My family and I recently embarked on a Disney Cruise for our annual vacation. Excitement filled my 4-year-old daughter, Layla, because of the opportunity to meet with the princesses. Her suitcase stuffed with all the ballgowns she could carry; she wore a different dress every evening as she hoped to meet every princess on board our ship.
One evening, she wore her outfit from Beauty and the Beast; a bright gold number with thin shoulder straps and pleated waves from the waist down. Belle wore a similar gown, albeit more elaborate than my daughter’s version. As we waited in line to see Belle, she turned to me and said, “Finally, daddy, I can meet a princess that looks like me.”
Now, I am sure my 4-year-old fashionista was alluding to the twin ensemble she and Belle wore. However, her poignant words also provided a moment of clarity as I reflected on the most recent #JHMChat on Dr. Mercy Adetoye’s article, “Strategies to Build Trust with Trainees Who are Underrepresented in Medicine.” Meeting individuals who share similar backgrounds and values is a special experience, one that our colleagues underrepresented in medicine (UiM) are less likely to find.
Dr. Adetoye defined intersectionality as “the complex and cumulative way in which the effects of multiple forms of discrimination combine, overlap, or intersect especially in the experience of marginalized individuals or groups.” Historically, clinical medicine values conformity over individuality and many UiM trainees may question their role in this environment. Attendings may not fully appreciate the role intersectionality plays in a trainee’s experience. Participants in the JHM chat voiced this opportunity to improve awareness of their trainees’ intersectionality.
I think first part is being aware that not all “labels” are as obvious as skin color and presenting gender.
As Ted Lasso says, be curious and ask to understand and truly get to know the trainee as a person#JHMChat pic.twitter.com/ba4AFqU60t
— Suchita Shah Sata, MD (@SuchitaSata) January 31, 2023
This opportunity includes increasing awareness of our identity and intersectionality and modeling this behavior to those around us.
A1. I think we have to create a safe environment where trainees feel safe practicing along side us. I model my own intersectionality so others feel welcome discussing in my presence. #JHMChat
— Anika Kumar, MD (she/her) (@freckledpedidoc) January 31, 2023
A1 create trusted spaces first …so you can have these conversations and self disclose your own identities and experiences. Hard work #jhmchat
— Vinny Arora MD MAPP (@FutureDocs) January 31, 2023
The concept of safe spaces manifested as the JHM chat progressed. Safe spaces, opportunities for dialogue and sharing of experiences of individuals, are especially important when microaggressions are encountered in the clinical environment. Initiating these discussions should start with attendings and not disproportionately fall on UIM trainees who may feel that they are imposing a “minority tax burden” on others.
A2: This question really strikes a chord. We expect URM trainees/faculty to do it all: speak on or educate peers about racism and discrimination, have the capacity to share our experiences all while holding it together. It is A LOT! Our trainees do not need this pressure #JHMChat
— Ndidi Unaka MD, MEd (@NdidiUnaka) January 31, 2023
Change once again starts with individual and institutional reflection of how racism can affect delivery of care and the individuals that deliver that care.
#JHMChat Need to first be trustworthy. Address how racism is manifested in your place of work. Locations of faculties, mix of clinicians for e.g.
— Daniel Wolfson (@WolfsonD) January 31, 2023
A2: As Dr. Adetoye alludes to in her paper, it has to baked into the culture. This problem isn’t going to be solved by one person. The institution and its leadership need create the culture of trust and safety. #JHMChat
— Charlie M. Wray, DO, MS (@WrayCharles) January 31, 2023
#JHMChat A2: For me, it starts with acknowledging that I am still learning and working on this, and I then I just put it out there. “I want you to feel okay bringing stuff up to me if you feel comfortable, and we can try to address it.”(1/2)
— Joseph Thomas, MD (@DocWithBowtie) January 31, 2023
Shared responsibility lightens the burden and allows for everyone to benefit from the diverse experiences of all members of the team.
Attendings can support their UiM trainees and provide an invaluable education for all team members by modeling inclusive, equitable, and empathetic behaviors. Some meaningful ways to bolster your teams include setting clear goals and expectations at the beginning of rotations, being intentional in action, and offering support when microaggressions occur.
A3: As others have said, I include it in my expectations that I send and say it on day 1 that let’s them know I am happy to be called out and will help call out for them.
I like the approach of coming from curiosity or clarity: “Can you repeat what you said?” #JHMChat
— Jen Readlynn, MD, FHM (she/her) (@jenreadlynn) January 31, 2023
A3.
It’s important to start by creating psychological safety on the team.
We’re all learning together.
We’re not afraid to redirect each other, and to speak up when needed.#JHMChat#MedEd
— Sherine Salib (@DrSherineSalib) January 31, 2023
Learning these new skills may feel awkward or even intrusive to some. However, the stakes are never higher than during these moments. As Dr. Ndidi Unaka elegantly acknowledged, “The discomfort that an attending may feel does not compare to the disillusionment of trainees who observe or are the target of microaggressions.”
Eight years ago, I completed my pediatric residency and many of the challenges I faced as a trainee are still present today; balancing learning with clinical responsibilities, self-care, and the shadow of imposter syndrome. Institutional awareness of the needs of trainees has increased but is still far from ideal, particularly for those underrepresented in medicine. An institution’s foundation is its people and the responsibility for making the institution better lies within each of us.
Join us for the February #JHMChat on Monday, February 27, at 9 p.m. ET, when we will discuss “Addressing Ableism and Caring for Chronically Ill Patients,” based on this recent Journal of Hospital Medicine perspective, “Go the Extra Mile.”
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