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Navigating Hair Loss in Medical School: Experiences of 2 Young Black Women
As medical students, we often assume we are exempt from the diagnoses we learn about. During the first 2 years of medical school, we learn about alopecia as a condition that may be associated with stress, hormonal imbalances, nutrient deficiencies, and aging. However, our curricula do not explore the subtypes, psychosocial impact, or even the overwhelming number of Black women who are disproportionately affected by alopecia. For Black women, hair is a colossal part of their cultural identity, learning from a young age how to nurture and style natural coils. It becomes devastating when women begin to lose them.
The diagnosis of alopecia subtypes in Black women has been explored in the literature; however, understanding the unique experiences of young Black women is an important part of patient care, as alopecia often is destructive to the patient’s self-image. Therefore, it is important to shed light on these experiences so others feel empowered and supported in their journeys. Herein, we share the experiences of 2 authors (J.D. and C.A.V.O.)—both young Black women—who navigated unexpected hair loss in medical school.
Jewell’s Story
During my first year of medical school, I noticed my hair was shedding more than usual, and my ponytail was not as thick as it once was. I also had an area in my crown that was abnormally thin. My parents suggested that it was a consequence of stress, but I knew something was not right. With only 1 Black dermatologist within 2 hours of Nashville, Tennessee, I remember worrying about seeing a dermatologist who did not understand Black hair. I still scheduled an appointment, but I remember debating if I should straighten my hair or wear my naturally curly Afro. The first dermatologist I saw diagnosed me with seborrheic dermatitis—without even examining my scalp. She told me that I had a “full head of hair” and that I had nothing to worry about. I was unconvinced. Weeks later, I met with another dermatologist who took the time to listen to my concerns. After a scalp biopsy and laboratory work, she diagnosed me with telogen effluvium and androgenetic alopecia. Months later, I had the opportunity to visit the Black dermatologist, and she diagnosed me with central centrifugal cicatricial alopecia. I am grateful for the earlier dermatologists I saw, but I finally feel at ease with my diagnosis and treatment plan after being seen by the latter.
Chidubem’s Story
From a young age, I was conditioned to think my hair was thick, unmanageable, and a nuisance. I grew accustomed to people yanking on my hair, and my gentle whispers of “this hurts” and “the braid is too tight” being ignored. That continued into adulthood. While studying for the US Medical Licensing Examination, I noticed a burning sensation on my scalp. I decided to ignore it. However, as the days progressed, the slight burning sensation turned into intense burning and itching. I still ignored it. Not only did I lack the funds for a dermatology appointment, but my licensing examination was approaching, and it was more important than anything related to my hair. After the examination, I eventually made an appointment with my primary care physician, who attributed my symptoms to the stressors of medical school. “I think you are having migraines,” she told me. So, I continued to ignore my symptoms. A year passed, and a hair braider pointed out that I had 2 well-defined bald patches on my scalp. I remember feeling angry and confused as to how I missed those findings. I could no longer ignore it—it bothered me less when no one else knew about it. I quickly made a dermatology appointment. Although I opted out of a biopsy, we decided to treat my hair loss empirically, and I have experienced drastic improvement.
Final Thoughts
We are 2 Black women living more than 500 miles away from each other at different medical institutions, yet we share the same experience, which many other women unfortunately face alone. It is not uncommon for us to feel unheard, dismissed, or misdiagnosed. We write this for the Black woman sorting through the feelings of confusion and shock as she traces the hairless spot on her scalp. We write this for the medical student ignoring their symptoms until after their examination. We even write this for any nondermatologists uncomfortable with diagnosing and treating textured hair. To improve patient satisfaction and overall health outcomes, physicians must approach patients with both knowledge and cultural competency. Most importantly, dermatologists (and other physicians) should be appropriately trained in not only the structural differences of textured hair but also the unique practices and beliefs among Black women in relation to their hair.
Acknowledgments—Jewell Dinkins is the inaugural recipient of the Janssen–Skin of Color Research Fellowship at Howard University (Washington, DC), and Chidubem A.V. Okeke is the inaugural recipient of the Women’s Dermatologic Society–La Roche-Posay dermatology fellowship at Howard University.
