Ieta Shams is a medical student in the Class of 2021 at the University of Ottawa.

There is a riddle I came across during my undergraduate years that continues to resonate with me to this day. A boy and his father are in a terrible car accident. The father dies and the boy is rushed to the hospital where he is taken for surgery. As he goes into the operating room, the surgeon proclaims, “I cannot operate on this boy, he is my son!” How do you explain this? I remember thinking, perhaps the boy has two fathers? Or maybe he was adopted? Because surely these explanations came more easily than the realization that the surgeon was his mother. Studies found that even young people and self-identified feminists often overlooked the possibility that the surgeon was a “she”.

I am a woman, a person of colour, and a first-generation university graduate—these identifiers were not as apparent to me until medical school. For most of my life I did not see myself as different from my peers. However, as I advanced forward in my studies and moved to different cities, I became less sure of my place in the world, and louder grew the voice in my head questioning whether or not I might even belong. During my first year of medical school, we had a skills session for which my classmate and I were to interview a patient in the hospital. This was my first time donning the white coat; the first semblance of a future physician to be. I recall the patient’s kind smile—nothing mean or sinister about him as he nonchalantly asked if we were Canadian citizens. I remember wondering if anyone else is asked this.

I am now a third year medical student. Throughout my short tenure in the clinical setting, I have met patients who, before all else, will ask where I am from. When I respond with “Toronto”, this answer is often insufficient because it’s followed by “Where are your parents from?” While cultural heritage can be an important aspect to learning about a person, it is information that should be offered, not elicited prematurely nor used as the sole basis on which to make an initial characterization. Whether knowingly or not, when this question is asked before all else, the response is used to formulate an impression, in the absence of further (and arguably more relevant) data points.

During my third year ENT rotation, I was seeing patients in clinic with a renowned surgeon and a skilled resident. As the female resident was preparing to perform a laryngoscopy the patient made a remark about her appearance and questioned her ability to perform the scope. Later, the surgeon aptly acknowledged the comment and recognized that as a Caucasian male, he would not endure such struggles in his career. This encounter stands in the setting of countless instances of my being confused for anyone but a medical student. Over time it has become apparent that when I enter a patient’s room, I possess no intrinsic qualities that one associates with expertise, as I do not resemble our fathers of medicine. The name on my badge does not roll off the tongue and the foreign sounding phonemes are often replaced by “that medical student”. These seemingly insignificant occurrences, after experienced repeatedly, begin to carry weight.

I bring attention to these experiences in my medical training, not to paint myself as a victim or to suggest that the system is oppressive. It is the exact opposite. I recognize how fortunate I am to pursue a career in medicine, and I believe it is a system that is striving to become more diverse and equitable. However, I also recognize that despite these attempts, challenges remain. There are pervasive implicit biases grounded in generations of gender and racial discrimination that continue to exist. Such entrenched implicit biases are the most challenging to dismantle because, unlike overt racism or sexism, these are not as apparent. In essence, it gives way to psychological torment…how can I feel this way when society says we are equal? Or when over 60% of my class is female?

I am not sure what the solution is on a societal scale, but perhaps as a profession we can actively continue to set a precedent of equity and inclusivity. Similar to the stages of change model, often used to characterize our patients’ state of mind, I believe the first step is contemplation. To reflect on how implicit biases might influence our decision-making. To consider instances when we might defer to a male colleague over a female one of equivalent stature. To recognize how cultural background might impact our impressions. And whenever possible, to serve as allies for our colleagues who are treated as an extension of their gender or race. Deborah Belle, a psychology professor at Boston University who studied implicit biases using the aforementioned riddle, eloquently stated that “eternal vigilance, I think, is the only solution, as these schemas do change over time, although the pace is glacial.”1 As I reflect on my place in medicine, I am grateful to the pioneers who paved the way for women and people of colour. So that, while today she might be a medical student who is often mistaken for anything except that, she will persist, and tomorrow she will be the chief of medicine, a staff surgeon, or any of the countless impeccable physicians in our hospitals and clinics. She will lead teams, command operating rooms, run codes, and provide patient care of the highest standards. And there will come a day, when children will envision the prototypical doctor as none other than their mother.