Addressing racism in the clinical setting: OU-HCOM workshops help students, preceptors

The family medicine doctor was aghast at her patient’s comment. The patient had been referred to a cardiologist and was unhappy with her experience with that physician.

“She doesn’t belong here,” the patient said of the cardiologist. “She needs to go back to where she came from.”

At the time, the family doc was precepting a student and unsure how to address the patient’s xenophobic comment, either in the exam room or afterward with the student. She asked for guidance from Sharon Casapulla, EdD, the director of the Rural and Urban Scholars Pathways (RUSP) program at Ohio University Heritage College of Osteopathic Medicine (OU-HCOM).

OU-HCOM’s RUSP is for students who intend to practice in either rural or urban underserved areas. The program includes many students who are underrepresented minorities. Dr. Casapulla heard similar stories from students in the program, who were unsure how to handle racist and sexist comments they received while shadowing, on observations and on clinical rotations.

A workshop is born

Learning about these incidents inspired Dr. Casapulla to help organize workshops for OU-HCOM students and physicians dealing with racism in the clinical setting. The workshops, which have been running for about a year now, include actors from OU’s theater department, who role-play scripts based on students’ and physicians’ real-life experiences. Med student and physician participants are then invited to act out these scenes with the actors and practice responding to derogatory comments.

Ebonee Hayward, OMS II, says the workshops gave her a voice. “There’s a power dynamic in medicine, and as a medical student, it’s easy to feel powerless,” she says. “These workshops give me an opportunity to speak freely about my experiences without fear of retaliation.”

Hayward, who is African-American, was taken aback during her first month of medical school, when a patient asked her where she was from. After responding that she came from Houston, the patient asked, “But where are you really from? What tribe?”

At the time, Hayward laughed off the comment. After attending the workshop, she plans to discuss any future incidents with her preceptor.

Advice

The RUSP workshops generate sound advice on handling inappropriate comments, whether the commenter is a patient, physician or fellow student, says Dr. Casapulla, who’s quick to note that there’s rarely one right way to respond. She also notes that in some cases, commenters may not realize that what they’re saying is offensive.

In the case of the family doc whose patient made an inappropriate comment about her cardiologist, the family doc could have addressed the comment simply by validating the patient’s experience while stating facts, Dr. Casapulla notes.

“She could say, ‘I understand that you had a bad experience and that that was hard for you. I want you to get the best care possible, which is why I referred you to this cardiologist. She is one of the top cardiologists in the country,’ ” Dr. Casapulla says.

The family doc also could have pulled the student aside after the encounter to acknowledge the patient’s inappropriate comment and talk through strategies for handling those types of situations.

Workshop co-facilitator Katy Kropf, DO, a family medicine physician and preceptor for OU-HCOM students, notes the importance of physicians addressing inappropriate comments while they are precepting.

“When somebody says something that is sexist or racist or inappropriate, there may be an assumption on the part of the student that the physician agrees with what was said if it isn’t addressed,” she says.

“Depending on the comment, it could mean saying something along the lines of, ‘This language is not tolerated here.’ But it doesn’t always mean saying something in the moment. There is a commitment to serving the patient. It could mean debriefing with the student after the encounter instead.”

Techniques

Here are a few strategies students who participated in the workshops employed:

• Redirecting: Without reacting to the comment, changing the subject back to the matter at hand: Patient care.
• Notifying: Telling a preceptor or attending what happened, possibly with another student who also witnessed the encounter (strength in numbers).
• Debriefing: Talking about what happened with fellow students.

Dr. Kropf advises any students and physicians who experience racism or sexism at work to speak up about it to someone they trust, noting that many students avoid doing so out of fear of retaliation.

“It’s a good idea to report it to the administration via an ally, so that somebody in a position of leadership has the potential to address it,” Dr. Kropf says.

Helping students and their teachers

So far, RUSP has held four workshops, which were attended by more than 120 students. The workshops create a space for students to talk about these issues; a space that doesn’t otherwise exist formally in medical school, Dr. Casapulla notes. They also offer students a chance to practice responding to racist or sexist comments in a low-stakes setting.

While other medical schools have similar programs, Dr. Casapulla is not aware of one currently in place at another osteopathic medical school.

RUSP has additionally presented the workshop to physicians at the Ohio Osteopathic Symposium, where it also served as a tool for educating preceptors who hadn’t encountered racism or sexism and weren’t aware of what their students were experiencing.

“Creating awareness is really important for building empathy between physicians and the students they are teaching,” Dr. Casapulla notes.

Further reading:

‘Discrimination affects us all’: When physicians experience prejudice

Prejudiced patients: Offensive comments reported by nearly 60% of surveyed physicians