As medical students, we often assume we are exempt from the diagnoses we learn about. During the first 2 years of medical school, we learn about alopecia as a condition that may be associated with stress, hormonal imbalances, nutrient deficiencies, and aging. However, our curricula do not explore the subtypes, psychosocial impact, or even the overwhelming number of Black women who are disproportionately affected by alopecia. For Black women, hair is a colossal part of their cultural identity, learning from a young age how to nurture and style natural coils. It becomes devastating when women begin to lose them.
The diagnosis of alopecia subtypes in Black women has been explored in the literature; however, understanding the unique experiences of young Black women is an important part of patient care, as alopecia often is destructive to the patient’s self-image. Therefore, it is important to shed light on these experiences so others feel empowered and supported in their journeys. Herein, we share the experiences of 2 authors (J.D. and C.A.V.O.)—both young Black women—who navigated unexpected hair loss in medical school.
Jewell’s Story
During my first year of medical school, I noticed my hair was shedding more than usual, and my ponytail was not as thick as it once was. I also had an area in my crown that was abnormally thin. My parents suggested that it was a consequence of stress, but I knew something was not right. With only 1 Black dermatologist within 2 hours of Nashville, Tennessee, I remember worrying about seeing a dermatologist who did not understand Black hair. I still scheduled an appointment, but I remember debating if I should straighten my hair or wear my naturally curly Afro. The first dermatologist I saw diagnosed me with seborrheic dermatitis—without even examining my scalp. She told me that I had a “full head of hair” and that I had nothing to worry about. I was unconvinced. Weeks later, I met with another dermatologist who took the time to listen to my concerns. After a scalp biopsy and laboratory work, she diagnosed me with telogen effluvium and androgenetic alopecia. Months later, I had the opportunity to visit the Black dermatologist, and she diagnosed me with central centrifugal cicatricial alopecia. I am grateful for the earlier dermatologists I saw, but I finally feel at ease with my diagnosis and treatment plan after being seen by the latter.
Chidubem’s Story
From a young age, I was conditioned to think my hair was thick, unmanageable, and a nuisance. I grew accustomed to people yanking on my hair, and my gentle whispers of “this hurts” and “the braid is too tight” being ignored. That continued into adulthood. While studying for the US Medical Licensing Examination, I noticed a burning sensation on my scalp. I decided to ignore it. However, as the days progressed, the slight burning sensation turned into intense burning and itching. I still ignored it. Not only did I lack the funds for a dermatology appointment, but my licensing examination was approaching, and it was more important than anything related to my hair. After the examination, I eventually made an appointment with my primary care physician, who attributed my symptoms to the stressors of medical school. “I think you are having migraines,” she told me. So, I continued to ignore my symptoms. A year passed, and a hair braider pointed out that I had 2 well-defined bald patches on my scalp. I remember feeling angry and confused as to how I missed those findings. I could no longer ignore it—it bothered me less when no one else knew about it. I quickly made a dermatology appointment. Although I opted out of a biopsy, we decided to treat my hair loss empirically, and I have experienced drastic improvement.
Final Thoughts
We are 2 Black women living more than 500 miles away from each other at different medical institutions, yet we share the same experience, which many other women unfortunately face alone. It is not uncommon for us to feel unheard, dismissed, or misdiagnosed. We write this for the Black woman sorting through the feelings of confusion and shock as she traces the hairless spot on her scalp. We write this for the medical student ignoring their symptoms until after their examination. We even write this for any nondermatologists uncomfortable with diagnosing and treating textured hair. To improve patient satisfaction and overall health outcomes, physicians must approach patients with both knowledge and cultural competency. Most importantly, dermatologists (and other physicians) should be appropriately trained in not only the structural differences of textured hair but also the unique practices and beliefs among Black women in relation to their hair.
Acknowledgments—Jewell Dinkins is the inaugural recipient of the Janssen–Skin of Color Research Fellowship at Howard University (Washington, DC), and Chidubem A.V. Okeke is the inaugural recipient of the Women’s Dermatologic Society–La Roche-Posay dermatology fellowship at Howard University.
As medical students, we often assume we are exempt from the diagnoses we learn about. During the first 2 years of medical school, we learn about alopecia as a condition that may be associated with stress, hormonal imbalances, nutrient deficiencies, and aging. However, our curricula do not explore the subtypes, psychosocial impact, or even the overwhelming number of Black women who are disproportionately affected by alopecia. For Black women, hair is a colossal part of their cultural identity, learning from a young age how to nurture and style natural coils. It becomes devastating when women begin to lose them.
