The trap of Black excellence in medical education


“To become successful, you need to be excellent and likable,” said a local Black physician giving advice to young underrepresented students facing the usual challenges of medical school.

“Black excellence is the only way forward. The system and the institutions are racist, but we just need to work extra hard. If we do, we will get what we deserve,” said another prominent African-American doctor trying to inspire graduating Black physicians.

Both of these speeches reflect how two Black physicians have dealt with racism and succeeded in their ambitious endeavors. They are valid, but are they good words of advice to students?

Should we tell medical students that, because life is not fair, they should go above and beyond to overcome structural inequities? Or should we simply tell them that, because life is not fair, they might not receive the acknowledgment they deserve? My vote goes to the latter.

Throughout my own life, I have actually chosen the first option to guide me. I grew up in an impoverished neighborhood on the outskirts of Rio de Janeiro, Brazil, and was brought up by parents who were only able to finish the 8th grade before dropping out and joining the workforce to help at home. My path to becoming a successful medical student in a leading medical school in the United States has been fueled by my belief that I could achieve my dreams if I studied and worked hard enough. While that mentality helped me to get where I am today, for years now, I have tried to get rid of this subconscious mindset that haunts me and tells me, “Is this your best? It is not enough. You need to work harder.”

I have worked exceedingly hard since day one of medical school, yet I have made sure to spend essential time with family and friends doing activities that make me feel at peace. I would not give up any of this for the subjective idea of “Black excellence,” and I don’t think anyone should. As future physicians, we must strive for excellence, but we should not lose ourselves in this process.

As medical students, we are well aware of the widespread imposter syndrome among us, given that our educators’ expectations are high, and we are often surrounded by other brilliant, dedicated, and caring human beings. In medical school, the feeling of inadequacy is pervasive. So, why would you tell anyone that they need to be even better than their best? Shouldn’t we encourage them to become the best doctors they can and tell them they are going to be great physicians? Shouldn’t we tell them that they deserve to feel like they are enough? I think so.

Reassurance and recognition may seem, for some, like a way of sheltering us from the often harsh realities of practicing medicine, but supportive and understanding mentors can be crucial to guide us through the process of becoming the best physicians we can be. Telling someone that they are not doing or are not enough when they are already exhausted and unsure about how to do better is much more likely to be damaging than helpful. Instead of the traditional “Black excellence” speech, most people I know would rather hear, “I see you. I know you are struggling. But I know how hard you work, so I am confident that everything will be alright”.

As educated Black professionals, we often do not feel included or supported and are constantly working to perform at a very high level without necessarily having the same opportunities, resources, and networks. Despite these shortcomings, most of us will succeed and become inspiring role models, regardless of any lofty ideals of Black excellence.

Helio Neves da Silva is a medical student.

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