you get the experience of living life outside of the safety of your parent’s home that way you learn to trust your own decisions and develop your own instincts. At the very least living on your own will teach you a thing or two about budgeting and time management.

THE DECISION

Now let us focus on how to make the decision of choosing a major. A lot of these rules may seem counter intuitive but I am guiding you to make a decision that your 40 year old self will not regret. I will give you 3 simple rules on picking a college major so here goes:

DON’T PICK WHAT YOU LIKE

Okay I know that this may be counter intuitive and may even contradict everything that you have heard up to this point. But one thing I know is, your likes will change and so will you. Picking what you like usually leads to cul-de-sacs of regret and next thing you know you will be working in a field that you vowed never to consider and your 40 year old self will be begging to get a job that you sneered at in your 20’s. Well if you can’t pick what you like, what should you pick then?

PICK WHAT THE MARKET LIKES

This is the most underrated piece of advice ever. Not only is it the best piece of advice when it comes to making a decision regarding job prospects it is the most logical one as well. For starters, your 40 year old self will thank you for making this decision. I made a decision to change my major from Mathematics to Nursing and I have never regretted that decision. While Math was way cooler and easier, Nursing was a booming field and had a stronger job market. I knew nothing about Nursing and when I left home (Cameroon, Africa) at 18, Nursing was not even a major it was just a vocation. My sister Roseline literally badgered me into considering Nursing as a major and once I did my research I was sold. I finished college in Dec 21st, 2006 and within a week I found a job working as an ICU/Stepdown unit nurse that offered me a $10,000 sign on bonus. I was working 3 days a week and I had 4 days left to do the things that I enjoyed. Or as some would say, I had that time to “find myself” as some would like to say. My advice is, it is easier to “find yourself” on a full belly. My friends who had counseled me to not switch from Mathematics to Nursing were jobless for a few months and eventually found jobs teaching middle school Mathematics.

YOU ARE NOT WHAT YOU DO

There is this pervasive way of thinking in western culture which likes to permeate the idea that you are what you do. I for one do not agree with that way of thinking. I don’t believe that your job defines you. I have had all kinds of jobs. My first job was been a Popeyes cashier and that was a big deal! I eventually became a Certified Nurses’s Assistant (CNA), next I became a Registered Nurse (RN) and eventually I went back to school and became a medical doctor (MD). I am now completing my training as a Radiologist. However, none of those jobs defined me. There are a few roles that define me in life; wife, mother, daughter, sister, friend, mentor etc. My advice to you is to not be so fixated on the job description.

YOUR PASSIONS CANNOT BE STIFLED BY YOUR PROFESSION

The full sentence really is; Your passions cannot be stifled by your profession but you will go broke if you only follow your passions. Nothing delays your dreams more than being hungry and broke. One of my greatest passions in life is to be a mentor. I love working with young and not so young people who are rethinking their career and life choices. I also love Math, I never got a chance to finish my Math major in college (I completed about 2/3rd of the core curriculum and graduated with Nursing). However, I have found a way to incorporate Math in every aspect of my life. I combined my passions and created my company CNATOMD (get it? from a CNA to an MD) which is really my passion in life. I have mentored young people for over 10 years on a volunteer basis (I recently began charging a small fee due to constraints on time). I assist them with life strategy skills and provide guidance with decision making when it comes to career and education choices. Simply put, I believe in finding the shortest, cheapest and fastest way to living out your passions while building a healthy financial portfolio. I believe in strategic goals and although it may seem like your career may not intersect with your passion for a few years they will eventually collide in an explosive manner. All you need is strategy!

How to MAXIMIZE the POWER OF CONCENTRATION in your life

How to MAXIMIZE the POWER OF CONCENTRATION in your life

power of concentration

The power of concentration when harnessed becomes one of the most powerful tools for success and increased productivity. Concentration however is a skill that is totally antithetic to today’s pop culture. Let’s admit it our inner man-child or woman-child craves to be entertained. Being entertained is fun and refreshing but it also kills productivity like nothing else if  you overindulge.

While…

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How to MAXIMIZE the POWER OF CONCENTRATION in your life

power of concentration

The power of concentration when harnessed becomes one of the most powerful tools for success and increased productivity. Concentration however is a skill that is totally antithetic to today’s pop culture. Let’s admit it our inner man-child or woman-child craves to be entertained. Being entertained is fun and refreshing but it also kills productivity like nothing else if  you overindulge.