The diagnosis of alopecia subtypes in Black women has been explored in the literature; however, understanding the unique experiences of young Black women is an important part of patient care, as alopecia often is destructive to the patient’s self-image. Therefore, it is important to shed light on these experiences so others feel empowered and supported in their journeys. Herein, we share the experiences of 2 authors (J.D. and C.A.V.O.)—both young Black women—who navigated unexpected hair loss in medical school.
Jewell’s Story
During my first year of medical school, I noticed my hair was shedding more than usual, and my ponytail was not as thick as it once was. I also had an area in my crown that was abnormally thin. My parents suggested that it was a consequence of stress, but I knew something was not right. With only 1 Black dermatologist within 2 hours of Nashville, Tennessee, I remember worrying about seeing a dermatologist who did not understand Black hair. I still scheduled an appointment, but I remember debating if I should straighten my hair or wear my naturally curly Afro. The first dermatologist I saw diagnosed me with seborrheic dermatitis—without even examining my scalp. She told me that I had a “full head of hair” and that I had nothing to worry about. I was unconvinced. Weeks later, I met with another dermatologist who took the time to listen to my concerns. After a scalp biopsy and laboratory work, she diagnosed me with telogen effluvium and androgenetic alopecia. Months later, I had the opportunity to visit the Black dermatologist, and she diagnosed me with central centrifugal cicatricial alopecia. I am grateful for the earlier dermatologists I saw, but I finally feel at ease with my diagnosis and treatment plan after being seen by the latter.
Chidubem’s Story
From a young age, I was conditioned to think my hair was thick, unmanageable, and a nuisance. I grew accustomed to people yanking on my hair, and my gentle whispers of “this hurts” and “the braid is too tight” being ignored. That continued into adulthood. While studying for the US Medical Licensing Examination, I noticed a burning sensation on my scalp. I decided to ignore it. However, as the days progressed, the slight burning sensation turned into intense burning and itching. I still ignored it. Not only did I lack the funds for a dermatology appointment, but my licensing examination was approaching, and it was more important than anything related to my hair. After the examination, I eventually made an appointment with my primary care physician, who attributed my symptoms to the stressors of medical school. “I think you are having migraines,” she told me. So, I continued to ignore my symptoms. A year passed, and a hair braider pointed out that I had 2 well-defined bald patches on my scalp. I remember feeling angry and confused as to how I missed those findings. I could no longer ignore it—it bothered me less when no one else knew about it. I quickly made a dermatology appointment. Although I opted out of a biopsy, we decided to treat my hair loss empirically, and I have experienced drastic improvement.
Final Thoughts
We are 2 Black women living more than 500 miles away from each other at different medical institutions, yet we share the same experience, which many other women unfortunately face alone. It is not uncommon for us to feel unheard, dismissed, or misdiagnosed. We write this for the Black woman sorting through the feelings of confusion and shock as she traces the hairless spot on her scalp. We write this for the medical student ignoring their symptoms until after their examination. We even write this for any nondermatologists uncomfortable with diagnosing and treating textured hair. To improve patient satisfaction and overall health outcomes, physicians must approach patients with both knowledge and cultural competency. Most importantly, dermatologists (and other physicians) should be appropriately trained in not only the structural differences of textured hair but also the unique practices and beliefs among Black women in relation to their hair.
Acknowledgments—Jewell Dinkins is the inaugural recipient of the Janssen–Skin of Color Research Fellowship at Howard University (Washington, DC), and Chidubem A.V. Okeke is the inaugural recipient of the Women’s Dermatologic Society–La Roche-Posay dermatology fellowship at Howard University.
Practice Points
- Hair loss is a common dermatologic concern among Black women and can represent a diagnostic challenge to dermatologists who may not be familiar with textured hair.
- Dermatologists should practice cultural sensitivity and provide relevant recommendations to Black patients dealing with hair loss.
Bonds and Bridges: The Role of Social Capital in Building a More Diverse Dermatology Workforce
As our specialty seeks to address its lack of racial diversity, many dermatologists have answered recent calls to action.1,2 As we work toward dismantling systemic issues that have created pervasive inequality in our residency application review and interview processes, consideration also should be given to psychosocial issues that underrepresented-in-medicine (UIM) students face before their applications come to our attention. In this article, we explore how potential differences in the social capital of UIM and other disadvantaged dermatology residency applicants contribute to persistent homogeneity among dermatology training programs and the workforce.
