This article is part of a series spotlighting Black leaders in pathology and laboratory medicine.
Roger A. Mitchell, Jr., MD, is a forensic and anatomical pathologist in Washington, DC. As the current chair of pathology at Howard University, and former chief medical examiner for Washington, DC, Dr. Mitchell has a family history of working in medicine. Here, he shares his thoughts on how to encourage students toward pathology, what inspired him to go into medicine, and more.
What pathway efforts have been most successful in fostering the interest of medical students in Pathology?
Any time that you are trying to foster interest, it's really about relationships and visibility. At the end of the day, medical students want to be mentored, and they want to have real relationships. As physicians, we’re often busy trying to get our clinical work done, trying to balance our resident education, research responsibilities, and our need to excel within the promotions and tenure track. So, if you’re in an academic institution, you really have to be intentional about wanting to foster relationships with your medical students. If you show legitimate interest in the education of your students, whether they become a pathologist or not, then you will find that more medical students will want to go into pathology because they can see themselves as a pathologist, because they met you. That’s important for my colleagues to understand.
These can't be relationships that are just checking a box. They must be real. Medical students need to be empowered in the relationship as well and be persistent. I tell my medical students all the time, I'm the chair of the department I have a lot going on. So, if I don't get back to you, then you need to call me or text me. How many of your medical students have your cell phone number? Are you just telling them to email your assistant, or you're just giving them to your resident? No, you must be willing to have real authentic relationships. That means being accessible.
You want to give these students opportunities to shadow whether with you or a resident. Medical students don't get a lot of time in pathology. Particularly beyond the second year and beyond didactic, so you want to make it easy for a medical student who has an interested in pathology to be able to get into grossing, get in the autopsy suite, get behind the multiheaded scope.
One of the reasons why I made the choice to come into academic medicine is because I want the students at Howard University to know that they can absolutely be themselves and be successful. You don't have to be some watered-down version of yourself, or some version of yourself that may be historically more keeping with the larger view of what Black people should be, and what Black people should look like, to be successful.
I want them to understand that they're relevant just as a function of who they are. That relevancy is extremely, extremely important. And part of that relevancy, particularly if we're looking to recruit Black medical students into pathology, means that faculty must look like those who we're trying to recruit.
What are some of the systemic healthcare challenges that affect Black people, and what role can the laboratory play in addressing them?
We know that there are health disparities along the lines of class and race. We know that, for Black males, there's a higher rate of heart disease and cancer, unintentional injuries and accidents, stroke, cerebrovascular disease, diabetes, just to name a few.
But most of these are not a function of race. It's not a function of the very limited amount of genome that makes my skin brown. But, most health disparity is a function of access. As W.E.B. DuBois puts it, it is about equitable access to education, economics, housing, healthcare, and criminal justice, I would add environmental justice. It’s a function of this access paradigm that Black people and poor people may have outcomes that are better or worse. And then it’s a function of social determinants of health. Laboratory leadership must understand and teach the concept of the social determinants of health.
This fall I taught a lecture for my residents and faculty on social determinants, and there were many who had not been exposed to the formal concepts of the social determinants of health: where we live, work, play, love, and have our being can affect our access to healthcare, and on our individual health outcomes.
Lab physicians tend to have our heads in books and heads and microscopes. We don't see the role of the laboratory playing out in public health. There are articles written that talk about the need for the laboratory's role in population health. The laboratory has an opportunity to be a single source of truth as well as a unique opportunity to drive healthcare delivery with data. The pathologist is diagnosis and outcomes driven and if we leverage our data, we can really inform a whole community. We can identify early trends of disease and care management; we can use it for predictive analysis within a population. And then we can use autopsy to reduce diagnostic errors. The laboratory needs to understand social determinants and its role in providing data as a reliable source of ground truth for the population it serves.
Why did you pick the areas in which you focus in your professional life? What do you hope to leave as a legacy from your professional life?
My grandfather was one of the first Black physicians in New Jersey. He graduated from Howard College of Medicine in 1932. He was a black bag doctor—carried his black bag from door to door, delivered babies on kitchen floors. His house in Atlantic City was where Black people of prominence would come when visiting Atlantic City. I grew up hearing stories about how he served people in the community. And I wanted to be like him.
I went to Howard undergrad, in an effort to be like my grandfather, and, and then I was one of the first Black men in the FBI DNA laboratories as a forensic biologist. And while I was a forensic biologist there, I got exposed to the Dr. David Satcher’s Surgeon General's report on youth violence. And that changed my life.
When I read that exposure to violence could lead to violence within the community, it became clear that I wanted to leave the FBI and study violence as a public health issue. I thought the best way to do that was to be a medical examiner. So much of my career has been in forensic pathology, violence prevention, fatality, management, and death in custody. In the process, I became the chief medical examiner and at one point I was the youngest chief medical examiner in the country. I was one of the few black chief medical examiners in any major city in the country.
Now, after having a full career as a forensic pathologist, I wanted to come to Howard to teach the next generation. I pray that my legacy is such that the mentorship of young physicians, no matter what their specialty, leads them and helps them to figure out their next steps. I want them to have the confidence that it takes to become a successful physician. I want them to understand the importance of being an advocate physician, and the importance of using our craft, for the true liberation and freedom of our people. This is extremely important as we are in a very conflicted time in our history. It's even now more important than ever to galvanize allies within all professions, particularly medicine, to stand up in the face of white supremacy, and engage in a way that leads to better health outcomes for Black, Brown, poor and disenfranchised people in this country. So, I'm hoping that my legacy is such that it is not just words, but also action.