While in medical school I had to be a full time medical student studying 40+ hours per week, plus I had to be a full time wife and mother to 2 beautiful girls, in addition I also worked part time as a nurse working 20 hours per week. Trust me, increasing my productivity was not just an option it was a necessity. Starting medical school felt a little like a “sink or swim” moment and since sinking has never been an option for me I had to find a way to swim fast and to do so, I had to become PRODUCTIVE really really fast.

The most important thing I learned about PRODUCTIVITY was, in order to maximize your PRODUCTIVITY, you must increase your CONCENTRATION. I quickly realized that the ability to concentrate on a specific task or goal was the secret ingredient to most success stories. The problem is CONCENTRATION is just not sexy. It is boring and it involves things like forming great habits and breaking bad ones. Who wants to hear about that when you could be catching up on Beyonce’s pregnancy pictures? But the truth of the matter is,  the ability to increase your CONCENTRATION is directly proportional to your chance of success:

concentration

So here a 5 really quick tips I learned on how to be productive. You may know some of them and you probably just need a quick reminder so here goes;

KEEP AN ACCURATE SCHEDULE:

I learned this the hard way. After forgetting important events and missing important deadlines, I finally learned my lesson. Your schedule becomes your blueprint for increasing your ability to concentrate. Although this may sound paradoxical, my ability to increase my concentration is increased when my schedule is busier. I found out that blocking out 2 hour blocks for certain tasks led to decrease productivity because there is no way I am ever going to be able to focus for 120 mins. Rather, breaking everything up into smaller time blocks usually less than one hour (see below) leads to increased productivity. Also hearing the alarm sound prompting me to move on to the next task is usually a welcomed nudge.

UNDERSTAND AND DETERMINE YOUR “FOCUS CYCLE”

“Focus cycle” is a term I made up and I define it as the amount of time you are able to solely focus on a single task before your mind wanders for good. In reality, you will get interrupted by multiple thoughts during this period but eventually your will lose concentration and your mind will wander for good. This number is different for everyone and for some it is 20 mins for others it is 60 mins. You have to determine what your study cycle is? For me it is somewhere between 30 to 40 mins. After that amount of time I am fried and I am ready to be distracted. Think of your focus cycle like the REM/NREM cycles of sleep. It is often more refreshing to wake up during the lighter stage of sleep (NREM). Likewise it is also refreshing to break your concentration at the end of your focus cycle rather than abruptly stopping in the middle of it. My focus/relaxation cycles are usually in 30–40 mins/15 mins. Notice how my focus/relaxation cycles last anywhere between 45 – 55 mins which as you may recall is the average time of each college class or period. That time length was not just chosen haphazardly but I believe it is more than likely the average time of concentration for most adult. Now I know some people who are able to be fully concentrate for 120+ mins but do not be envious these are freaks of nature. Remember the surest path to success is to be consistent with mundane but necessary tasks.

Mundane

 

SCHEDULE SOMETHING FUN DURING YOUR 15 MINS RELAXATION BREAK

I often reward myself by watching 15 mins of my favorite show. It does however take a lot of discipline to turn off that show after 15 mins. Other times I just listen to music or I get up and dance. Unfortunately, sometimes I just answer emails because breaking out into my favorite dance steps randomly in the library may be frowned upon. My favorite thing to do however is to call my husband or a good friend for a few minutes. I usually get a great conversation and a good laugh and I can resume my work feeling refreshed.

TURN OFF YOUR PHONE

This is a real issue and yes I know you have heard it before and will probably read it on other blog posts but it bears repeating. TURN IT OFF! Or at least turn off the notifications on your phone, your watch, your laptop, your tablet. I used to turn off the notification on just my phone but then I realized that being constantly notified via my laptop was just as bad if not worst. It was getting harder and harder to ignore my daily 3 on Medium and that is just no bueno! I turned off all notifications using my mute button on my devices and this works wonders for me.

REWARD YOURSELF FOR MAJOR MILESTONES

Every time you meet a major milestone reward yourself with something fun or something useful that you would not normally splurge on. I just rewarded myself by updating my bedding linen recently. For some this is no big deal but for me this was a real splurge. I saved for a few months and I can’t explain it but I sleep much better now. Activate your mesolimbic pathway (that is the reward pathway in the brain). Get your dopamine levels and endorphins pumping and teach your brain to associate increased CONCENTRATION and PRODUCTIVITY with PLEASURE. Before you know it, you will cultivate and develop the most valuable skill and habit to ensure your success.