The Theory of Capital
The concepts of economic, social, and cultural capital originate from the writings of social theorist Pierre Bourdieu.3 All 3 forms of capital are interconnected, and they relate to each other in ways that often facilitate social division and inequality. Economic capital denotes an individual’s economic resources or wealth, while cultural capital refers to the knowledge, behaviors, and skills that demonstrate his/her economic class (eg, communication style, table manners).3 Social capital refers to an individual’s interpersonal connections in personal and professional settings and can be subdivided into 3 categories: bonds, bridges, and linkages.4,5 Herein, we will focus on bonds and bridges.
It has been suggested that bonds are important for “getting by,” while bridges are critical for “getting ahead.”5 Bonds refer to close relationships within a community of people with shared characteristics, such as racial/ethnic identity and culture, access to information, and resources (eg, family, friends). These bonds provide trust, safety, and financial and emotional support; however, they are considered to be inward-looking and can promote exclusion and homogeneity.5
On the other hand, bridges refer to social relationships that extend outward beyond one’s close circle of family and friends to other people with shared interests and goals who may have different social or cultural identities (eg, professional colleagues). These bridges are considered to be outward-looking and provide many benefits to individuals and society. They link diverse individuals, which tends to increase tolerance and disrupt stereotypes, and they facilitate the sharing of ideas, information, and innovation. Additionally, bridges between individuals from different networks facilitate access to increased resources and opportunities for all parties.5
The 3 forms of capital are inextricably linked. For example, with economic capital, a child’s family can purchase access to a prestigious private high school, where he/she will gain valuable social capital through bridges with other students and their families. At this school, the child also will accumulate cultural capital that increases his/her sense of belonging in these circles. Subsequently, both the social and cultural capital accumulated at this private high school can be exchanged for economic capital via social networks, skills, values, and behaviors that facilitate entry into higher education and professional training. As such, these 3 forms of capital work together to continue social/class divisions, hierarchies, and ultimately inequality.
Impact of Social Capital in Pursuing a Medical Career
For medical students whose bonds (ie, close family, friends) include physicians or other health care professionals, the journey to studying medicine and entering their chosen specialty will be facilitated by financial security, valuable “inside information” about the application process, study skills, and even clinical guidance. Additionally, these students will have access to professional networks for mentorship, shadowing experiences, and other potential advantages. Furthermore, social capital is associated with higher self-esteem,6 which likely improves academic performance and wards off imposter syndrome in these students.
For medical students from lower socioeconomic status backgrounds or those whose inner circles do not include physicians or other health care professionals, accumulating the social and cultural capital needed to successfully navigate a medical career is more difficult. Although they may receive support and encouragement from family and friends, they will not have access to the same valuable information and connections that facilitate success; rather, they will have a further distance to travel, and this distance should be acknowledged in the residency application review process.
Acquiring Social Capital as a UIM Student
Despite the benefits of social and cultural capital, acquiring them takes a toll. For those UIM students who start life from a disadvantaged place, the accumulation of social capital does not come easily; rather, it demands effort and time that has the potential to detract from a student’s focus on the academic demands of medical education.7 Programs that attempt to improve disadvantaged students’ access to credible information, role models, and mentors can help lift some of the burden from the individual student’s shoulders. For example, studies have demonstrated the benefits of harnessing technology to enhance mentorship programs that increase social capital of disadvantaged populations.8-11 This approach already is in progress, bolstered by advances made in digital communications during the coronavirus disease 2019 pandemic.12 Student-led networking groups that connect remotely have been shown to build social capital bonds and bridges that facilitate collaborative learning, relationship building, and information sharing.8-11 There are existing online UIM student networks that individual dermatologists, institutions, and national organizations can partner with to facilitate the construction of bridges between these UIM student groups and dermatologists who can provide accurate, high-yield information and professional networking; however, one limitation of this suggestion is the disparate access to technology in the UIM community.
