Disrupting the Effects of Racism

As all medical students know, medical school is a challenge. But for Black students and others underrepresented in medicine, racism is an additional challenge.

“As a medical student, you’re learning a lot, changing a lot, and the hours and schedule are challenging, and then students who are underrepresented in medicine have to deal with racism and a system that doesn’t always see them equally,” says Jean-Marie Alves-Bradford, MD, associate clinical professor of psychiatry and director of the Office of Equity, Diversity & Inclusion in the Department of Psychiatry at the Vagelos College of Physicians and Surgeons (VP&S).

“So we created spaces for them to have time to process and heal.” 

With funds provided last fall by the Columbia University provost office, Alves-Bradford joined forces with Hetty Cunningham, MD, director of equity & justice in curricular affairs at VP&S, and Hilda Hutcherson, MD, senior associate dean for diversity and multicultural affairs, to develop interactive workshops that foster healing and agency among medical students who have experienced racism.

The workshops grew out of conversations the three had with members of the Black and Latino Students Organization to find ways to lend support when the pandemic first began. “Then because of George Floyd and numerous other murders and horrible acts of violence toward people of color, it's been very difficult for students in general, but especially for students underrepresented in medicine,” Alves-Bradford says. “So we wanted to help. It's hard to learn when you’re dealing with trauma, and medical students have a limited time to learn what they need to learn.”

The workshops started this spring for medical trainees—medical students, residents, and fellows—from groups underrepresented in medicine.

The workshops assess trainees’ experiences of microaggressions and racial trauma and teach therapeutic and coping skills. The students learn about existing systems of privilege and oppression, share experiences of being confronted with racism, practice microaggression response strategies to disrupt racism, and learn resilience strategies to cope with racialized trauma.

Coping with microaggressions

Although all trainees have experienced microaggression before coming to medical school, a different dynamic in the medical training setting is new to them.

“There are lots of incidents where others have minimized the value of the student, or presumed that the trainees don't deserve various things, whether it be a grade on a test, or admittance to the institution itself,” Alves-Bradford says. “Many people also have presumptions that Black and Latinx people are not physicians, so when trainees walk into a room in the hospital, they're  presumed to be housekeeping or patient transport staff.

“Microaggressions tend to be things that leave you feeling like, what just happened here? Was that an insult to me, because of my identity?” Alves-Bradford says. “It really takes you out of what you're doing, it makes you think for a while about what happened, and it leaves you feeling uncomfortable.”

The workshop leaders introduce the trainees to published frameworks for dealing with microaggressions, but often the best advice comes from the other trainees in the workshop, which includes everyone from first-year students to fellows and faculty volunteers.

“How people respond depends on lots of different factors, including who you are, the setting, who’s present, and who has uttered the microaggression. In a health care setting, it can be complex; you may have a responsibility to provide health care to the person,” Alves-Bradford says.

Some of the coping strategies involve what’s called “making the invisible visible.”

“It's about taking a moment to have the person think more about what they said,” she says. “So one way to address the microaggression is to tell the person, ‘When you said X, I felt offended.’ Or ask them, ‘What makes you say that?’”

It’s not necessary to say something in the moment, Alves-Bradford adds. If a patient needs care before the situation can be addressed, or if the power dynamics make the trainee uncomfortable, it’s OK to wait.

In one of the response models, “the first step sometimes is to stop and take some time, 24 or 48 hours, to think about what happened, think about how you want to respond,” she says. “You can talk to a trusted colleague or supervisor. If you’re able, you want to get the message to the person who made the statement. People need feedback when they’re making these statements.”

The workshops also fostered community among the participants, which can be tapped to form a support group. “Finding people who can function as a support group, with whom you can share experiences and exchange coping skills, is an essential resilience strategy,” Alves-Bradford says, “and is something that needs ongoing adjustment as trainees move from medical school to residency and beyond.”

Changing the VP&S curriculum

The workshops have received such positive feedback that Alves-Bradford and her colleagues received funding from the Apgar Academy of Medical Educators to weave the material into the medical school curriculum for all students beginning this fall.

“It was important to start with underrepresented in medicine students first, because there were particular needs at the time, but of course many people experience microaggressions because of their ethnicity, race, gender identity, sexual orientation, or ability status,” Alves-Bradford says.

The curriculum will include actions bystanders can take. “We can't just leave it up to the people who are the targets of microaggressions to be the ones to respond. Upstander response skills help protect the individual who is the target,” she says. “We really want to have a community of people who are able to recognize bias, and some of it may be subtle and not always so obvious to people. We want to teach skills to everyone so they can recognize bias and better respond.”