The resident of color experience how to build

community and safe spaces

August 20 2020Dr Courtney Ann Gilliam

Seattle Childrenrsquos Hospital Pediatric Hospital Fellow

Format for Todayrsquos Meeting

Turn on video so we can see each other Keep audio on mute unless talking to avoid

background noise We will share a few thoughts and then open up

for discussion If any questionscomments come up as we are

presenting please record them in the chat box

Development Programs for UiM Residents

Advancing Inclusiveness in Medical Education (AIMS sponsored by APPD) For UIM PGY2 residents interested in medical education

Attend the Spring APPD Conference

Year-long mentorshipleadership program

New Century Scholars (NCS sponsored by APA ABP APS) For UIM PGY2 residents interested in academic medicine

Attend the PAS Conference 2 years in a row

Year-long mentorshipleadership program

Frontiers in Science (FIS sponsored by AMSPDC) For UIM PGY2 residents interested in research careers

Attend the AMSPDC Conference (FebMarch)

Agenda

1 Setting the stage

2 Literature and Background

3 Institutional Example

4 Community Building

The trainee of color experience how to build community and s spaces

08202020

ldquoIt is not our differences that divide us It is our inability to recognize accept and celebrate those differences

- Audre Lorde in Sister Outsider Essays and Speeches

ldquoIt is not our differences that divide us It is our inability to recognize accept and celebrate those differences

- Audre Lorde in Sister Outsider Essays and Speeches

Format for Todayrsquos Meeting

Turn on video so we can see each other Keep audio on mute unless talking to avoid

background noise We will share a few thoughts and then open up

for discussion If any questionscomments come up as we are

presenting please record them in the chat box

Development Programs for UiM Residents

Advancing Inclusiveness in Medical Education (AIMS sponsored by APPD) For UIM PGY2 residents interested in medical education

Attend the Spring APPD Conference

Year-long mentorshipleadership program

New Century Scholars (NCS sponsored by APA ABP APS) For UIM PGY2 residents interested in academic medicine

Attend the PAS Conference 2 years in a row

Year-long mentorshipleadership program

Frontiers in Science (FIS sponsored by AMSPDC) For UIM PGY2 residents interested in research careers

Attend the AMSPDC Conference (FebMarch)

Agenda

1 Setting the stage

2 Literature and Background

3 Institutional Example

4 Community Building

The trainee of color experience how to build community and s spaces

08202020

ldquoIt is not our differences that divide us It is our inability to recognize accept and celebrate those differences

- Audre Lorde in Sister Outsider Essays and Speeches

ldquoIt is not our differences that divide us It is our inability to recognize accept and celebrate those differences

- Audre Lorde in Sister Outsider Essays and Speeches

Development Programs for UiM Residents

Advancing Inclusiveness in Medical Education (AIMS sponsored by APPD) For UIM PGY2 residents interested in medical education

Attend the Spring APPD Conference

Year-long mentorshipleadership program

New Century Scholars (NCS sponsored by APA ABP APS) For UIM PGY2 residents interested in academic medicine

Attend the PAS Conference 2 years in a row

Year-long mentorshipleadership program

Frontiers in Science (FIS sponsored by AMSPDC) For UIM PGY2 residents interested in research careers

Attend the AMSPDC Conference (FebMarch)

Agenda

1 Setting the stage

2 Literature and Background

3 Institutional Example

4 Community Building

The trainee of color experience how to build community and s spaces

08202020

ldquoIt is not our differences that divide us It is our inability to recognize accept and celebrate those differences

- Audre Lorde in Sister Outsider Essays and Speeches

ldquoIt is not our differences that divide us It is our inability to recognize accept and celebrate those differences

- Audre Lorde in Sister Outsider Essays and Speeches

Agenda

1 Setting the stage

2 Literature and Background

3 Institutional Example

4 Community Building

The trainee of color experience how to build community and s spaces

08202020

ldquoIt is not our differences that divide us It is our inability to recognize accept and celebrate those differences

- Audre Lorde in Sister Outsider Essays and Speeches

ldquoIt is not our differences that divide us It is our inability to recognize accept and celebrate those differences

- Audre Lorde in Sister Outsider Essays and Speeches

The trainee of color experience how to build community and s spaces

08202020

ldquoIt is not our differences that divide us It is our inability to recognize accept and celebrate those differences

- Audre Lorde in Sister Outsider Essays and Speeches

ldquoIt is not our differences that divide us It is our inability to recognize accept and celebrate those differences

- Audre Lorde in Sister Outsider Essays and Speeches

Who am I

Black

TraineeFemale

bull The intersections of my lived experience

Setting the stage terminology

Underrepresented in medicine (UiM) those racial and ethnic populations that are

underrepresented in the medical profession relative to their numbers in the general

population

TraineeResident of Color Adapted from person of color A broad overarching term

to distinguish any person that is not white

Black Indigenous and other person of color (BIPOC) Aims to emphasize the

historical oppression of Black and Indigenous populations

Underrepresented in Medicine Definition (2020) AAMC httpswwwaamcorgwhat-we-domission-areasdiversity-inclusionunderrepresented-in-medicine

Setting the stage Current Workforce Demographics

0

10

20

30

40

50

60

70

80

White (non-Hispanic) Asian LatinoHispanic (anyrace)

BlackAfrican American Other

Pediatricians RacialEthnic Distribution 2019

Pediatricians RacialEthnic Distribution 2019

Source American Academy of Pediatrics Periodic Survey 2019 (PS102)

Literature and Background

ldquoI get in work mode and I prepare myself I put my shield up because you never know whorsquos going to act and in what kind of way in my department I just canrsquot be how I am at home or with my friendsrdquo

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

In the minority Black physicians in residency and their experiences (2006)

Discrimination

Differing Expectations

Social Isolation

Consequences to self-identity

Methods Interviews with 21 resident physicians from all postgraduate training programs affiliated with one medical school

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Minority Resident Physiciansrsquo Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace (2018)

Methods Interviews with 27 resident physicians from 21 residency programs representing a diverse range of medical specialties and geographic locations Racesethnicities were 19 (70) Black 3 (11) Hispanic 1 (4) Native American and 4 (15) mixed raceethnicity

Daily Barrage of microaggressions and bias

Minority Tax

Seen as ldquootherrdquo

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Professionalism 101 for Black Physicians (2020)

ldquoAs a resident I have not mastered the art of reconciling my identity as a Black woman with my identity as a physician I frequently feel I have to silence the Black woman and simply be a physician colorless un-Blackrdquo

AbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

Literature summary

bull Common themes in minority trainee experience persist

bull Othering racism microaggressions social isolation lack of whole-

self and minority tax

bull Call for supportive networks and space

bull Need to understand these differences

bull Lack of reporting

Institutional Example

ldquoI think sometimes you just have to feel like theres a little bit more of something in the air you know to really feel like I can grab on to this Especially if youre in a trainee

role This [curriculum] is now part of the conversation in the residency program and I feel like we have a greater degree of confidence to be able to go there But we need

morehelliprdquo

INCLUDE Curriculum = INclusion CuLtural hUmility Diversity and Equity28 training hours per year

Skill Building Trainings = 10 hours

bull EDI Foundationbull Cultural Humilitybull Microaggressions

Didactics = 15 hours

bull SDOHbull Racism and bias in

healthcarebull Trauma informed

carebull Refugee and

Immigrant Healthbull Religion in Medicinebull Housing Insecurity

Small Group Discussions = 3 hours

bull Book discussion on ldquoBlindspotrdquo

bull Tuesday AM sessions

bull Key stakeholders including faculty residents and consultants utilized the needs assessment findings to inform the curriculum content

Culturally effective care gt Learning Climate and Inclusion

Feedback and learning from the 1st year of implementation- Data from follow-up survey