Final Thoughts
It is important to note that assumptions should not be made about the level of economic, social, or cultural capital an individual possesses based on his/her race or ethnicity. Instead, mentors should attempt to be available to a diverse pool of students; take the time to get to know these students; and then provide the types of mentorship, information, exposure, and networking that each individual student needs. Another approach is to make a concerted effort to ensure that all students receive the same amount and quality of information about medical education and our specialty regardless of their level of economic, cultural, or social capital. Moreover, beyond the promotion of diversity through increasing numbers of UIM applicants, we should seek to reshape our specialty into a space that does not require students to subdue their existing diverse forms of capital but rather to bring these different perspectives and lived experiences to the table.13
- Bray JK, McMichael AJ, Huang WW, et al. Publication rates on the topic of racial and ethnic diversity in dermatology versus other specialties. Dermatol Online J. 2020;26:7.
- Pritchett EN, Pandya AG, Ferguson NN, et al. Diversity in dermatology: roadmap for improvement. J Am Acad Dermatol. 2018;79:337-341.
- Bourdieu P. The forms of capital. In: Richardson J, ed. Handbook of Theory and Research for the Sociology of Education. Westport, CT: Greenwood; 1986:241-258.
- Granovetter MS. The strength of weak ties. Am J Sociol. 1973;78:1360-1380.
- Putnam RD. Bowling alone: America’s declining social capital. J Democracy. 1995;6:65-78.
- Han S. Longitudinal association between social capital and self-esteem: a matter of context. Psychiatry Research. 2015;226:340-346.
- Kirschling JM. Building social capital: leading and leveraging constituencies outside the college. J Nurs Educ. 2004;43:517-519.
- Radlick RL, Svedberg P, Nygren JM, et al. Digitally enhanced mentoring for immigrant youth social capital: protocol for a mixed methods pilot study and a randomized controlled trial [published online March 17, 2020]. JMIR Research Protocols. doi:10.2196/16472.
- Koh LC, Walker R, Wollersheim D, et al. I think someone is walking with me: the use of mobile phone for social capital development among women in four refugee communities. Int J Migration Health Social Care. 2018;14:411-424.
- Hartley A, Kassam AA. Social networking for learning in higher education: capitalising on social capital. ResearchGate website.https://www.researchgate.net/publication/311097860_Social_Networking_for_Learning_in_Higher_Education_Capitalising_on_Social_Capital. Published November 2016. Accessed October 19, 2020.
- Zalon ML. Using technology to build community in professional associations. J Contin Educ Nurs. 2008;39:235-240.
- Stewart CR, Chernoff KA, Wildman HF, et al. Recommendations for medical student preparedness and equity for dermatology residency applications during the COVID-19 pandemic. J Am Acad Dermatol. 2020;83:E225-E226.
- Brosnan C, Southgate E, Outram S, et al. Experiences of medical students who are first in family to attend university. Med Educ. 2016;50:842-851.
As our specialty seeks to address its lack of racial diversity, many dermatologists have answered recent calls to action.1,2 As we work toward dismantling systemic issues that have created pervasive inequality in our residency application review and interview processes, consideration also should be given to psychosocial issues that underrepresented-in-medicine (UIM) students face before their applications come to our attention. In this article, we explore how potential differences in the social capital of UIM and other disadvantaged dermatology residency applicants contribute to persistent homogeneity among dermatology training programs and the workforce.
The Theory of Capital
The concepts of economic, social, and cultural capital originate from the writings of social theorist Pierre Bourdieu.3 All 3 forms of capital are interconnected, and they relate to each other in ways that often facilitate social division and inequality. Economic capital denotes an individual’s economic resources or wealth, while cultural capital refers to the knowledge, behaviors, and skills that demonstrate his/her economic class (eg, communication style, table manners).3 Social capital refers to an individual’s interpersonal connections in personal and professional settings and can be subdivided into 3 categories: bonds, bridges, and linkages.4,5 Herein, we will focus on bonds and bridges.