Reward pathway

I recognize  that we are all overworkedover exposed and over stimulated today but if you liked this article, consider liking it and sharing it with a friend, family member, colleague, hater or frenemy!

Share your thoughts below, I can’t wait to hear from YOU!

5 REASONS WHY YOU NEED A KNOW-IT-ALL ON YOUR TEAM!

Know-it-all

Know-it-alls can be annoying and extremely difficult to get along with; trust me, I know quite a few know-it-alls and I may or may not be one. However, they are extremely useful assets in life and in business. Rather than trying to stifle their exuberance, you can re-channel their focus and put them to good use. Here are 5 simple ways that know-it-alls can be of benefit:

THEY MAKE GREAT RESEARCH ASSISTANTS:

In general, they tend to obsess over topics and dutifully go over mundane details in order to be well informed. So use them to do research on a topic or subject you may be interested in and then give them a platform to broadcast their knowledge. They will love having an audience and your team will only benefit from their research. As I always say, know-it-alls make great learn-it-alls.

know it alls

THEY ARE GOOD AT PUBLIC SPEAKING:

If you need someone to help you build your public speaking skills, study the way know-it-alls handle an audience. They tend to be undisturbed by the size of the crowd or the group. In general, they are good orators and because they are sometimes outrageous in their claims they have a good handle on how to deal with an unengaged and sometimes a hostile audience.

USE THEM TO INTRODUCE DIFFICULT OR TOUCHY SUBJECTS:

Know-it-alls tend to be unperturbed by negative reactions from their audience. As such they are well equipped to broach touchy subjects or topics. They will appreciate and revel in the fact that they have some exclusivity and will gladly introduce touch subjects on your behalf. By the time they are done with their segments, your group will be ready for questions and you can answer questions and redirect the group’s energy. By the time the know-it-all is done with the group, they will be so happy to hear from you. Caution: this usually works better in group settings and not so well in one-on-one conversations since know-it-alls can be overwhelming in private settings. 

THEY ARE GREAT TEAM CHEERLEADERS:

Let’s be honest, know-it-alls can be annoying but once they decide to be on your team, they will sing your praises like a songbird. The fact that they are so emphatic in their beliefs, means they are extremely useful for boosting team moral.

THEY ARE AWESOME FRIENDS:

Know-it-alls tend to be extremely loyal which may seem a little counter-intuitive but trust me, you want them as your friend. They will silence your doubts and speak to your strengths like no one. Once they are on team YOU, it is extremely hard for them to switch teams. They reason being, they tend to over-analyze everything and they spend a lot of time researching the benefits of a friendship with you. Once they make the decision to be your friend, they will stick around no matter how long it takes to get a return on their investment. After all, they are so used to going against the grain that they will not falter when everyone else does.

Merriam-Webster defines a know-it-all as one who claims to know everything. 

Grace Favor & Faith definition: One who loves to know everything and is willing to put in the work. 

Learn it all

Disclaimer: Of course this is only my opinion which is extremely biased. I may be a little know-it-all… okay who am I kidding? I am a full fledged know-it-all. However, growing up with 7 headstrong siblings gave me a unique perspective on interpersonal relationships.

Definition of a know it all

I recognize that we are all overworkedover exposed and over stimulated today but if you liked this article, consider liking it and sharing it with a friend, family member, colleague, hater or frenemy!

Share your thoughts below, I can’t wait to hear from YOU!

 

 

Why America’s Minority Doctor Problem Begins in the Third Grade

Written By Sydney Lupkin. Originally published by VICE news on March 16, 2016.

Ashley White-Stern was pouring over a gastroenterology textbook one night when she came across a passage that made her bristle: “In the United States, H. pylori infection is associated with poverty, household crowding, limited education, African American or Mexican American ethnicity, residence in areas with poor sanitation, and birth outside the United States.”

White-Stern, a medical student at Columbia University who is black, says that while she didn’t think the passage was overtly racist, she did think it had the potential to imbue medical students with a subtle bias about blacks and Mexican Americans. So she decided to email the authors of the textbook.

“If we didn’t live in a country or world where being of color predisposed society to look down on a person, the published sentence [would] not raise an eyebrow,” White-Stern wrote in her email to the authors. “My humble belief is that we owe it to people of color to consider how and when we include their identities in lists of ‘undesirable’ characteristics.”

Within 24 hours, the authors called White-Stern, thanked her, and asked her to help them change the passage. The next version of the book will explain each association in a little bit more detail and add that higher rates of infection among black and Mexican Americans are not completely understood.

