Anti-Black racism in clinical supervision: asynchronous simulated encounters facilitate reflective practice

Amanda J Calhoun; Andrés Martin; Ayodola Adigun; Shirley D Alleyne; Kammarauche Aneni; Tara Thompson-Felix; Andrea Asnes; Marco A de Carvalho-Filho; Laelia Benoit; Inginia Genao

doi:10.12688/mep.19487.2

Anti-Black racism in clinical supervision: asynchronous simulated encounters facilitate reflective practice

MedEdPublish (2016). 2023 Apr 14:13:4. doi: 10.12688/mep.19487.2. eCollection 2023.

Affiliations

¹ Child Study Center, Yale School of Medicine, New Haven, CT, 06520, USA.
² Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA.
³ Division of Child Psychiatry, Lakeland Regional Health Medical Center, Lakeland, FL, 33805, USA.
⁴ Department of Pediatrics, Yale School of Medicine, New Haven, CT, 06520, USA.
⁵ Department of Medical Education, University of Groningen, Groningen, 9700, The Netherlands.
⁶ Office of Equity, Inclusion and Belonging, Penn State College of Medicine, State College, PA, 17033, USA.

^# Contributed equally.

Abstract

Background Racist interactions in clinical practice remain a pervasive reality for Black healthcare providers. We sought to develop a framework to inform supervisors' actions when confronting racism in clinical practice and protecting trainees under their oversight. Methods We conducted a qualitative study in which experienced supervisors responded to seven short, videotaped interactions between: 1) Black trainees and a simulated patient (SP) in a racist role; 2) the trainees and their respective supervisors; and 3) the trainees and their supervisors together with the SP. The clinical exchanges exemplified different types of racist (entrenching) or antiracist (uprooting) behaviors by the supervisors. After viewing each clip, participants wrote their reflections confidentially; they later joined a structured debriefing together. We used thematic analysis to identify supervisors' behavioral patterns when confronting racist interactions. Results Based on the input of 52 participants recruited into five two-hour-long sessions, we categorized the behaviors of supervisors facing anti-Black racial injuries involving learners under their oversight. We organized supervisor behaviors into five interlocking domains, each with a range of possible themes: 1) Joining: from conciliatory to confrontational in communicating with the aggressor; 2) Explicitness: from avoiding to naming racism; 3) Ownership: from individual to shared responsibility of the event and the response to it; 4) Involving: from excusing to including the aggrieved party when confronting the aggressor; and 5) Stance: from protective to paternalistic in supporting the learner's autonomy. Conclusions Our qualitative findings can provide a framework for facilitated discussion toward reflective practice among healthcare providers who may have experienced, witnessed, or intervened in anti-Black racist interactions. They can also help medical educators to inform faculty development to fight anti-Black racism in clinical practice. The video materials we developed are available for viewing and download and can be used or adapted as springboards for reflective discussion or faculty development activities.

Keywords: Racism; anti-racism; medical education; qualitative; supervision.

Associated data

figshare/10.6084/m9.figshare.21669506.v2

Grants and funding

This study was supported by the Riva Ariella Ritvo Endowment at the Yale School of Medicine, and by National Institute of Mental Health (R25 MH077823), Research Education for Future Physician-Scientists in Child Psychiatry.