Race, Power and Privilege

Introduction

Teams participating in the UMass Medical School Population Health Clerkship are invited to attend a full-day intensive workshop on the topic of Race, Power and Privilege.  On the day of the workshop, medical and graduate nursing students, together with a few academic and community faculty preceptors, spend the day learning, talking, discussing and reflecting on the ways that race, power and privilege can shape one's experiences as a student, care provider, community member or person seeking health care.

The workshop has been developed and facilitated in close collaboration with community partners who bring expertise in the area of racial justice, including Keesha LaTulippe, Red Tab Consulting (2014-2016), and Maritza Cruz, Director of Racial Equity for the YWCA of Central MA(2017-), working in partnership with sociologist Heather-Lyn Haley, PhD, assistant professor of Family Medicine and Community Health.  SIgnificant student input has also improved the program, as described below in the history section.

Resources for participants

We would like to make the following resources available:

Presentation slides:

2014
2015 - no slides used
2016

Links to video clips used:

Anderson Cooper CNN Doll Experiment - scenes used in training were taken from this source.

Mirrors of Privilege: Making Whiteness Visible - used in 2014 only

Camara Jones' Gardener's Tale, short version - as used in FM Residency Bias Session 2

Recommended resources:

Tim Wise talk on the Pathology of Whiteness We also strongly recommend his quick history lesson on the creation of race.

Brown medical student Katherine C. Brooks' opinion piece in JAMA on A Silent Curriculum that enforces disparities through example and through what is not said in clinical learning situations.

 
DiAngelo, Robin. Nothing to Add: A Challenge to White SIlence in Racial Discussions. 2012. Understanding and Dismantling Privilege 2(1): 1-17. Matrix Center for the Advancement of Social Equity and Inclusion. 

Showing Up for Racial Justice: national organization for white people looking to support black leadership in the Movement for Black Lives.  Local chapter info available from Dr. Haley. 

Witnessing Whiteness - Shelly Tochluk's book targets white people looking to develop their racial identity as anit=racist whites, with supporting materials for self-study or small group workshops.  Especially useful are her:

Readings and on-line resources:

•Burgess D; van Ryn M, Dovidio J; Saha S. 2007. Reducing Racial Bias Among Health Care Providers: Lessons from Social-Cognitive Psychology. J Gen Intern Med. Jun 2007; 22(6): 882–887. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219858/
•Sabin JA, Greenwald AG. 2012. The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma. Am J Public Health. 2012 May;102(5):988-95. doi: 10.2105/AJPH.2011.300621. Epub 2012 Mar 15. http://www.ncbi.nlm.nih.gov/pubmed/22420817
•Centers for Disease Control. CDC Health Disparities and Inequalities Report — United States, 2013 MMWR / November 22, 2013 / Vol. 62 / No. 3. http://www.cdc.gov/mmwr/pdf/other/su6203.pdf
•Lozano P, Finkelstein JA, Chi FW, Jensvold NG, Capra AM, Quesenberry CP, Selby JV, Farber HJ. Racial/ethnic variation in asthma status and management practices among children in managed medicaid.  Lieu TA1, .  http://www.ncbi.nlm.nih.gov/pubmed/11986447 
•Kleinman, Arthur. Taken from UPenn’s Kleinman’s 8 Handout. http://www.med.upenn.edu/gec/user_docs/PDF/Health%20Equity%20and%20Literacy/Kleinman_s_8_Questions.pdf

 Where to begin?  In clinical situations, try the Kleinman questions.

1. "What do you call the problem?
2. What do you think has caused the problem?
3. Why do you think it started when it did?
4. What do you think the sickness does? How does it work?
5. How severe is the sickness? Will it have a long or a short course?
6. What kind of treatment do you think you/the patient should receive?
7. What are the chief problems the sickness has caused?
8. What do you fear most about the sickness?" 

 

History of the workshop: 

We have offered this opportunity since 2014. In the first year, the leaders of six teams decided that the topic was relevant to the population of interest to their team so added the offering to their team schedules; 32 students were trained that first year.  In 2015 and 2016 we had eight teams enrolled, allowing us to reach a total of 32 and 35 students respectively. 

 Student leaders were also involved in planning and facilitation of the event, including

2014: Solange Bayard, Jasmine Khubchandani and Jessica Long, second year medical students active in the local chapter of the Student National Medical Association, prepared and led the section on microaggressions, and Lauren Powell from the Graduate School of Biomedical Sciences Clinical and Population Health Research program helped us design an evaluation. 

2015: Elizabeth Ferzacca, Jasleen Kaur, Michael Buckner, and Robert Gakwaya, second year medical students, focused on the impact of racism focusing on UMMS students as the population of interest for the Population Health CLerkship team experience. They created an online tool for eliciting examples of micro-agression on campus, prepared and facilitated that session during the workshop, and took a leadership role in beginning conversations about the need for faculty development.  

2016: Robert Gakwaya, now a third year medical student, was a valuable assistant, creating and working through a one-week Flexible Clinical Experience on the impact of racism coming from patients during our preparatory period and sharing that information during the planning phase.  Elizabeth Ferzacca remains committed to the work through her capstone initiative to add content on Race, Power and Privilege to the orientaiton day for students from all three schools.  

Future plans

Evaluations show that the students appreciated the chance to talk about this topic and to explore the concept of whiteness, which was new to many.  We need to do a better job of recognizing bias and microaggression against nursing as it happens.  To address this weakness, we hope to strengthen the inter-professional nature of the training, adding a section explicitly dealing with implicit biases and assumptions affecting relations between physicians, nurses and other health professionals. We are working to engage graduate school of nursing students nd faculty in the planning process.