“Unless you have a diverse [medical school] class, you can’t have that discussion,” White-Stern said.

Today, student groups across the United States are calling attention to the lack of diversity on medical campuses, pushing administrators to recruit and enroll more minority students to help end racial health disparities that have persisted for decades. But creating a more diverse class of doctors-to-be is no easy task; while there has been progress made over the last several decades, there still aren’t enough minority medical school applicants.

“The pipeline itself is just too small,” said Marc Nivet, chief diversity officer of the Association of American Medical Colleges (AAMC). “The barriers exist up and down the continuum to our segregated education system…. Too many of our minority students are in poor-performing or underperforming K-12 school systems.”

https://public.tableau.com/views/Applicants_By_Race/Dashboard1?:embed=y&:toolbar=no&:display_count=no&:showVizHome=no#1

According to the latest data from the US Census Bureau, 62.1 percent of the US population is white, 17.4 percent is Hispanic, 13.2 percent is black, and 5.4 percent is Asian. Meanwhile, 60.1 percent of students entering med school between the 2013-14 academic year and the 2015-16 academic year have been white, 22 percent Asian, 9.8 percent Hispanic, and 7.5 percent black, according to the latest data from AAMC, which runs the MCAT, the standardized test that aspiring physicians (MDs and DOs) must take to get into med school.

Studies have repeatedly shown that this mismatch between the racial breakdown of the population and that of doctors causes problems, even if the biases aren’t explicit. For instance, a 2012 study of primary care physicians in urban areas published in the American Journal of Public Health revealed that increases in “implicit racial bias and stereotyping of patient compliance” was linked to negative experiences for black patients and positive ones for white patients. A 2015 study found that black lupus patients were more likely to perceive racial bias and suffer as a result of it. And in 2008, the American Medical Association issued an apology for a century of racial discrimination in the organization’s past.

Related: Scientists Find Cancer’s ‘Achilles Heel’ — Which the Body Could Be Trained to Attack

White Coats for Black Lives, an offshoot of the Black Lives Matter movement comprised mostly of medical students, has attempted to draw attention to racial injustices in medicine since its first “die in” protest in late 2014. The group has called for an acknowledgment of racism’s role in creating health disparities, including the ongoing segregation of healthcare based on insurance status, which they called “colorblind” racial discrimination in an editorial published last fall in the Journal of Urban Health.

A crucial step toward equality in health care is raising the number of minority doctors, medical students, and medical professionals in leadership positions, they say. But fewer black students applied to and enrolled in medical school in 2014 than in 1978, according to AAMC. The group’s report, entitled “Altering the Course: Black Males in Medicine,” says the problem goes all the way back to grade school math and science courses often offered to black students.

A look at the data suggests the largest proportion of would-be minority physicians are effectively eliminated long before it’s time to apply to medical school.

  • 56 percent of black high school graduates enrolled in college in the year after graduation, compared with 70 percent of whites, according to 2008 data from the College Board.
  • Of the 1.6 million students who received bachelor’s degrees in 2010, nine percent were black and 77.5 percent were white, according to the latest data from the US Department of Education. According to 2010 US census data, black people made up 14.4 percent of the population of 20- to 24-year-olds; white people made up 67.3 percent of the same age group.
  • The same year, 3,475 black students applied to medical school, making up 8.1 percent of all applicants, according to data from AAMC; there were 46,410 white applicants, accounting for 61.8 percent of the total applicant population.
  • Again in 2010, of the 165,000 black students who received bachelor’s degrees, 2.1 percent went on to apply to medical school. By comparison, 2.3 percent of the 1.2 million white students who received bachelor’s degrees that year applied.

In other words, by the time students receive undergraduate degrees, blacks and whites are on nearly equal footing. The disparity develops earlier.

In fact, minority students start to fall behind on their standardized test scores as soon as third grade, and the gap widens over time, Nivet said. To make matters worse, 17 states don’t require students to pass Algebra II to graduate from high school, meaning public school students aren’t pushed to take that class or the math and science classes that would follow.

“We don’t have enough minority students taking the right classes early on and becoming successful in those classes early on to make successful applicants to any health professional school,” Nivet said.

Dr. Damon Tweedy, author of the memoir Black Man in a White Coat, said that he credits a teacher for pushing him to apply to a magnet program before he started high school. He got in, and was bused from the school in his predominantly working-class black community to a school in a mostly white neighborhood.

If current medical student Dennis Dacarett-Galeano had finished grade school where he started it, he said he probably wouldn’t be on his way to becoming a doctor at Icahn School of Medicine at Mount Sinai in Manhattan.

