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Learning to address anti-Black racism in the clinic

A course designed by Stanford Medicine's Presence 5 helps medical instructors teach anti-Black racism in the clinic.

Studies have shown that, on average, when physicians encounter Black patients, they speak faster, dominate the conversation and have shorter visits. These communication practices can contribute to racial disparities in health care quality and outcomes, said Donna Zulman, a Stanford Medicine associate professor of medicine in primary care and population health.

Now, Stanford researchers have developed a workshop that is being offered across the country to teach clinicians how to better communicate with patients about race to address anti-Black racism in health care and promote health equity.

The workshop was described in a recent paper in MedEdPORTAL. Megha Shankar, MD, a physician and Stanford Presence fellow, was the lead author and Zulman, co-director of Presence 5, was the senior author. It was developed by a team from Stanford Medicine's Presence 5 project, which is aimed at improving patient care by fostering meaningful human connections between doctors and patients during clinical encounters.

Stephen Russell, MD, a professor of primary care and pediatrics at the University of Alabama, said the workshop changed how he approaches the subject of race with patients.

"It gave me the boldness and the vulnerability to say, 'I've been practicing medicine a long time, but I'm still learning,'" said Russell, who has started asking his patients how news reports of racism, such as the murder of George Floyd, affected them. "I felt a palpable sense of appreciation for bringing it up and being willing to listen."

Help with talking about race

Russell participated in an online continuing medical education course, called Disrupting Anti-Black Racism to Promote Health Equity, which trains medical educators to run the workshop.

Zulman said she and her colleagues created the course after pandemic-highlighted racial disparities emerged and they became aware of the challenges doctors experience when addressing race-related health issues with their Black patients.

"For physicians who don't have experience talking about racial identity and systemic racism, it's valuable to learn some practices grounded in the many decades of scholarship on this topic," Zulman said. "It's something that requires ongoing attention and effort, but this course can at least offer a starting point."

Bolstered by research

A multidisciplinary, racially diverse team at Stanford and other institutions adapted principles from Presence 5 to create the course, which provides step-by-step instructions to help trainees discuss experiences of racism that their patients face. A case study of a 35-year-old Black woman with high blood pressure illustrates discussion points for the social, cultural and health care factors that impact how clinicians can best care for her.

The course describes communication strategies and recommended practices that address anti-Black racism in clinical settings, and it trains medical educators to lead workshops with medical students, residents and fellows. Among the tips is a caution for instructors against expecting non-white class participants to share their experiences with racism as a way of teaching others how to handle or deal with it.

Zulman said the course centers specifically on anti-Black racism because of the "unique, lived experience among Black individuals in this country" and the "intense level of injustice this community faces."

Zulman and her colleagues plan to create additional courses to address bias and to promote collaborative efforts to support physicians and faculty of color, she said, noting that, though designed for physicians, the course could apply to other fields, such as education.

Russell said he hopes the course and workshops like the one he attended proliferate across the country: "I would love to see this become scaled to other institutions and in other venues where people can learn from it."

Photo by M_Agency

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