racismThe year 2020 has been a year of upheaval. The COVID pandemic revealed disparities in healthcare and its effects on marginalized groups such as the Black community. The pervasive effects of structural racism affect all of us, including in medical education. We cannot and must not remain silent. As we honor Juneteenth, #BlackLivesMatter, and #WhiteCoatsforBlackLives, let us reflect on ways we can address racial injustice in our direct environment.

Several EM physicians of color have used our voice to call for action towards using education to train nonviolent de-escalation techniques. Dr. Adaira Landry and her team also have shared our collective experience on microaggressions and ways to overcome this experience. Some of us have knelt in solidarity for 8 minutes and 46 seconds.

How else can we, as educators, promote a learning environment that is inclusive and respectful of diverse cultures and experiences? How do we advance antiracism efforts within the medical education community?

In reflecting back to some of the works done at ALiEM, we’re reminded of the Medical Education in Cases (MEdIC) Series. In Case of the Culture Clash, Dr. Anne Smith and #MedEd experts from different parts of the world share their opinion on how to handle different cultures in our clinical environment. Some lessons: We must value different cultural backgrounds in teams. We must not make assumptions about people based on how they look, talk, or act, as this can cause miscommunications. Edgar Schein writes in Humble Leadership about the concept of “personizing,” and investing ourselves in mutually developing working relationships and seeing a person as a whole, rather than focusing on a transactional relationship. Pushing this further, “Individualizing Education goes beyond Culture.” In creating a curriculum that is equitable and available for all, we can do better for individual students. We can run one-on-one sessions and offer more advanced notice to allow for those who learn in a different language to prepare on their own time. We can engage in self-reflection and feedback and specifically solicit honest and constructive feedback from learners. Lastly, we should be keenly aware of our own biases; this is a crucial step in overcoming cross-cultural miscommunication.

Another important and relevant piece is the Case of the Discriminatory Patient, by Dr. Arden Azim. In this case, a trainee who is caring for a patient is interrupted with, “Sorry but I just can’t understand what you’re saying. Not to be rude, but can I get a Canadian doctor?” Curated medical community commentary and expert perspectives on this not so rare scenario share several learning points and observations on how the attending physician addressed the incident. Scenarios like this are not uncommon and cause long-lasting effects on trainees. Racial discrimination is an issue that can occur anywhere there are transecting borders.

Faculty often feel conflicted about how to best address the situation without alienating the patient, making a systemic issue deeply personal and morally distressing. For systemic issues, a systemic approach to change must be part of the solution. Institutions should have policies in place with clear pathways for responding to discrimination in clinical and educational settings. Learners and faculty must feel supported. “Passive silence implies acceptance of the discriminatory behavior.”

As we help mold the future of medicine and honor the lives lost due to structural racism, we must develop clear organizational position statements that are more than just a series of words. As individuals, we must push ourselves to learn more about ourselves, and learn about effective antiracism efforts, and use our newfound knowledge to serve as agents of change. As organizations, we must provide transparent, actionable, and measurable objectives that ensure an inclusive environment focused on developing compassion, belonging, and respect within our medical education community.

Al'ai Alvarez, MD

Al'ai Alvarez, MD

Assistant Residency Program Director
Clinical Assistant Professor
Department of Emergency Medicine
Stanford University School of Medicine
Teresa Chan, MD, MHPE
ALiEM Associate Editor
Emergency Physician, Hamilton
Associate Professor, McMaster University
Assistant Dean, Program for Faculty Development, McMaster University Ontario, Canada
Teresa Chan, MD, MHPE

@TChanMD

ERDoc. #meded #FOAMed Own views expressed. Contributor to @ALiEMteam, @WeAreCanadiEM, ICE Blog, #FeminEM. @MedEdLIFE founder. Works @McMasterU & @HamHealthSci