Anti-Black racism in clinical supervision: asynchronous simulated encounters facilitate reflective practice

Abstract

Background Racist interactions in clinical practice remain a pervasive reality for Black healthcare providers. We sought to develop a framework to inform supervisors’ actions when confronting racism in clinical practice and protecting trainees under their oversight. Methods We conducted a qualitative study in which experienced supervisors responded to seven short, videotaped interactions between: 1) Black trainees and a simulated patient (SP) in a racist role; 2) the trainees and their respective supervisors; and 3) the trainees and their supervisors together with the SP. The clinical exchanges exemplified different types of racist (entrenching) or antiracist (uprooting) behaviors by the supervisors. After viewing each clip, participants wrote their reflections confidentially; they later joined a structured debriefing together. We used thematic analysis to identify supervisors’ behavioral patterns when confronting racist interactions. Results Based on the input of 52 participants recruited into five two-hour-long sessions, we categorized the behaviors of supervisors facing anti-Black racial injuries involving learners under their oversight. We organized supervisor behaviors into five interlocking domains, each with a range of possible themes: 1) Joining: from conciliatory to confrontational in communicating with the aggressor; 2) Explicitness: from avoiding to naming racism; 3) Ownership: from individual to shared responsibility of the event and the response to it; 4) Involving: from excusing to including the aggrieved party when confronting the aggressor; and 5) Stance: from protective to paternalistic in supporting the learner’s autonomy. Conclusions Our qualitative findings can provide a framework for facilitated discussion toward reflective practice among healthcare providers who may have experienced, witnessed, or intervened in anti-Black racist interactions. They can also help medical educators to inform faculty development to fight anti-Black racism in clinical practice. The video materials we developed are available for viewing and download and can be used or adapted as springboards for reflective discussion or faculty development activities.

Palliative Care Clinician Perspectives on Person-Centered End-of-Life Communication for Racially and Culturally Minoritized Persons with Cancer

“…Thus, cultural humility supports clinicians to develop introspective and flexible practices to ensure person-centeredness that transcends racial and cultural differences. Safe spaces for teams to debrief and foster reflective practice about cultural challenges in care provision, the application of cultural humility, and approaches to forging an antiracist clinical culture (e.g., through supportive clinical supervision and collaboration) are imperative for high-quality palliative care delivery throughout serious illness and especially in high-stakes scenarios at EOL [ 25 , 58 , 59 ]. Furthermore, clinicians should cultivate and adopt practices of intentional stillness and solidarity with recipients of inequitable care to integrate ethical practices that mitigate ineffective responses of both inaction and delay (i.e., the opposite of antiracist practice) [ 60 ].…”