Creating a safe learning environment for Black trainees
New CanRAC Working Group aims to embed anti-Black racism principles in accreditation standards
Residency is a difficult journey. For Black trainees — many of whom report racism from patients, their peers and supervisors — residency can be a lonely and overwhelming experience.
“I don’t think residency should be a traumatic experience but for many [Black] trainees it is,” explains Hadal El-Hadi, MD, co-founder of Black Physicians of Canada, an advocacy organization that provides mentorship, community and support for Black physicians and trainees. She explains that microaggressions, implicit bias and a lack of representation and support affect Black trainees’ chances of success, to a point where not everyone finishes their training.
“It’s hard to advocate for yourself when no one understands your experience or why you’re uncomfortable.”
But structural change can help make the learning experience safer for Black trainees.
Transform the experience for Black trainees
Kannin Osei-Tutu, MD, MSc, CCFP, a hospitalist physician and clinical assistant professor at the University of Calgary, is leading this disruption. As chair of the Canadian Residency Accreditation Consortium (CanRAC) Accreditation Working Group to Address Anti-Black Racism (AWG-ABR), he is working with Black trainees across Canada to develop and embed anti-Black racism principles within accreditation standards.
As a physician who has gone through the system and holds a faculty position, Dr. Osei-Tutu acknowledges he has a unique perspective on how these policies can transform the experience for current and future Black trainees.
“Accreditation is a small but incredibly impactful space. Making these changes would be a significant disruption of structural racism,” he says.
While equity, diversity and inclusion (EDI) initiatives have become more commonplace in the medical education space in the past two years, Dr. Osei-Tutu explains that there is power in identifying how racism affects a specific group, rather than approaching inequality as a one-size fits all solution.
“In the current EDI and anti-racism discourse, for reasons that are not entirely clear, it seems to remain more palatable to some people that we talk about anti-racism in general rather than anti-Black racism specifically,” he says. “Our lived experience makes us uniquely positioned to address anti-Black racism and the issues and needs that are specific to Black residents.”
Identifying gaps and proposing solutions
Since its founding in June 2021, AWG-ABR has reviewed current institutional accreditation standards through the lens of anti-Black racism to see where there are gaps, and what policies and structures need to be strengthened to address anti-Black racism in the learning environment.
Now, based on their research and consultation with national groups, the group is proposing several pillars to bring about change:
- Safe and effective reporting mechanisms: Residents need pathways to bring forward complaints without fear of retaliation or career repercussions, and currently these pathways are felt to be lacking. For example, due to inherent power imbalances, one cannot safely report a person in authority. AWG-ABR is proposing options for residents to safely make complaints that circumnavigate existing hierarchies and ensure a fair and objective resolution for trainees.
- Training at all levels: Mandatory training for all actors in the accreditation space — postgraduate deans, program directors and surveyors — should include anti-Black racism, anti-Indigenous racism, implicit bias and trauma-informed care training. Postgraduate deans should be equipped to hear these reports and have a better sense of how to appropriately respond and offer support to residents who bring forth complaints.
- Data collection: Racist incidents against Black trainees are happening but, in Canada, we do not collect data around race and racism in the learning environment. Incorporating questions on anti-Black racism experiences within the Canadian Excellence in Residency Accreditation (CanERA) national resident and faculty survey would be one way to ensure these incidents are reported and documented.
- Black representation in decision-making groups: Black physicians are underrepresented in positions of leadership in medical education; ensuring there are mechanisms for mentorship and support to boost their representation is essential.
Dr. Osei-Tutu is presenting these proposals to the CanRAC accreditation committees and PGME stakeholders including postgraduate deans. These meetings are the first step of many more to come.
“The markers and standards we set in the context of accreditation will serve as an impetus for the culture shift needed in medical education, and more broadly in our health care system as a whole,” he says, explaining the effect this work will have on the DNA of the accreditation process.
The goal is for Black trainees to enter residency knowing that they have supports in place and a system that will help them thrive.
“I’m most looking forward to seeing a safer space for Black trainees to learn and succeed,” Dr. El-Hadi admits, saying this journey may take years. “I hope even knowing they have people who are working on this on their behalf will provide relief.”