It has been suggested that bonds are important for “getting by,” while bridges are critical for “getting ahead.”5 Bonds refer to close relationships within a community of people with shared characteristics, such as racial/ethnic identity and culture, access to information, and resources (eg, family, friends). These bonds provide trust, safety, and financial and emotional support; however, they are considered to be inward-looking and can promote exclusion and homogeneity.5
On the other hand, bridges refer to social relationships that extend outward beyond one’s close circle of family and friends to other people with shared interests and goals who may have different social or cultural identities (eg, professional colleagues). These bridges are considered to be outward-looking and provide many benefits to individuals and society. They link diverse individuals, which tends to increase tolerance and disrupt stereotypes, and they facilitate the sharing of ideas, information, and innovation. Additionally, bridges between individuals from different networks facilitate access to increased resources and opportunities for all parties.5
The 3 forms of capital are inextricably linked. For example, with economic capital, a child’s family can purchase access to a prestigious private high school, where he/she will gain valuable social capital through bridges with other students and their families. At this school, the child also will accumulate cultural capital that increases his/her sense of belonging in these circles. Subsequently, both the social and cultural capital accumulated at this private high school can be exchanged for economic capital via social networks, skills, values, and behaviors that facilitate entry into higher education and professional training. As such, these 3 forms of capital work together to continue social/class divisions, hierarchies, and ultimately inequality.
Impact of Social Capital in Pursuing a Medical Career
For medical students whose bonds (ie, close family, friends) include physicians or other health care professionals, the journey to studying medicine and entering their chosen specialty will be facilitated by financial security, valuable “inside information” about the application process, study skills, and even clinical guidance. Additionally, these students will have access to professional networks for mentorship, shadowing experiences, and other potential advantages. Furthermore, social capital is associated with higher self-esteem,6 which likely improves academic performance and wards off imposter syndrome in these students.
For medical students from lower socioeconomic status backgrounds or those whose inner circles do not include physicians or other health care professionals, accumulating the social and cultural capital needed to successfully navigate a medical career is more difficult. Although they may receive support and encouragement from family and friends, they will not have access to the same valuable information and connections that facilitate success; rather, they will have a further distance to travel, and this distance should be acknowledged in the residency application review process.
Acquiring Social Capital as a UIM Student
Despite the benefits of social and cultural capital, acquiring them takes a toll. For those UIM students who start life from a disadvantaged place, the accumulation of social capital does not come easily; rather, it demands effort and time that has the potential to detract from a student’s focus on the academic demands of medical education.7 Programs that attempt to improve disadvantaged students’ access to credible information, role models, and mentors can help lift some of the burden from the individual student’s shoulders. For example, studies have demonstrated the benefits of harnessing technology to enhance mentorship programs that increase social capital of disadvantaged populations.8-11 This approach already is in progress, bolstered by advances made in digital communications during the coronavirus disease 2019 pandemic.12 Student-led networking groups that connect remotely have been shown to build social capital bonds and bridges that facilitate collaborative learning, relationship building, and information sharing.8-11 There are existing online UIM student networks that individual dermatologists, institutions, and national organizations can partner with to facilitate the construction of bridges between these UIM student groups and dermatologists who can provide accurate, high-yield information and professional networking; however, one limitation of this suggestion is the disparate access to technology in the UIM community.
Final Thoughts
It is important to note that assumptions should not be made about the level of economic, social, or cultural capital an individual possesses based on his/her race or ethnicity. Instead, mentors should attempt to be available to a diverse pool of students; take the time to get to know these students; and then provide the types of mentorship, information, exposure, and networking that each individual student needs. Another approach is to make a concerted effort to ensure that all students receive the same amount and quality of information about medical education and our specialty regardless of their level of economic, cultural, or social capital. Moreover, beyond the promotion of diversity through increasing numbers of UIM applicants, we should seek to reshape our specialty into a space that does not require students to subdue their existing diverse forms of capital but rather to bring these different perspectives and lived experiences to the table.13
As our specialty seeks to address its lack of racial diversity, many dermatologists have answered recent calls to action.1,2 As we work toward dismantling systemic issues that have created pervasive inequality in our residency application review and interview processes, consideration also should be given to psychosocial issues that underrepresented-in-medicine (UIM) students face before their applications come to our attention. In this article, we explore how potential differences in the social capital of UIM and other disadvantaged dermatology residency applicants contribute to persistent homogeneity among dermatology training programs and the workforce.
The Theory of Capital
The concepts of economic, social, and cultural capital originate from the writings of social theorist Pierre Bourdieu.3 All 3 forms of capital are interconnected, and they relate to each other in ways that often facilitate social division and inequality. Economic capital denotes an individual’s economic resources or wealth, while cultural capital refers to the knowledge, behaviors, and skills that demonstrate his/her economic class (eg, communication style, table manners).3 Social capital refers to an individual’s interpersonal connections in personal and professional settings and can be subdivided into 3 categories: bonds, bridges, and linkages.4,5 Herein, we will focus on bonds and bridges.
