Insights on Residency Training

Dr. Kaplan is a Chief Resident in Internal Medicine at Baylor College of Medicine in Houston, TX.

As residency interview season ramps up, the topic of diversity arises frequently. Residency programs emphasize diversity in the locations at which their trainees practice, the variety of patients their trainees have the opportunity to see and care for, and the characteristics of the residents they matriculate. Diversity is an important characteristic of residency programs for applicants to be aware of and question during their interviews.

Practice settings

At my residency program, we rotate through a county hospital, a Veterans Affairs hospital, a private hospital, and a specialty cancer center. At our county hospital, I have seen and treated patients with disseminated tuberculosis, cerebral malaria, pyogenic liver abscesses, lupus cerebritis, and almost every type of vasculitis I learned about in medical school. I also had the opportunity to learn about the importance of community resources to patients who have very limited resources of their own. At our VA hospital, I had the privilege of taking care of older patients with innumerable decompensated chronic medical conditions, including patients with heart failure, cirrhosis, end-stage renal disease, and chronic obstructive pulmonary disease. I learned what it truly means to be a “fighter,” in multiple senses of the word. At our private hospital, I cared for profoundly immunosuppressed patients who had received organ transplants or bone marrow transplants in addition to patients on varied types of advanced mechanical circulatory support that I never would have seen at our other hospitals. And finally, at our specialty cancer center I treated patients with both rare and common malignancies in different stages who had the chance to receive experimental treatments only available in limited hospitals in the world. Having experienced this diversity of practice settings, the treatments offered and not offered at each, and the variety of patients I had the opportunity to see, I think having a diverse residency training experience rotating at only one type of hospital would be challenging.

Patients

As physicians, we have the honor of taking care of patients from many different walks of life. We have a professional obligation to provide compassionate care to all of our patients. Open-mindedness is an important trait for a physician, and this trait primarily develops from exposure to a variety of people. I have had the opportunity to care of patients who have, for a variety of reasons, been excluded from the standard medical system. In one day, I have cared for patients who speak only Spanish, Urdu, Farsi, or Vietnamese and are surprised when I go to the effort of calling an interpreter to converse with them instead of trying to use English. I have treated women who have been sexually assaulted multiple times throughout their lives and refuse to be examined by male physicians. And I have cared for a transgender patient who was refused care by her primary care doctor who had used derogatory terms; the patient had developed a fear of seeking out healthcare. Our ability to serve as physicians and advocates for our patients is partially dependent on our ability to empathize with them and their life experiences. Achieving this empathy is much more difficult if you have never taken care of a non-English-speaking patient, a sexually abused patient, or a transgender patient.

Co-workers

Finally, I think having the opportunity to work with co-residents, fellows, and faculty coming from a variety of backgrounds in terms of race, ethnicity, sexual orientation, religion, and abled-ness truly allows one to respect different types of people. Any residency program touting its “diversity” should have that diversity represented not only in the patients who trainees see, but also in the trainees it selects for its program. Your co-residents are the people you grab coffee with after a long call in the ICU, go to the program holiday party with, run ideas by when you are unsure of what to do for a sick patient, and who ultimately will probably become your lifelong friends. Working with colleagues from backgrounds different from your own is the best way to develop a better understanding of and foster respect for our differences.

I feel privileged to have trained at an institution that has diversity in training sites, the medical conditions we see, the types of patients we have the chance to care for, and the backgrounds of the residents with whom I trained. For those applying to residency now, I suggest focusing some of your questions for the residents and program leadership on how they can offer you diverse medical training to enable you to get the most robust training experience for you, both personally and professionally.

What are some other reasons diversity is important in residency training?