- Key gaps were identified in areas of learning climate and inclusion

- These gaps informed an additional qualitative study to assess the impact

Qualitative Assessment

Focus groups (n = 13)61 (813) were R2s31 (413) were residents of color77 (1013) were female

Four project members coded the notes and transcripts using a codebook

Constant comparative analysis Common and recurrent themes discussed

Themes KnowledgeSkillsBehaviors

Importance and resident empowerment to engage in EDI issues

Recognizing and addressing microaggressions

Increased awareness of bias in patient care interactions

Limitation in providing equitable care due to lack of interpreters

Themes Residents of Color

Loneliness due to ldquootheringrdquo

Barrage of microaggressions

Limited Mentorship

The one who always has to ldquospeak uprdquo

Illustrative Quotes Residents of Color

ldquohellipIn the ED we had three black male residents one for each year and two of us were working in the emergency room at the same time with a fellow too and more than once nurses would mix up who you are And somebody asked me about a brain MRI for my asthma patient it didnt make sense I joked about it a little bit but itrsquos not funny And this has real safety implicationsrdquo

Illustrative Quotes Residents of Color

ldquoI was on a rotation with another Indian resident and an attending was confusing us for each other And with an attending they review us at the end of the month So I got feedback in my review that obviously was not my feedback but the other residents feedback Like how can you even Who am I supposed to call that out to I donrsquot even knowrdquo

Illustrative Quotes Residents of Color

I dont have any Latino doctors that I can look up to I dont know a single one here I know there are some but Ive never met them So I dont know my experience has been a little different I mean all of you guys are great but sometimes it is really hard to fit in when you have come from somewhere differentrdquo

Illustrative Quotes Residents of Color

ldquoSome parts of my experience here are similar others are not I have Indian physician role models abundantly in all fields of healthcare so for me it was never lsquoOh I cant see myself therersquo because theres so many Indian people But thats not the case for a lot of minorities in our countryrdquo

Summary of institution findings

A specialized medical education curriculum empowers trainees with the knowledge and tools to address inequities within institution

For residents of color themes of othering racism microaggressions and minority tax are persistent

More is needed to truly address the inclusion of our trainees

The faculty experience

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Setting the stage terminology

Underrepresented in medicine (UiM) those racial and ethnic populations that are

underrepresented in the medical profession relative to their numbers in the general

population

TraineeResident of Color Adapted from person of color A broad overarching term

to distinguish any person that is not white

Black Indigenous and other person of color (BIPOC) Aims to emphasize the

historical oppression of Black and Indigenous populations

Underrepresented in Medicine Definition (2020) AAMC httpswwwaamcorgwhat-we-domission-areasdiversity-inclusionunderrepresented-in-medicine

Setting the stage Current Workforce Demographics

0

10

20

30

40

50

60

70

80

White (non-Hispanic) Asian LatinoHispanic (anyrace)

BlackAfrican American Other

Pediatricians RacialEthnic Distribution 2019

Pediatricians RacialEthnic Distribution 2019

Source American Academy of Pediatrics Periodic Survey 2019 (PS102)

Literature and Background

ldquoI get in work mode and I prepare myself I put my shield up because you never know whorsquos going to act and in what kind of way in my department I just canrsquot be how I am at home or with my friendsrdquo

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

In the minority Black physicians in residency and their experiences (2006)

Discrimination

Differing Expectations

Social Isolation

Consequences to self-identity

Methods Interviews with 21 resident physicians from all postgraduate training programs affiliated with one medical school

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Minority Resident Physiciansrsquo Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace (2018)

Methods Interviews with 27 resident physicians from 21 residency programs representing a diverse range of medical specialties and geographic locations Racesethnicities were 19 (70) Black 3 (11) Hispanic 1 (4) Native American and 4 (15) mixed raceethnicity

Daily Barrage of microaggressions and bias

Minority Tax

Seen as ldquootherrdquo

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Professionalism 101 for Black Physicians (2020)

ldquoAs a resident I have not mastered the art of reconciling my identity as a Black woman with my identity as a physician I frequently feel I have to silence the Black woman and simply be a physician colorless un-Blackrdquo

AbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

Literature summary

bull Common themes in minority trainee experience persist

bull Othering racism microaggressions social isolation lack of whole-

self and minority tax

bull Call for supportive networks and space

bull Need to understand these differences

bull Lack of reporting

Institutional Example

ldquoI think sometimes you just have to feel like theres a little bit more of something in the air you know to really feel like I can grab on to this Especially if youre in a trainee

role This [curriculum] is now part of the conversation in the residency program and I feel like we have a greater degree of confidence to be able to go there But we need

morehelliprdquo

INCLUDE Curriculum = INclusion CuLtural hUmility Diversity and Equity28 training hours per year

Skill Building Trainings = 10 hours

bull EDI Foundationbull Cultural Humilitybull Microaggressions

Didactics = 15 hours

bull SDOHbull Racism and bias in

healthcarebull Trauma informed

carebull Refugee and

Immigrant Healthbull Religion in Medicinebull Housing Insecurity

Small Group Discussions = 3 hours

bull Book discussion on ldquoBlindspotrdquo

bull Tuesday AM sessions

bull Key stakeholders including faculty residents and consultants utilized the needs assessment findings to inform the curriculum content

Culturally effective care gt Learning Climate and Inclusion

Feedback and learning from the 1st year of implementation- Data from follow-up survey

- Key gaps were identified in areas of learning climate and inclusion

- These gaps informed an additional qualitative study to assess the impact

Qualitative Assessment

Focus groups (n = 13)61 (813) were R2s31 (413) were residents of color77 (1013) were female

Four project members coded the notes and transcripts using a codebook

Constant comparative analysis Common and recurrent themes discussed

Themes KnowledgeSkillsBehaviors

Importance and resident empowerment to engage in EDI issues

Recognizing and addressing microaggressions

Increased awareness of bias in patient care interactions

Limitation in providing equitable care due to lack of interpreters

Themes Residents of Color

Loneliness due to ldquootheringrdquo

Barrage of microaggressions

Limited Mentorship

The one who always has to ldquospeak uprdquo

Illustrative Quotes Residents of Color

ldquohellipIn the ED we had three black male residents one for each year and two of us were working in the emergency room at the same time with a fellow too and more than once nurses would mix up who you are And somebody asked me about a brain MRI for my asthma patient it didnt make sense I joked about it a little bit but itrsquos not funny And this has real safety implicationsrdquo

Illustrative Quotes Residents of Color

ldquoI was on a rotation with another Indian resident and an attending was confusing us for each other And with an attending they review us at the end of the month So I got feedback in my review that obviously was not my feedback but the other residents feedback Like how can you even Who am I supposed to call that out to I donrsquot even knowrdquo

Illustrative Quotes Residents of Color

I dont have any Latino doctors that I can look up to I dont know a single one here I know there are some but Ive never met them So I dont know my experience has been a little different I mean all of you guys are great but sometimes it is really hard to fit in when you have come from somewhere differentrdquo

Illustrative Quotes Residents of Color

ldquoSome parts of my experience here are similar others are not I have Indian physician role models abundantly in all fields of healthcare so for me it was never lsquoOh I cant see myself therersquo because theres so many Indian people But thats not the case for a lot of minorities in our countryrdquo

Summary of institution findings

A specialized medical education curriculum empowers trainees with the knowledge and tools to address inequities within institution

For residents of color themes of othering racism microaggressions and minority tax are persistent

More is needed to truly address the inclusion of our trainees

The faculty experience

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Setting the stage Current Workforce Demographics

0

10

20

30

40

50

60

70

80

White (non-Hispanic) Asian LatinoHispanic (anyrace)

BlackAfrican American Other

Pediatricians RacialEthnic Distribution 2019

Pediatricians RacialEthnic Distribution 2019

Source American Academy of Pediatrics Periodic Survey 2019 (PS102)

