Race & Medicine

White Caucusing

Caucusing Activities

 

Not sure what racial identity caucusing is?

 

Help Getting Started

It can be frightening to start facilitating white caucuses or discussions about race. This can be particularly true in the field of medicine where we value expertise and years of experience. In starting this work, you will undoubtedly make mistakes but also learn a lot in the process. Sometimes it can be helpful to find an outside facilitator when you are first beginning, but don’t let that be a barrier. Many people don’t start anti-racist discussions because they don’t feel like they know enough - the result of that is often that these conversations simply don’t happen. The following resources have some tips for getting started to help you feel more prepared:

These guidelines are intended to be read aloud at the beginning of each session. They help to create some norms and expectations.

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White Caucus Activities

Introductory activity on privilege. This activity is helpful for creating a starting ground to address white privilege.

In US society, whiteness is often considered the “norm.” When presenting patients on rounds, race is often mentioned only to note if someone is not white. When race is not noted, it’s often assumed the person is white. This invisibility of whiteness often makes it challenging to address whiteness and white superiority. This activity is meant to help start discussions around this topic.

Healthcare providers have often committed themselves to caring for patients regardless of race, ethnicity, gender, or other variables. Most physicians would probably agree with the statement that “racism is wrong.” Yet studies have repeatedly shown that implicit bias exists among physicians as it does in the larger population. This activity helps to begin discussion around the specific privilege of white people in medicine and of white physicians.

Part of anti-racism work for white folks includes the need to address the history of whiteness and white supremacy in the US. This work can be particularly important for physicians, since we have additional privilege. This activity is meant to start this process and discussion.

Many white people report having witnessed racism but didn’t know how to respond. This exercise is intended to provide practice in responding to overt acts of racism or more subtle microaggressions.

Innumerable studies find racial differences, ranging from the prevalence of diseases to predicting prognoses. In many cases, these findings have been integrated into medical calculators or diagnostic machines. When medical studies use race as a scientific variable and find differences, how do we square that with the argument that race is not biologically based? The pre-reading looks at how race is used in scientific studies using the example of spirometry and lung function.

For a deeper dive into how race is confused for genetics, check out the resources here.

Despite the work of most institutions to promote cultural humility, many small unconscious behaviors and curricular examples can undermine those larger efforts. This 2002 study looked at what identifying features were portrayed in case presentations and how they were portrayed. Their findings can help promote discussion around what other places “hidden curriculum” can be found and what its impact can be.

In discussions about race and racism, multiple patterns have been noted among white participants. Recognizing these patterns in ourselves can help us be better allies to people of color.

The Coronavirus pandemic has brought to the surface many inequities in the United States. Communities of color represent a disproportionate number of infections and deaths from COVID-19. This has also translated into greater economic losses worsening poverty. “Research on influenza has found that in an epidemic, poverty and inequality can exacerbate rates of transmission and mortality for everyone.” This activity facilitates discussion around the interaction between Coronavirus and inequality, and actions that might be taken in this unique moment.

Microaggressions are common. Responding to them can be a challenge. This is another activity that helps participants practice responses and get feedback on how to improve.

A common dynamic in interracial discussions is white silence. While participants often cite many reasons for this. In this article by Robin DiAngelo, she makes the argument of how white silence is harmful and promotes white privilege. This activity promotes discussion around white silence to help white participants discuss this phenomenon in an all white group.

Mistakes in antiracism work are inevitable. It doesn’t make you a bad person, it makes you human. How we respond to mistakes, however, can be essential to anti-racist work. This activity promotes discussion around reframing mistakes, and responding to being called out.

One insidious way that medicine treats race as a scientific variable is the use of race in calculators, scoring tools, and algorithms, which healthcare providers use to assess risk or determine treatment. This exercise helps to promote discussion about the potential consequences of this use and question its validity.

Being called out (or called “in”) can be painful. It can provoke feelings of shame, defensiveness, embarrassment, anger, and more. How we respond to being called out is important can both promote or hinder our own growth, can strengthen or silence voices of people of color, and is something we can change with practice.

Hiring and recruitment are common places where implicit bias is found and can have profound consequences. “Colorblind” practices have been found to perpetuate disparities in hiring and promotion. This activity is intended to promote discussion around hiring, recruitment, promotion, and retention in your institution.

Professionalism has become coded language for white favoritism in workplace practices that more often than not privilege the values of white and Western employees and leave behind people of color.

Tools for Discussing Identity and Privilege Among Medical Students, Trainees, and Faculty

Free MedEdPORTAL module

Physicians and students of all backgrounds should be prepared to interact with patients of various socioeconomic, racial, ethnic, gender, religious, and sexual orientation identities. The approach described in this MedEdPortal module emphasizes how important it is for physicians and physicians-in-training to develop self-awareness before engaging with patients.  These exercises guide learners toward critical thinking about privilege and identity to better prepare them for culturally inclusive patient interactions. These materials can be used with physicians at various levels of training. The earlier they are used, the more time learners will have to reflect on social and professional identities before interacting with patients.