Dacarett-Galeano, who identifies himself as Latino, said most of his elementary school in Austin, Texas’s effectively segregated education system was considered economically disadvantaged. At the school, white students are the minority, making up 11 percent of the student body.

But thanks to a move to the suburbs and some luck, Dacarett-Galeano was able to attend the wealthiest public high school in the region, which was predominantly white. He had access to the Advanced Placement classes he needed to get into Columbia University, but he said not all of his underrepresented minority Columbia classmates had the same educational privileges — and it showed.

“When I really started to notice the difference between underrepresented minority experiences and otherwise was when I was in a college biology class there,” he said, explaining that biology is considered a “weed-out” class for pre-med students. “Most of my friends who were pre-med who dropped that track were underrepresented minorities or students from disadvantaged backgrounds.”

More could be done to encourage minority undergraduate students to consider medical school, Nivet and Tweedy said.

For minority students, secondary barriers to getting into medical school continue into their undergraduate careers, which are often at historically minority-heavy schools that do not have a full time medical school advisor to guide pre-med students through their coursework and the medical school application process, Nivet said. Such advisors are commonplace at Ivy League and other elite institutions.

Advice from advisers can range from telling pre-med students not to take organic chemistry and physics the same semester to telling them what’s an acceptable MCAT score. Nivet said he occasionally hears about less-informed advisors who have discouraged minority students from applying to medical school based on their MCAT scores, not knowing that those MCAT scores that would be competitive at most medical schools.

Tweedy said that schools lacking diversity may also be more passive about their recruitment methods. For instance, they don’t go to historically black undergraduate institutions to tell students about scholarship opportunities and fee waivers.

“Medical school is an incredible burden,” said Tweedy, who is a psychiatry professor at Duke University Medical Center. “That alone, the time it takes and the cost itself, may deter people from otherwise even considering it. That’s where someone like a recruiter could talk about various options for financial aid, invite students to at least apply and waive the application fees. All these things make it more accessible.”

https://public.tableau.com/views/Med_School_Applicants/Sheet5?:embed=y&:toolbar=no&:display_count=no&:showVizHome=no#1

Racial disparities continue throughout the application process. From 2013-14 through 2015-16, acceptance rates were lower for black students compared with other racial groups, according to MCAT and GPA data from AAMC.

Although 45.2 percent of white applicants got accepted into medical school — as well as 44.3 percent of hispanic applicants and 42.1 percent of Asian applicants — only 36.2 percent of black applicants were accepted.

Part of this may be tied to the fact that black students tend to score lower on the MCAT. Of the 2,460 students who earned the lowest scores on the test from 2013-14 through 2015-16, 43 percent were black. Of the 221 top-scoring medical school applicants over the same period, 11 percent were black.

https://public.tableau.com/views/MCATScoresByRace/Sheet1?:embed=y&:toolbar=no&:display_count=no&:showVizHome=no#1

For some minority students accepted to medical school, shaking the “false narrative” in their own minds that they don’t deserve to be there can be difficult, Nivet said. When Tweedy was a first-year medical student at Duke University in the 1990s, his professor mistook him for a handyman, Tweedy wrote in his book. He recalled feeling insecure about whether he was inferior to his classmates at the beginning of medical school once he learned that his MCAT score was “a few points below the class average” and that his classmates had come from Ivy League schools and other prestigious undergraduate institutions. He wrote that he knew his full scholarship to Duke’s medical school was the result of affirmative action, but wondered whether he was about to become an “academic casualty.”

Rowan University School of Osteopathic Medicine in New Jersey has a series of pipeline programs to recruit a diverse class of medical students early, but some students — not just minorities — have test scores or GPAs that indicate they may have trouble later on in their medical education, says Thomas Cavalieri, DO, the school’s dean. As a result, the school has a boot camp–like program that starts before the official school year begins to get these students up to speed. It also has a number of interventions to help struggling students throughout their medical education.

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Nivet said it’s especially important for minority students to remember that being near or below the average MCAT score isn’t a big deal — and that they’re hardly the only ones in the bottom half of their class.

“A whole bunch of white kids have lower MCAT scores,” he said. “Duke University is not ‘taking a chance’ on any kid…. Students who go to these elite institutions graduate and have become leaders across this country in medicine.”

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TOPICS: health, medical school, doctors, racial health disparities, medical school applicants, white coats for black lives, united states, americas, medical school application, damon tweedy