Literature and Background

ldquoI get in work mode and I prepare myself I put my shield up because you never know whorsquos going to act and in what kind of way in my department I just canrsquot be how I am at home or with my friendsrdquo

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

In the minority Black physicians in residency and their experiences (2006)

Discrimination

Differing Expectations

Social Isolation

Consequences to self-identity

Methods Interviews with 21 resident physicians from all postgraduate training programs affiliated with one medical school

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Minority Resident Physiciansrsquo Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace (2018)

Methods Interviews with 27 resident physicians from 21 residency programs representing a diverse range of medical specialties and geographic locations Racesethnicities were 19 (70) Black 3 (11) Hispanic 1 (4) Native American and 4 (15) mixed raceethnicity

Daily Barrage of microaggressions and bias

Minority Tax

Seen as ldquootherrdquo

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Professionalism 101 for Black Physicians (2020)

ldquoAs a resident I have not mastered the art of reconciling my identity as a Black woman with my identity as a physician I frequently feel I have to silence the Black woman and simply be a physician colorless un-Blackrdquo

AbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

Literature summary

bull Common themes in minority trainee experience persist

bull Othering racism microaggressions social isolation lack of whole-

self and minority tax

bull Call for supportive networks and space

bull Need to understand these differences

bull Lack of reporting

Institutional Example

ldquoI think sometimes you just have to feel like theres a little bit more of something in the air you know to really feel like I can grab on to this Especially if youre in a trainee

role This [curriculum] is now part of the conversation in the residency program and I feel like we have a greater degree of confidence to be able to go there But we need

morehelliprdquo

INCLUDE Curriculum = INclusion CuLtural hUmility Diversity and Equity28 training hours per year

Skill Building Trainings = 10 hours

bull EDI Foundationbull Cultural Humilitybull Microaggressions

Didactics = 15 hours

bull SDOHbull Racism and bias in

healthcarebull Trauma informed

carebull Refugee and

Immigrant Healthbull Religion in Medicinebull Housing Insecurity

Small Group Discussions = 3 hours

bull Book discussion on ldquoBlindspotrdquo

bull Tuesday AM sessions

bull Key stakeholders including faculty residents and consultants utilized the needs assessment findings to inform the curriculum content

Culturally effective care gt Learning Climate and Inclusion

Feedback and learning from the 1st year of implementation- Data from follow-up survey

- Key gaps were identified in areas of learning climate and inclusion

- These gaps informed an additional qualitative study to assess the impact

Qualitative Assessment

Focus groups (n = 13)61 (813) were R2s31 (413) were residents of color77 (1013) were female

Four project members coded the notes and transcripts using a codebook

Constant comparative analysis Common and recurrent themes discussed

Themes KnowledgeSkillsBehaviors

Importance and resident empowerment to engage in EDI issues

Recognizing and addressing microaggressions

Increased awareness of bias in patient care interactions

Limitation in providing equitable care due to lack of interpreters

Themes Residents of Color

Loneliness due to ldquootheringrdquo

Barrage of microaggressions

Limited Mentorship

The one who always has to ldquospeak uprdquo

Illustrative Quotes Residents of Color

ldquohellipIn the ED we had three black male residents one for each year and two of us were working in the emergency room at the same time with a fellow too and more than once nurses would mix up who you are And somebody asked me about a brain MRI for my asthma patient it didnt make sense I joked about it a little bit but itrsquos not funny And this has real safety implicationsrdquo

Illustrative Quotes Residents of Color

ldquoI was on a rotation with another Indian resident and an attending was confusing us for each other And with an attending they review us at the end of the month So I got feedback in my review that obviously was not my feedback but the other residents feedback Like how can you even Who am I supposed to call that out to I donrsquot even knowrdquo

Illustrative Quotes Residents of Color

I dont have any Latino doctors that I can look up to I dont know a single one here I know there are some but Ive never met them So I dont know my experience has been a little different I mean all of you guys are great but sometimes it is really hard to fit in when you have come from somewhere differentrdquo

Illustrative Quotes Residents of Color

ldquoSome parts of my experience here are similar others are not I have Indian physician role models abundantly in all fields of healthcare so for me it was never lsquoOh I cant see myself therersquo because theres so many Indian people But thats not the case for a lot of minorities in our countryrdquo

Summary of institution findings

A specialized medical education curriculum empowers trainees with the knowledge and tools to address inequities within institution

For residents of color themes of othering racism microaggressions and minority tax are persistent

More is needed to truly address the inclusion of our trainees

The faculty experience

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Literature and Background

ldquoI get in work mode and I prepare myself I put my shield up because you never know whorsquos going to act and in what kind of way in my department I just canrsquot be how I am at home or with my friendsrdquo

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

In the minority Black physicians in residency and their experiences (2006)

Discrimination

Differing Expectations

Social Isolation

Consequences to self-identity

Methods Interviews with 21 resident physicians from all postgraduate training programs affiliated with one medical school

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Minority Resident Physiciansrsquo Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace (2018)

Methods Interviews with 27 resident physicians from 21 residency programs representing a diverse range of medical specialties and geographic locations Racesethnicities were 19 (70) Black 3 (11) Hispanic 1 (4) Native American and 4 (15) mixed raceethnicity

Daily Barrage of microaggressions and bias

Minority Tax

Seen as ldquootherrdquo

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Professionalism 101 for Black Physicians (2020)

ldquoAs a resident I have not mastered the art of reconciling my identity as a Black woman with my identity as a physician I frequently feel I have to silence the Black woman and simply be a physician colorless un-Blackrdquo

AbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

Literature summary

bull Common themes in minority trainee experience persist

bull Othering racism microaggressions social isolation lack of whole-

self and minority tax

bull Call for supportive networks and space

bull Need to understand these differences

bull Lack of reporting

Institutional Example

ldquoI think sometimes you just have to feel like theres a little bit more of something in the air you know to really feel like I can grab on to this Especially if youre in a trainee

role This [curriculum] is now part of the conversation in the residency program and I feel like we have a greater degree of confidence to be able to go there But we need

morehelliprdquo

INCLUDE Curriculum = INclusion CuLtural hUmility Diversity and Equity28 training hours per year

Skill Building Trainings = 10 hours

bull EDI Foundationbull Cultural Humilitybull Microaggressions

Didactics = 15 hours

bull SDOHbull Racism and bias in

healthcarebull Trauma informed

carebull Refugee and

Immigrant Healthbull Religion in Medicinebull Housing Insecurity

Small Group Discussions = 3 hours

bull Book discussion on ldquoBlindspotrdquo

bull Tuesday AM sessions

bull Key stakeholders including faculty residents and consultants utilized the needs assessment findings to inform the curriculum content

Culturally effective care gt Learning Climate and Inclusion

Feedback and learning from the 1st year of implementation- Data from follow-up survey

- Key gaps were identified in areas of learning climate and inclusion

- These gaps informed an additional qualitative study to assess the impact

Qualitative Assessment

Focus groups (n = 13)61 (813) were R2s31 (413) were residents of color77 (1013) were female

Four project members coded the notes and transcripts using a codebook

Constant comparative analysis Common and recurrent themes discussed

Themes KnowledgeSkillsBehaviors

Importance and resident empowerment to engage in EDI issues

Recognizing and addressing microaggressions

Increased awareness of bias in patient care interactions

Limitation in providing equitable care due to lack of interpreters

Themes Residents of Color

Loneliness due to ldquootheringrdquo

Barrage of microaggressions

Limited Mentorship

The one who always has to ldquospeak uprdquo

Illustrative Quotes Residents of Color

ldquohellipIn the ED we had three black male residents one for each year and two of us were working in the emergency room at the same time with a fellow too and more than once nurses would mix up who you are And somebody asked me about a brain MRI for my asthma patient it didnt make sense I joked about it a little bit but itrsquos not funny And this has real safety implicationsrdquo