It has been suggested that bonds are important for “getting by,” while bridges are critical for “getting ahead.”5 Bonds refer to close relationships within a community of people with shared characteristics, such as racial/ethnic identity and culture, access to information, and resources (eg, family, friends). These bonds provide trust, safety, and financial and emotional support; however, they are considered to be inward-looking and can promote exclusion and homogeneity.5
On the other hand, bridges refer to social relationships that extend outward beyond one’s close circle of family and friends to other people with shared interests and goals who may have different social or cultural identities (eg, professional colleagues). These bridges are considered to be outward-looking and provide many benefits to individuals and society. They link diverse individuals, which tends to increase tolerance and disrupt stereotypes, and they facilitate the sharing of ideas, information, and innovation. Additionally, bridges between individuals from different networks facilitate access to increased resources and opportunities for all parties.5
The 3 forms of capital are inextricably linked. For example, with economic capital, a child’s family can purchase access to a prestigious private high school, where he/she will gain valuable social capital through bridges with other students and their families. At this school, the child also will accumulate cultural capital that increases his/her sense of belonging in these circles. Subsequently, both the social and cultural capital accumulated at this private high school can be exchanged for economic capital via social networks, skills, values, and behaviors that facilitate entry into higher education and professional training. As such, these 3 forms of capital work together to continue social/class divisions, hierarchies, and ultimately inequality.
Impact of Social Capital in Pursuing a Medical Career
For medical students whose bonds (ie, close family, friends) include physicians or other health care professionals, the journey to studying medicine and entering their chosen specialty will be facilitated by financial security, valuable “inside information” about the application process, study skills, and even clinical guidance. Additionally, these students will have access to professional networks for mentorship, shadowing experiences, and other potential advantages. Furthermore, social capital is associated with higher self-esteem,6 which likely improves academic performance and wards off imposter syndrome in these students.
For medical students from lower socioeconomic status backgrounds or those whose inner circles do not include physicians or other health care professionals, accumulating the social and cultural capital needed to successfully navigate a medical career is more difficult. Although they may receive support and encouragement from family and friends, they will not have access to the same valuable information and connections that facilitate success; rather, they will have a further distance to travel, and this distance should be acknowledged in the residency application review process.
Acquiring Social Capital as a UIM Student
Despite the benefits of social and cultural capital, acquiring them takes a toll. For those UIM students who start life from a disadvantaged place, the accumulation of social capital does not come easily; rather, it demands effort and time that has the potential to detract from a student’s focus on the academic demands of medical education.7 Programs that attempt to improve disadvantaged students’ access to credible information, role models, and mentors can help lift some of the burden from the individual student’s shoulders. For example, studies have demonstrated the benefits of harnessing technology to enhance mentorship programs that increase social capital of disadvantaged populations.8-11 This approach already is in progress, bolstered by advances made in digital communications during the coronavirus disease 2019 pandemic.12 Student-led networking groups that connect remotely have been shown to build social capital bonds and bridges that facilitate collaborative learning, relationship building, and information sharing.8-11 There are existing online UIM student networks that individual dermatologists, institutions, and national organizations can partner with to facilitate the construction of bridges between these UIM student groups and dermatologists who can provide accurate, high-yield information and professional networking; however, one limitation of this suggestion is the disparate access to technology in the UIM community.
Final Thoughts
It is important to note that assumptions should not be made about the level of economic, social, or cultural capital an individual possesses based on his/her race or ethnicity. Instead, mentors should attempt to be available to a diverse pool of students; take the time to get to know these students; and then provide the types of mentorship, information, exposure, and networking that each individual student needs. Another approach is to make a concerted effort to ensure that all students receive the same amount and quality of information about medical education and our specialty regardless of their level of economic, cultural, or social capital. Moreover, beyond the promotion of diversity through increasing numbers of UIM applicants, we should seek to reshape our specialty into a space that does not require students to subdue their existing diverse forms of capital but rather to bring these different perspectives and lived experiences to the table.13
- Bray JK, McMichael AJ, Huang WW, et al. Publication rates on the topic of racial and ethnic diversity in dermatology versus other specialties. Dermatol Online J. 2020;26:7.
