Getting in but not getting on
Despite efforts to widen access to the medical profession for under-represented groups, Black students still face a host of barriers. It’s time for medical education to move beyond simply opening doors, writes Carl Kulimushi, a student at the University of Manchester.
The shortage of doctors in the NHS is well known. You may be one of the seven and a half million patients stuck on NHS waiting lists or have taken part in the early morning scrum to get a GP appointment. The principal cause is that not enough doctors are being trained.
It is true that universities are expanding places and widening access. Contextual offers, outreach, targeted support and groups like Melanin Medics have opened doors and built belief for aspiring doctors from under-represented backgrounds. Educational charity the Sutton Trust continues to push for fairer admissions for students from across the socio-economic spectrum. Even so, I didn’t get into medicine first time. Many applicants from under-represented backgrounds still don’t. So, when the offer arrived, the relief was real.
But getting in was only the beginning. Once Black-heritage students like me get into medical school, there are big challenges to getting on. I noticed the raised eyebrows, the small exclusions, the offhand remarks. What some call microaggressions have macro impacts: they drain focus, chip away at confidence, and on placement that can mean hesitating when you should speak up, a risk we can’t afford to take when it comes to patients.
‘The emotional and psychological toll of subtle exclusion’
I ran into the same barriers again and again, the emotional and psychological toll of subtle exclusion and cultural alienation, the daily reminders that belonging isn’t guaranteed. These challenges are not abstract: they profoundly impact mental health, academic performance, self-confidence and engagement in education, with consequences that ripple into the workforce and patient care. In medicine, a diverse workforce is not just a matter of fairness, it is a strategic necessity.
Alongside this there is the Eurocentric curricula that neglect conditions disproportionately affecting Black communities, such as sickle cell disease. Beneath the surface sits the ‘hidden curriculum’, unspoken norms around professionalism, communication and conduct that can entrench disadvantage for students who don’t fit the dominant cultural profile. And all these inequities have a measurable impact on grades awarded to Black students.
Far too often, medical schools leave Black heritage students feeling persistently unwelcome. We need to move beyond inclusion – beyond simply being invited to study medicine – and towards creating a genuine and lasting sense of belonging, where students feel safe, trusted, valued and able to thrive.
As the BMJ Commission on the Future of the NHS shows, tackling racism and inequity improves safety and care quality, strengthens trust, and reduces system costs – the pay-off is better outcomes for patients and staff. If we want a service that’s safe and effective for everyone, we have to create the conditions for every student to thrive.
'Students have stepped up’
We students have stepped up. As a Student Inclusion Partner, I’ve helped to drive that shift, co-authoring an education toolkit to embed anti-racist practice across teaching and assessment. At the African & Caribbean Medical Society (ACMS) in Manchester, we’ve hosted teaching on neglected conditions and been building community through flagship events such as the Beyond the Bedside conference, which brought together more than 100 Black heritage delegates. These spaces matter: they educate, advocate and show students they belong.
But there are limits to what students can achieve on their own (not to mention the emotional and professional burden, the ‘minority tax’, this can put on students). Lasting change comes when advocacy translates into institutions. It is the culture of an institution that makes reform real. Without it, even the best-designed EDI initiatives risk becoming tokenistic, performative.
So what does this cultural shift look like for Black students? Last year I took part in a workshop for Black student leaders run by Grit: Breakthrough Programmes, which suggested a number of key elements that go towards creating a culture that generates belonging and fosters the leadership mindset that medicine demands.
‘It’s time for medical education to move beyond simply opening doors’
It begins with access to safe Black spaces, a space to connect with people who knew what I had been going through, a space where I don’t have to self-censor, where there isn’t the weight of always being different.
It continues with representation, both in how opportunities are presented and in who delivers them, so we see our own racial identity and cultural background reflected back. It’s about the affirmation of identity, of the right to be noticed, the right to feel heard, of seeing that my voice, my opinion matters.
And it grows into leadership, being able to see that I already have the skills and qualities that make a leader and going out of my way to be visible, showing how anyone just like me can make a difference, can be successful.
It’s time for medical education to move beyond simply opening doors. It’s time to reshape the culture so that equity, belonging and success are not add-ons, but the default for every student, every time they walk through the door. As the BMJ makes clear, in a climate where there growing questioning and resistance to equity, systemic change is not optional; it is urgent. Because for the NHS to thrive, getting in is not enough – students must also be able to truly get on.
Carl Kulimushi is a third-year medical student at the University of Manchester and Student Inclusion Partner in the Faculty of Biology, Medicine and Health (School of Medical Sciences).
Find out more about Grit: Breakthrough Programmes at www.grit.org.uk.
The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect those of the Runnymede Trust.
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Photo © Grit: Breakthrough Programmes