Illustrative Quotes Residents of Color

ldquoI was on a rotation with another Indian resident and an attending was confusing us for each other And with an attending they review us at the end of the month So I got feedback in my review that obviously was not my feedback but the other residents feedback Like how can you even Who am I supposed to call that out to I donrsquot even knowrdquo

Illustrative Quotes Residents of Color

I dont have any Latino doctors that I can look up to I dont know a single one here I know there are some but Ive never met them So I dont know my experience has been a little different I mean all of you guys are great but sometimes it is really hard to fit in when you have come from somewhere differentrdquo

Illustrative Quotes Residents of Color

ldquoSome parts of my experience here are similar others are not I have Indian physician role models abundantly in all fields of healthcare so for me it was never lsquoOh I cant see myself therersquo because theres so many Indian people But thats not the case for a lot of minorities in our countryrdquo

Summary of institution findings

A specialized medical education curriculum empowers trainees with the knowledge and tools to address inequities within institution

For residents of color themes of othering racism microaggressions and minority tax are persistent

More is needed to truly address the inclusion of our trainees

The faculty experience

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

In the minority Black physicians in residency and their experiences (2006)

Discrimination

Differing Expectations

Social Isolation

Consequences to self-identity

Methods Interviews with 21 resident physicians from all postgraduate training programs affiliated with one medical school

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Minority Resident Physiciansrsquo Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace (2018)

Methods Interviews with 27 resident physicians from 21 residency programs representing a diverse range of medical specialties and geographic locations Racesethnicities were 19 (70) Black 3 (11) Hispanic 1 (4) Native American and 4 (15) mixed raceethnicity

Daily Barrage of microaggressions and bias

Minority Tax

Seen as ldquootherrdquo

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Professionalism 101 for Black Physicians (2020)

ldquoAs a resident I have not mastered the art of reconciling my identity as a Black woman with my identity as a physician I frequently feel I have to silence the Black woman and simply be a physician colorless un-Blackrdquo

AbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

Literature summary

bull Common themes in minority trainee experience persist

bull Othering racism microaggressions social isolation lack of whole-

self and minority tax

bull Call for supportive networks and space

bull Need to understand these differences

bull Lack of reporting

Institutional Example

ldquoI think sometimes you just have to feel like theres a little bit more of something in the air you know to really feel like I can grab on to this Especially if youre in a trainee

role This [curriculum] is now part of the conversation in the residency program and I feel like we have a greater degree of confidence to be able to go there But we need

morehelliprdquo

INCLUDE Curriculum = INclusion CuLtural hUmility Diversity and Equity28 training hours per year

Skill Building Trainings = 10 hours

bull EDI Foundationbull Cultural Humilitybull Microaggressions

Didactics = 15 hours

bull SDOHbull Racism and bias in

healthcarebull Trauma informed

carebull Refugee and

Immigrant Healthbull Religion in Medicinebull Housing Insecurity

Small Group Discussions = 3 hours

bull Book discussion on ldquoBlindspotrdquo

bull Tuesday AM sessions

bull Key stakeholders including faculty residents and consultants utilized the needs assessment findings to inform the curriculum content

Culturally effective care gt Learning Climate and Inclusion

Feedback and learning from the 1st year of implementation- Data from follow-up survey

- Key gaps were identified in areas of learning climate and inclusion

- These gaps informed an additional qualitative study to assess the impact

Qualitative Assessment

Focus groups (n = 13)61 (813) were R2s31 (413) were residents of color77 (1013) were female

Four project members coded the notes and transcripts using a codebook

Constant comparative analysis Common and recurrent themes discussed

Themes KnowledgeSkillsBehaviors

Importance and resident empowerment to engage in EDI issues

Recognizing and addressing microaggressions

Increased awareness of bias in patient care interactions

Limitation in providing equitable care due to lack of interpreters

Themes Residents of Color

Loneliness due to ldquootheringrdquo

Barrage of microaggressions

Limited Mentorship

The one who always has to ldquospeak uprdquo

Illustrative Quotes Residents of Color

ldquohellipIn the ED we had three black male residents one for each year and two of us were working in the emergency room at the same time with a fellow too and more than once nurses would mix up who you are And somebody asked me about a brain MRI for my asthma patient it didnt make sense I joked about it a little bit but itrsquos not funny And this has real safety implicationsrdquo

Illustrative Quotes Residents of Color

ldquoI was on a rotation with another Indian resident and an attending was confusing us for each other And with an attending they review us at the end of the month So I got feedback in my review that obviously was not my feedback but the other residents feedback Like how can you even Who am I supposed to call that out to I donrsquot even knowrdquo

Illustrative Quotes Residents of Color

I dont have any Latino doctors that I can look up to I dont know a single one here I know there are some but Ive never met them So I dont know my experience has been a little different I mean all of you guys are great but sometimes it is really hard to fit in when you have come from somewhere differentrdquo

Illustrative Quotes Residents of Color

ldquoSome parts of my experience here are similar others are not I have Indian physician role models abundantly in all fields of healthcare so for me it was never lsquoOh I cant see myself therersquo because theres so many Indian people But thats not the case for a lot of minorities in our countryrdquo

Summary of institution findings

A specialized medical education curriculum empowers trainees with the knowledge and tools to address inequities within institution

For residents of color themes of othering racism microaggressions and minority tax are persistent

More is needed to truly address the inclusion of our trainees

The faculty experience

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Minority Resident Physiciansrsquo Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace (2018)

Methods Interviews with 27 resident physicians from 21 residency programs representing a diverse range of medical specialties and geographic locations Racesethnicities were 19 (70) Black 3 (11) Hispanic 1 (4) Native American and 4 (15) mixed raceethnicity

Daily Barrage of microaggressions and bias

Minority Tax

Seen as ldquootherrdquo

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Professionalism 101 for Black Physicians (2020)

ldquoAs a resident I have not mastered the art of reconciling my identity as a Black woman with my identity as a physician I frequently feel I have to silence the Black woman and simply be a physician colorless un-Blackrdquo

AbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

Literature summary

bull Common themes in minority trainee experience persist

bull Othering racism microaggressions social isolation lack of whole-

self and minority tax

bull Call for supportive networks and space

bull Need to understand these differences

bull Lack of reporting

Institutional Example

ldquoI think sometimes you just have to feel like theres a little bit more of something in the air you know to really feel like I can grab on to this Especially if youre in a trainee

role This [curriculum] is now part of the conversation in the residency program and I feel like we have a greater degree of confidence to be able to go there But we need

morehelliprdquo

INCLUDE Curriculum = INclusion CuLtural hUmility Diversity and Equity28 training hours per year

Skill Building Trainings = 10 hours

bull EDI Foundationbull Cultural Humilitybull Microaggressions

Didactics = 15 hours

bull SDOHbull Racism and bias in

healthcarebull Trauma informed

carebull Refugee and

Immigrant Healthbull Religion in Medicinebull Housing Insecurity

Small Group Discussions = 3 hours

bull Book discussion on ldquoBlindspotrdquo

bull Tuesday AM sessions

bull Key stakeholders including faculty residents and consultants utilized the needs assessment findings to inform the curriculum content

Culturally effective care gt Learning Climate and Inclusion

Feedback and learning from the 1st year of implementation- Data from follow-up survey

- Key gaps were identified in areas of learning climate and inclusion

- These gaps informed an additional qualitative study to assess the impact

Qualitative Assessment

Focus groups (n = 13)61 (813) were R2s31 (413) were residents of color77 (1013) were female

Four project members coded the notes and transcripts using a codebook

Constant comparative analysis Common and recurrent themes discussed

Themes KnowledgeSkillsBehaviors

Importance and resident empowerment to engage in EDI issues

Recognizing and addressing microaggressions

Increased awareness of bias in patient care interactions

Limitation in providing equitable care due to lack of interpreters

Themes Residents of Color

Loneliness due to ldquootheringrdquo

Barrage of microaggressions

Limited Mentorship

The one who always has to ldquospeak uprdquo

Illustrative Quotes Residents of Color

ldquohellipIn the ED we had three black male residents one for each year and two of us were working in the emergency room at the same time with a fellow too and more than once nurses would mix up who you are And somebody asked me about a brain MRI for my asthma patient it didnt make sense I joked about it a little bit but itrsquos not funny And this has real safety implicationsrdquo