- Pritchett EN, Pandya AG, Ferguson NN, et al. Diversity in dermatology: roadmap for improvement. J Am Acad Dermatol. 2018;79:337-341.
- Bourdieu P. The forms of capital. In: Richardson J, ed. Handbook of Theory and Research for the Sociology of Education. Westport, CT: Greenwood; 1986:241-258.
- Granovetter MS. The strength of weak ties. Am J Sociol. 1973;78:1360-1380.
- Putnam RD. Bowling alone: America’s declining social capital. J Democracy. 1995;6:65-78.
- Han S. Longitudinal association between social capital and self-esteem: a matter of context. Psychiatry Research. 2015;226:340-346.
- Kirschling JM. Building social capital: leading and leveraging constituencies outside the college. J Nurs Educ. 2004;43:517-519.
- Radlick RL, Svedberg P, Nygren JM, et al. Digitally enhanced mentoring for immigrant youth social capital: protocol for a mixed methods pilot study and a randomized controlled trial [published online March 17, 2020]. JMIR Research Protocols. doi:10.2196/16472.
- Koh LC, Walker R, Wollersheim D, et al. I think someone is walking with me: the use of mobile phone for social capital development among women in four refugee communities. Int J Migration Health Social Care. 2018;14:411-424.
- Hartley A, Kassam AA. Social networking for learning in higher education: capitalising on social capital. ResearchGate website.https://www.researchgate.net/publication/311097860_Social_Networking_for_Learning_in_Higher_Education_Capitalising_on_Social_Capital. Published November 2016. Accessed October 19, 2020.
- Zalon ML. Using technology to build community in professional associations. J Contin Educ Nurs. 2008;39:235-240.
- Stewart CR, Chernoff KA, Wildman HF, et al. Recommendations for medical student preparedness and equity for dermatology residency applications during the COVID-19 pandemic. J Am Acad Dermatol. 2020;83:E225-E226.
- Brosnan C, Southgate E, Outram S, et al. Experiences of medical students who are first in family to attend university. Med Educ. 2016;50:842-851.
- Bray JK, McMichael AJ, Huang WW, et al. Publication rates on the topic of racial and ethnic diversity in dermatology versus other specialties. Dermatol Online J. 2020;26:7.
- Pritchett EN, Pandya AG, Ferguson NN, et al. Diversity in dermatology: roadmap for improvement. J Am Acad Dermatol. 2018;79:337-341.
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- Putnam RD. Bowling alone: America’s declining social capital. J Democracy. 1995;6:65-78.
- Han S. Longitudinal association between social capital and self-esteem: a matter of context. Psychiatry Research. 2015;226:340-346.
- Kirschling JM. Building social capital: leading and leveraging constituencies outside the college. J Nurs Educ. 2004;43:517-519.
- Radlick RL, Svedberg P, Nygren JM, et al. Digitally enhanced mentoring for immigrant youth social capital: protocol for a mixed methods pilot study and a randomized controlled trial [published online March 17, 2020]. JMIR Research Protocols. doi:10.2196/16472.
- Koh LC, Walker R, Wollersheim D, et al. I think someone is walking with me: the use of mobile phone for social capital development among women in four refugee communities. Int J Migration Health Social Care. 2018;14:411-424.
- Hartley A, Kassam AA. Social networking for learning in higher education: capitalising on social capital. ResearchGate website.https://www.researchgate.net/publication/311097860_Social_Networking_for_Learning_in_Higher_Education_Capitalising_on_Social_Capital. Published November 2016. Accessed October 19, 2020.
- Zalon ML. Using technology to build community in professional associations. J Contin Educ Nurs. 2008;39:235-240.
- Stewart CR, Chernoff KA, Wildman HF, et al. Recommendations for medical student preparedness and equity for dermatology residency applications during the COVID-19 pandemic. J Am Acad Dermatol. 2020;83:E225-E226.
- Brosnan C, Southgate E, Outram S, et al. Experiences of medical students who are first in family to attend university. Med Educ. 2016;50:842-851.
Practice Points
- Achieving diversity in the field of dermatology will require a concerted effort to equalize access to mentorship, information, exposure, and networking for students of all backgrounds.
- Valuing diverse forms of capital in applicants ultimately will strengthen the dermatology workforce through inclusion of various lived experiences and perspectives.