Illustrative Quotes Residents of Color

ldquoI was on a rotation with another Indian resident and an attending was confusing us for each other And with an attending they review us at the end of the month So I got feedback in my review that obviously was not my feedback but the other residents feedback Like how can you even Who am I supposed to call that out to I donrsquot even knowrdquo

Illustrative Quotes Residents of Color

I dont have any Latino doctors that I can look up to I dont know a single one here I know there are some but Ive never met them So I dont know my experience has been a little different I mean all of you guys are great but sometimes it is really hard to fit in when you have come from somewhere differentrdquo

Illustrative Quotes Residents of Color

ldquoSome parts of my experience here are similar others are not I have Indian physician role models abundantly in all fields of healthcare so for me it was never lsquoOh I cant see myself therersquo because theres so many Indian people But thats not the case for a lot of minorities in our countryrdquo

Summary of institution findings

A specialized medical education curriculum empowers trainees with the knowledge and tools to address inequities within institution

For residents of color themes of othering racism microaggressions and minority tax are persistent

More is needed to truly address the inclusion of our trainees

The faculty experience

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Professionalism 101 for Black Physicians (2020)

ldquoAs a resident I have not mastered the art of reconciling my identity as a Black woman with my identity as a physician I frequently feel I have to silence the Black woman and simply be a physician colorless un-Blackrdquo

AbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

Literature summary

bull Common themes in minority trainee experience persist

bull Othering racism microaggressions social isolation lack of whole-

self and minority tax

bull Call for supportive networks and space

bull Need to understand these differences

bull Lack of reporting

Institutional Example

ldquoI think sometimes you just have to feel like theres a little bit more of something in the air you know to really feel like I can grab on to this Especially if youre in a trainee

role This [curriculum] is now part of the conversation in the residency program and I feel like we have a greater degree of confidence to be able to go there But we need

morehelliprdquo

INCLUDE Curriculum = INclusion CuLtural hUmility Diversity and Equity28 training hours per year

Skill Building Trainings = 10 hours

bull EDI Foundationbull Cultural Humilitybull Microaggressions

Didactics = 15 hours

bull SDOHbull Racism and bias in

healthcarebull Trauma informed

carebull Refugee and

Immigrant Healthbull Religion in Medicinebull Housing Insecurity

Small Group Discussions = 3 hours

bull Book discussion on ldquoBlindspotrdquo

bull Tuesday AM sessions

bull Key stakeholders including faculty residents and consultants utilized the needs assessment findings to inform the curriculum content

Culturally effective care gt Learning Climate and Inclusion

Feedback and learning from the 1st year of implementation- Data from follow-up survey

- Key gaps were identified in areas of learning climate and inclusion

- These gaps informed an additional qualitative study to assess the impact

Qualitative Assessment

Focus groups (n = 13)61 (813) were R2s31 (413) were residents of color77 (1013) were female

Four project members coded the notes and transcripts using a codebook

Constant comparative analysis Common and recurrent themes discussed

Themes KnowledgeSkillsBehaviors

Importance and resident empowerment to engage in EDI issues

Recognizing and addressing microaggressions

Increased awareness of bias in patient care interactions

Limitation in providing equitable care due to lack of interpreters

Themes Residents of Color

Loneliness due to ldquootheringrdquo

Barrage of microaggressions

Limited Mentorship

The one who always has to ldquospeak uprdquo

Illustrative Quotes Residents of Color

ldquohellipIn the ED we had three black male residents one for each year and two of us were working in the emergency room at the same time with a fellow too and more than once nurses would mix up who you are And somebody asked me about a brain MRI for my asthma patient it didnt make sense I joked about it a little bit but itrsquos not funny And this has real safety implicationsrdquo

Illustrative Quotes Residents of Color

ldquoI was on a rotation with another Indian resident and an attending was confusing us for each other And with an attending they review us at the end of the month So I got feedback in my review that obviously was not my feedback but the other residents feedback Like how can you even Who am I supposed to call that out to I donrsquot even knowrdquo

Illustrative Quotes Residents of Color

I dont have any Latino doctors that I can look up to I dont know a single one here I know there are some but Ive never met them So I dont know my experience has been a little different I mean all of you guys are great but sometimes it is really hard to fit in when you have come from somewhere differentrdquo

Illustrative Quotes Residents of Color

ldquoSome parts of my experience here are similar others are not I have Indian physician role models abundantly in all fields of healthcare so for me it was never lsquoOh I cant see myself therersquo because theres so many Indian people But thats not the case for a lot of minorities in our countryrdquo

Summary of institution findings

A specialized medical education curriculum empowers trainees with the knowledge and tools to address inequities within institution

For residents of color themes of othering racism microaggressions and minority tax are persistent

More is needed to truly address the inclusion of our trainees

The faculty experience

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Literature summary

bull Common themes in minority trainee experience persist

bull Othering racism microaggressions social isolation lack of whole-

self and minority tax

bull Call for supportive networks and space

bull Need to understand these differences

bull Lack of reporting

Institutional Example

ldquoI think sometimes you just have to feel like theres a little bit more of something in the air you know to really feel like I can grab on to this Especially if youre in a trainee

role This [curriculum] is now part of the conversation in the residency program and I feel like we have a greater degree of confidence to be able to go there But we need

morehelliprdquo

INCLUDE Curriculum = INclusion CuLtural hUmility Diversity and Equity28 training hours per year

Skill Building Trainings = 10 hours

bull EDI Foundationbull Cultural Humilitybull Microaggressions

Didactics = 15 hours

bull SDOHbull Racism and bias in

healthcarebull Trauma informed

carebull Refugee and

Immigrant Healthbull Religion in Medicinebull Housing Insecurity

Small Group Discussions = 3 hours

bull Book discussion on ldquoBlindspotrdquo

bull Tuesday AM sessions

bull Key stakeholders including faculty residents and consultants utilized the needs assessment findings to inform the curriculum content

Culturally effective care gt Learning Climate and Inclusion

Feedback and learning from the 1st year of implementation- Data from follow-up survey

- Key gaps were identified in areas of learning climate and inclusion

- These gaps informed an additional qualitative study to assess the impact

Qualitative Assessment

Focus groups (n = 13)61 (813) were R2s31 (413) were residents of color77 (1013) were female

Four project members coded the notes and transcripts using a codebook

Constant comparative analysis Common and recurrent themes discussed

Themes KnowledgeSkillsBehaviors

Importance and resident empowerment to engage in EDI issues

Recognizing and addressing microaggressions

Increased awareness of bias in patient care interactions

Limitation in providing equitable care due to lack of interpreters

Themes Residents of Color

Loneliness due to ldquootheringrdquo

Barrage of microaggressions

Limited Mentorship

The one who always has to ldquospeak uprdquo

Illustrative Quotes Residents of Color

ldquohellipIn the ED we had three black male residents one for each year and two of us were working in the emergency room at the same time with a fellow too and more than once nurses would mix up who you are And somebody asked me about a brain MRI for my asthma patient it didnt make sense I joked about it a little bit but itrsquos not funny And this has real safety implicationsrdquo

Illustrative Quotes Residents of Color

ldquoI was on a rotation with another Indian resident and an attending was confusing us for each other And with an attending they review us at the end of the month So I got feedback in my review that obviously was not my feedback but the other residents feedback Like how can you even Who am I supposed to call that out to I donrsquot even knowrdquo

Illustrative Quotes Residents of Color

I dont have any Latino doctors that I can look up to I dont know a single one here I know there are some but Ive never met them So I dont know my experience has been a little different I mean all of you guys are great but sometimes it is really hard to fit in when you have come from somewhere differentrdquo

Illustrative Quotes Residents of Color

ldquoSome parts of my experience here are similar others are not I have Indian physician role models abundantly in all fields of healthcare so for me it was never lsquoOh I cant see myself therersquo because theres so many Indian people But thats not the case for a lot of minorities in our countryrdquo

Summary of institution findings

A specialized medical education curriculum empowers trainees with the knowledge and tools to address inequities within institution

For residents of color themes of othering racism microaggressions and minority tax are persistent

More is needed to truly address the inclusion of our trainees

The faculty experience

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Institutional Example

ldquoI think sometimes you just have to feel like theres a little bit more of something in the air you know to really feel like I can grab on to this Especially if youre in a trainee

role This [curriculum] is now part of the conversation in the residency program and I feel like we have a greater degree of confidence to be able to go there But we need

morehelliprdquo

INCLUDE Curriculum = INclusion CuLtural hUmility Diversity and Equity28 training hours per year

Skill Building Trainings = 10 hours

bull EDI Foundationbull Cultural Humilitybull Microaggressions

Didactics = 15 hours

bull SDOHbull Racism and bias in

healthcarebull Trauma informed

carebull Refugee and

Immigrant Healthbull Religion in Medicinebull Housing Insecurity

Small Group Discussions = 3 hours

bull Book discussion on ldquoBlindspotrdquo

bull Tuesday AM sessions

bull Key stakeholders including faculty residents and consultants utilized the needs assessment findings to inform the curriculum content

Culturally effective care gt Learning Climate and Inclusion

Feedback and learning from the 1st year of implementation- Data from follow-up survey

- Key gaps were identified in areas of learning climate and inclusion

- These gaps informed an additional qualitative study to assess the impact

Qualitative Assessment

Focus groups (n = 13)61 (813) were R2s31 (413) were residents of color77 (1013) were female

Four project members coded the notes and transcripts using a codebook

Constant comparative analysis Common and recurrent themes discussed

Themes KnowledgeSkillsBehaviors

Importance and resident empowerment to engage in EDI issues

Recognizing and addressing microaggressions

Increased awareness of bias in patient care interactions

Limitation in providing equitable care due to lack of interpreters

Themes Residents of Color

Loneliness due to ldquootheringrdquo

Barrage of microaggressions

Limited Mentorship

The one who always has to ldquospeak uprdquo

Illustrative Quotes Residents of Color

ldquohellipIn the ED we had three black male residents one for each year and two of us were working in the emergency room at the same time with a fellow too and more than once nurses would mix up who you are And somebody asked me about a brain MRI for my asthma patient it didnt make sense I joked about it a little bit but itrsquos not funny And this has real safety implicationsrdquo

Illustrative Quotes Residents of Color

ldquoI was on a rotation with another Indian resident and an attending was confusing us for each other And with an attending they review us at the end of the month So I got feedback in my review that obviously was not my feedback but the other residents feedback Like how can you even Who am I supposed to call that out to I donrsquot even knowrdquo

Illustrative Quotes Residents of Color

I dont have any Latino doctors that I can look up to I dont know a single one here I know there are some but Ive never met them So I dont know my experience has been a little different I mean all of you guys are great but sometimes it is really hard to fit in when you have come from somewhere differentrdquo

Illustrative Quotes Residents of Color

ldquoSome parts of my experience here are similar others are not I have Indian physician role models abundantly in all fields of healthcare so for me it was never lsquoOh I cant see myself therersquo because theres so many Indian people But thats not the case for a lot of minorities in our countryrdquo

Summary of institution findings

A specialized medical education curriculum empowers trainees with the knowledge and tools to address inequities within institution

For residents of color themes of othering racism microaggressions and minority tax are persistent

More is needed to truly address the inclusion of our trainees

The faculty experience

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

INCLUDE Curriculum = INclusion CuLtural hUmility Diversity and Equity28 training hours per year

Skill Building Trainings = 10 hours

bull EDI Foundationbull Cultural Humilitybull Microaggressions

Didactics = 15 hours

bull SDOHbull Racism and bias in

healthcarebull Trauma informed

carebull Refugee and

Immigrant Healthbull Religion in Medicinebull Housing Insecurity

Small Group Discussions = 3 hours

bull Book discussion on ldquoBlindspotrdquo

bull Tuesday AM sessions

bull Key stakeholders including faculty residents and consultants utilized the needs assessment findings to inform the curriculum content

Culturally effective care gt Learning Climate and Inclusion

Feedback and learning from the 1st year of implementation- Data from follow-up survey

- Key gaps were identified in areas of learning climate and inclusion

- These gaps informed an additional qualitative study to assess the impact

Qualitative Assessment

Focus groups (n = 13)61 (813) were R2s31 (413) were residents of color77 (1013) were female

Four project members coded the notes and transcripts using a codebook

Constant comparative analysis Common and recurrent themes discussed

Themes KnowledgeSkillsBehaviors

Importance and resident empowerment to engage in EDI issues

Recognizing and addressing microaggressions

Increased awareness of bias in patient care interactions

Limitation in providing equitable care due to lack of interpreters

Themes Residents of Color

Loneliness due to ldquootheringrdquo

Barrage of microaggressions

Limited Mentorship

The one who always has to ldquospeak uprdquo

Illustrative Quotes Residents of Color

ldquohellipIn the ED we had three black male residents one for each year and two of us were working in the emergency room at the same time with a fellow too and more than once nurses would mix up who you are And somebody asked me about a brain MRI for my asthma patient it didnt make sense I joked about it a little bit but itrsquos not funny And this has real safety implicationsrdquo

Illustrative Quotes Residents of Color

ldquoI was on a rotation with another Indian resident and an attending was confusing us for each other And with an attending they review us at the end of the month So I got feedback in my review that obviously was not my feedback but the other residents feedback Like how can you even Who am I supposed to call that out to I donrsquot even knowrdquo

Illustrative Quotes Residents of Color

I dont have any Latino doctors that I can look up to I dont know a single one here I know there are some but Ive never met them So I dont know my experience has been a little different I mean all of you guys are great but sometimes it is really hard to fit in when you have come from somewhere differentrdquo

Illustrative Quotes Residents of Color

ldquoSome parts of my experience here are similar others are not I have Indian physician role models abundantly in all fields of healthcare so for me it was never lsquoOh I cant see myself therersquo because theres so many Indian people But thats not the case for a lot of minorities in our countryrdquo

Summary of institution findings

A specialized medical education curriculum empowers trainees with the knowledge and tools to address inequities within institution

For residents of color themes of othering racism microaggressions and minority tax are persistent

More is needed to truly address the inclusion of our trainees

The faculty experience

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Culturally effective care gt Learning Climate and Inclusion

Feedback and learning from the 1st year of implementation- Data from follow-up survey

- Key gaps were identified in areas of learning climate and inclusion

- These gaps informed an additional qualitative study to assess the impact

Qualitative Assessment

Focus groups (n = 13)61 (813) were R2s31 (413) were residents of color77 (1013) were female

Four project members coded the notes and transcripts using a codebook

Constant comparative analysis Common and recurrent themes discussed

Themes KnowledgeSkillsBehaviors

Importance and resident empowerment to engage in EDI issues

Recognizing and addressing microaggressions

Increased awareness of bias in patient care interactions

Limitation in providing equitable care due to lack of interpreters

Themes Residents of Color

Loneliness due to ldquootheringrdquo

Barrage of microaggressions

Limited Mentorship

The one who always has to ldquospeak uprdquo

Illustrative Quotes Residents of Color

ldquohellipIn the ED we had three black male residents one for each year and two of us were working in the emergency room at the same time with a fellow too and more than once nurses would mix up who you are And somebody asked me about a brain MRI for my asthma patient it didnt make sense I joked about it a little bit but itrsquos not funny And this has real safety implicationsrdquo

Illustrative Quotes Residents of Color

ldquoI was on a rotation with another Indian resident and an attending was confusing us for each other And with an attending they review us at the end of the month So I got feedback in my review that obviously was not my feedback but the other residents feedback Like how can you even Who am I supposed to call that out to I donrsquot even knowrdquo

Illustrative Quotes Residents of Color

I dont have any Latino doctors that I can look up to I dont know a single one here I know there are some but Ive never met them So I dont know my experience has been a little different I mean all of you guys are great but sometimes it is really hard to fit in when you have come from somewhere differentrdquo

Illustrative Quotes Residents of Color

ldquoSome parts of my experience here are similar others are not I have Indian physician role models abundantly in all fields of healthcare so for me it was never lsquoOh I cant see myself therersquo because theres so many Indian people But thats not the case for a lot of minorities in our countryrdquo

Summary of institution findings

A specialized medical education curriculum empowers trainees with the knowledge and tools to address inequities within institution

For residents of color themes of othering racism microaggressions and minority tax are persistent

More is needed to truly address the inclusion of our trainees

The faculty experience

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Qualitative Assessment

Focus groups (n = 13)61 (813) were R2s31 (413) were residents of color77 (1013) were female

Four project members coded the notes and transcripts using a codebook

Constant comparative analysis Common and recurrent themes discussed

Themes KnowledgeSkillsBehaviors

Importance and resident empowerment to engage in EDI issues

Recognizing and addressing microaggressions

Increased awareness of bias in patient care interactions

Limitation in providing equitable care due to lack of interpreters

Themes Residents of Color

Loneliness due to ldquootheringrdquo

Barrage of microaggressions

Limited Mentorship

The one who always has to ldquospeak uprdquo

Illustrative Quotes Residents of Color

ldquohellipIn the ED we had three black male residents one for each year and two of us were working in the emergency room at the same time with a fellow too and more than once nurses would mix up who you are And somebody asked me about a brain MRI for my asthma patient it didnt make sense I joked about it a little bit but itrsquos not funny And this has real safety implicationsrdquo

Illustrative Quotes Residents of Color

ldquoI was on a rotation with another Indian resident and an attending was confusing us for each other And with an attending they review us at the end of the month So I got feedback in my review that obviously was not my feedback but the other residents feedback Like how can you even Who am I supposed to call that out to I donrsquot even knowrdquo

Illustrative Quotes Residents of Color

I dont have any Latino doctors that I can look up to I dont know a single one here I know there are some but Ive never met them So I dont know my experience has been a little different I mean all of you guys are great but sometimes it is really hard to fit in when you have come from somewhere differentrdquo

Illustrative Quotes Residents of Color

ldquoSome parts of my experience here are similar others are not I have Indian physician role models abundantly in all fields of healthcare so for me it was never lsquoOh I cant see myself therersquo because theres so many Indian people But thats not the case for a lot of minorities in our countryrdquo

Summary of institution findings

A specialized medical education curriculum empowers trainees with the knowledge and tools to address inequities within institution

For residents of color themes of othering racism microaggressions and minority tax are persistent

More is needed to truly address the inclusion of our trainees

The faculty experience

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Themes KnowledgeSkillsBehaviors

Importance and resident empowerment to engage in EDI issues

Recognizing and addressing microaggressions

Increased awareness of bias in patient care interactions

Limitation in providing equitable care due to lack of interpreters

Themes Residents of Color

Loneliness due to ldquootheringrdquo

Barrage of microaggressions

Limited Mentorship

The one who always has to ldquospeak uprdquo

Illustrative Quotes Residents of Color

ldquohellipIn the ED we had three black male residents one for each year and two of us were working in the emergency room at the same time with a fellow too and more than once nurses would mix up who you are And somebody asked me about a brain MRI for my asthma patient it didnt make sense I joked about it a little bit but itrsquos not funny And this has real safety implicationsrdquo

Illustrative Quotes Residents of Color

ldquoI was on a rotation with another Indian resident and an attending was confusing us for each other And with an attending they review us at the end of the month So I got feedback in my review that obviously was not my feedback but the other residents feedback Like how can you even Who am I supposed to call that out to I donrsquot even knowrdquo

Illustrative Quotes Residents of Color

I dont have any Latino doctors that I can look up to I dont know a single one here I know there are some but Ive never met them So I dont know my experience has been a little different I mean all of you guys are great but sometimes it is really hard to fit in when you have come from somewhere differentrdquo

Illustrative Quotes Residents of Color

ldquoSome parts of my experience here are similar others are not I have Indian physician role models abundantly in all fields of healthcare so for me it was never lsquoOh I cant see myself therersquo because theres so many Indian people But thats not the case for a lot of minorities in our countryrdquo

Summary of institution findings

A specialized medical education curriculum empowers trainees with the knowledge and tools to address inequities within institution

For residents of color themes of othering racism microaggressions and minority tax are persistent

More is needed to truly address the inclusion of our trainees

The faculty experience

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Themes Residents of Color

Loneliness due to ldquootheringrdquo

Barrage of microaggressions

Limited Mentorship

The one who always has to ldquospeak uprdquo

Illustrative Quotes Residents of Color

ldquohellipIn the ED we had three black male residents one for each year and two of us were working in the emergency room at the same time with a fellow too and more than once nurses would mix up who you are And somebody asked me about a brain MRI for my asthma patient it didnt make sense I joked about it a little bit but itrsquos not funny And this has real safety implicationsrdquo

Illustrative Quotes Residents of Color

ldquoI was on a rotation with another Indian resident and an attending was confusing us for each other And with an attending they review us at the end of the month So I got feedback in my review that obviously was not my feedback but the other residents feedback Like how can you even Who am I supposed to call that out to I donrsquot even knowrdquo

Illustrative Quotes Residents of Color

I dont have any Latino doctors that I can look up to I dont know a single one here I know there are some but Ive never met them So I dont know my experience has been a little different I mean all of you guys are great but sometimes it is really hard to fit in when you have come from somewhere differentrdquo

Illustrative Quotes Residents of Color

ldquoSome parts of my experience here are similar others are not I have Indian physician role models abundantly in all fields of healthcare so for me it was never lsquoOh I cant see myself therersquo because theres so many Indian people But thats not the case for a lot of minorities in our countryrdquo

Summary of institution findings

A specialized medical education curriculum empowers trainees with the knowledge and tools to address inequities within institution

For residents of color themes of othering racism microaggressions and minority tax are persistent

More is needed to truly address the inclusion of our trainees

The faculty experience

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Illustrative Quotes Residents of Color

ldquohellipIn the ED we had three black male residents one for each year and two of us were working in the emergency room at the same time with a fellow too and more than once nurses would mix up who you are And somebody asked me about a brain MRI for my asthma patient it didnt make sense I joked about it a little bit but itrsquos not funny And this has real safety implicationsrdquo

Illustrative Quotes Residents of Color

ldquoI was on a rotation with another Indian resident and an attending was confusing us for each other And with an attending they review us at the end of the month So I got feedback in my review that obviously was not my feedback but the other residents feedback Like how can you even Who am I supposed to call that out to I donrsquot even knowrdquo

Illustrative Quotes Residents of Color

I dont have any Latino doctors that I can look up to I dont know a single one here I know there are some but Ive never met them So I dont know my experience has been a little different I mean all of you guys are great but sometimes it is really hard to fit in when you have come from somewhere differentrdquo

Illustrative Quotes Residents of Color

ldquoSome parts of my experience here are similar others are not I have Indian physician role models abundantly in all fields of healthcare so for me it was never lsquoOh I cant see myself therersquo because theres so many Indian people But thats not the case for a lot of minorities in our countryrdquo

Summary of institution findings

A specialized medical education curriculum empowers trainees with the knowledge and tools to address inequities within institution

For residents of color themes of othering racism microaggressions and minority tax are persistent

More is needed to truly address the inclusion of our trainees

The faculty experience

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Illustrative Quotes Residents of Color

ldquoI was on a rotation with another Indian resident and an attending was confusing us for each other And with an attending they review us at the end of the month So I got feedback in my review that obviously was not my feedback but the other residents feedback Like how can you even Who am I supposed to call that out to I donrsquot even knowrdquo

Illustrative Quotes Residents of Color

I dont have any Latino doctors that I can look up to I dont know a single one here I know there are some but Ive never met them So I dont know my experience has been a little different I mean all of you guys are great but sometimes it is really hard to fit in when you have come from somewhere differentrdquo

Illustrative Quotes Residents of Color

ldquoSome parts of my experience here are similar others are not I have Indian physician role models abundantly in all fields of healthcare so for me it was never lsquoOh I cant see myself therersquo because theres so many Indian people But thats not the case for a lot of minorities in our countryrdquo

Summary of institution findings

A specialized medical education curriculum empowers trainees with the knowledge and tools to address inequities within institution

For residents of color themes of othering racism microaggressions and minority tax are persistent

More is needed to truly address the inclusion of our trainees

The faculty experience

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Illustrative Quotes Residents of Color

I dont have any Latino doctors that I can look up to I dont know a single one here I know there are some but Ive never met them So I dont know my experience has been a little different I mean all of you guys are great but sometimes it is really hard to fit in when you have come from somewhere differentrdquo

Illustrative Quotes Residents of Color

ldquoSome parts of my experience here are similar others are not I have Indian physician role models abundantly in all fields of healthcare so for me it was never lsquoOh I cant see myself therersquo because theres so many Indian people But thats not the case for a lot of minorities in our countryrdquo

Summary of institution findings

A specialized medical education curriculum empowers trainees with the knowledge and tools to address inequities within institution

For residents of color themes of othering racism microaggressions and minority tax are persistent

More is needed to truly address the inclusion of our trainees

The faculty experience

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Illustrative Quotes Residents of Color

ldquoSome parts of my experience here are similar others are not I have Indian physician role models abundantly in all fields of healthcare so for me it was never lsquoOh I cant see myself therersquo because theres so many Indian people But thats not the case for a lot of minorities in our countryrdquo

Summary of institution findings

A specialized medical education curriculum empowers trainees with the knowledge and tools to address inequities within institution

For residents of color themes of othering racism microaggressions and minority tax are persistent

More is needed to truly address the inclusion of our trainees

The faculty experience

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Summary of institution findings

A specialized medical education curriculum empowers trainees with the knowledge and tools to address inequities within institution

For residents of color themes of othering racism microaggressions and minority tax are persistent

More is needed to truly address the inclusion of our trainees

The faculty experience

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

The faculty experience

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Building community and safe spaces

ldquoWe canrsquot dismantle a system we didnrsquot buildrdquo

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Safe space domains

Med Ed

bull Specialized curriculum surrounding diversity equity and inclusionbull DEI cultural humility and microaggression formalized trainings

Supportbull Trainee of color debrief support groups and trainings

Mentorship

bull Resident and faculty diversity committeebull Intentional recruitment and retention of faculty of color

Policy

bull Creating space for anonymous reporting of micro and macroaggressions

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Building community and safe spaces

bull Formalized curriculum sets expectation to actively engage in DEI

bull Designated teaching spacesbull Trainings allow for common shared

language and knowledgebull Need for more discussion around

understanding of diverse trainee perspectives

Medical Education

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Building community and safe spaces

bull Well-being through inclusion framework

bull Promote bringing our whole selves to work

bull Create a robust support network for residents of color

Support

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Support networks

Education

Debriefs

Reflection

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Support networks

Reflection

Debriefs

Education

bullResident of color spaces for reflection and bonding

bullSpace for shared experiences

bullResident of color spaces for acute debrief and processing

bullDiscussions facilitated after the murders of Ahmaud Arbery Breonna Taylor Tony McDade George Floyd and countless others

bull ie microaggression debriefs

bullFacilitated small group discussions for residents of color after formalized trainings in our INCLUDE curriculum

bullie Microaggression training

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Building community and safe spaces

bull Facilitating relationship and connection with faculty of color for support and common shared experiences

bull ie Resident Diversity Committeebull Building community through

institutional networks

Mentorship

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Building community and safe spaces

bull Institutions must align DEI mission with over-arching policy

bull Formalized training for faculty and staff

bull Reporting systems for micro and macro- aggressions

Institution

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Conclusion

bull The resident of color experience is layered by othering racism microaggressions and minority tax

bull Acknowledgment and understanding of the experiences of trainees of color is critical in fostering a safe space

bull Cultivating this space must be Intentional and deliberate bull Four possible domains to explore medical education support

mentorship and institutional policybull Initiatives must permeate the culture for constant teaching and

conversation

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

ldquoWhat do you do when you are too tired to fight the fighthelliprdquo

ldquoYou pass the batonhellipwe are all in this race togetherrdquo

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

In gratitude

Seattle Childrenrsquos Graduate Medical Education Team Dr Heather McPhillips Dr Maneesh Batra Dr H Mollie Grow Dr Sahar Rooholamini Dr Celeste Quitiquit and Dr Elena Griego

INCLUDE Curriculum Team Dr Thelben Mullett Dr Shaquita Bell Dr Abena Knight

Mentor Dr Maya Jones

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

In gratitude

The residents who lead the charge and always speak their truth

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

ReferencesAbdelHameid Duaa Professionalism 101 for Black Physicians New England Journal of Medicine (2020) e34

ACGME Accreditation Council for Graduate Medical Education Policies and Procedures ACGME June 9 2018 2018

Acosta David MD Ackerman-Barger Kupiri PhD RN Breaking the Silence Time to Talk About Race and Racism Academic Medicine March 2017 - Volume 92 - Issue 3 - p 285-288 doi 101097ACM0000000000001416

Blackstock Uche Why Black doctors like me are leaving faculty positions in academic medical centers STAT news 2020

Brooks KC A piece of my mind A silent curriculum JAMA 2015313(19)1909-1910

Crenshaw K (1991) Mapping the Margins Intersectionality Identity Politics and Violence against Women of Color Stanford Law Review 43(6) 1241-1299 doi1023071229039

Cyrus K Why I gave up my dream of leading diversity efforts in medicine AAMC 2020

Grubbs V Diversity Equity and Inclusion That Matter New England Journal of Medicine July 23 2020 N Engl J Med 2020 383e25 DOI 101056NEJMpv2022639

Liebschutz JM Darko GO Finley EP Cawse JM Bharel M Orlander JD In the minority black physicians in residency and their experiences J Natl Med Assoc 200698(9)1441-1448

Osseo-Asare A Balasuriya L Huot SJ et al Minority Resident Physicians Views on the Role of RaceEthnicity in Their Training Experiences in the Workplace JAMA Netw Open 20181(5)e182723 Published 2018 Sep 7 doi101001jamanetworkopen20182723

Young K et al A Little Hurts a Lot Exploring the Impact of Microaggressions in Pediatric Medical Education Pediatrics July 2020 146 (1) e20201636 DOI httpsdoiorg101542peds2020-1636

Questions and Discussions

- What are the domains in your institution where you can intentionally build community

- What have you done to build community

- Are there ongoing discussions in place on the experiences of residents of color

• The resident of color experience how to build community and safe spaces
• Format for Todayrsquos Meeting
• Development Programs for UiM Residents
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• Themes KnowledgeSkillsBehaviors
• Themes Residents of Color
• Illustrative Quotes Residents of Color
• Illustrative Quotes Residents of Color
• Illustrative Quotes Residents of Color
• Illustrative Quotes Residents of Color
• Summary of institution findings
• The faculty experience
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