Creating a safe learning environment for Black trainees

February 23, 2022 | Author: Royal College Staff

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.

Dr. Hadal El-Hadi

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.”

Dr. Kannin Osei-Tutu

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.

Moving forward

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.”


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Leslie MacMillan | February 28, 2022
If EDI programs already ubiquitous are felt not to sufficiently root out anti-Black racism specifically, won't advocates for other self-identified racialized groups want their identity singled out for special attention, too? How would you say No to them? How many of the available training hours during residency are going to be devoted to making sure everyone makes trainees feel better about themselves as compared to learning how to render better treatment to patients? What will be the metric for deciding if a training program devotes sufficient effort to anti-Black racism specifically or identify politics generally to allow it to be accredited? Thanks.
Royal College Communications | March 9, 2022
Hi Leslie, thank you for your questions. Initiatives to address anti-Black racism within residency accreditation are the current step we are taking in a journey to root out and dismantle racism and discrimination, in all its forms, within the postgraduate medical education (PGME) learning environment. We are also undertaking initiatives to address anti-Indigenous racism and to incorporate Indigenous health consciousness within accreditation (our June Dialogue e-newsletter will have an article on this). More work will follow to ensure all equity-deserving groups are represented and included. When all trainees feel safe and supported in the learning environment, they can thrive in their learning experiences and provide optimal care for patients. The Accreditation Working Group to Address Anti-Black Racism will be working closely with the Canadian Residency Accreditation Consortium and its respective accreditation committees, as well as postgraduate deans and residency stakeholders, to determine how the accreditation process will appropriately and thoroughly evaluate anti-Black racism initiatives within our PGME institutions and programs. Please feel welcome to contact us with other questions or concerns: communications [at] royal college [dot] ca.
Everard PHALA | February 26, 2022
Thank you Drs. Osei-Tutu and El-Hadi. It is extremely important to identify and contact medical students and residents early upon their entrance into the Medical training environment. Black trainees need to be apprised of the very resources that will enable them to successfully navigate the Training environment. We need a way of expeditiously identifying and contacting Black medical trainees at the outset of their training/education. This should enable the possibility of mentoring and support early in their career and avoid the tragedies of trainees not completing their training or ending up with catastrophic psychologic and mental breakdowns. I will be cheering you for a long-awaited enterprise.
Pauline Alakija | February 24, 2022
Thank you Dr. Osei-Tutu. I agree with these recommendations. Let's hope they become embedded in our learning cultures.
Quebec Physician | February 24, 2022
Thank you for this incredible work! Yes!!! Let’s finally talk about anti-black racism as its own entity in medicine, which is so different from other forms of discrimination! It urgently needs to be addressed, includinf in medical guidelines, in approach to patient care, and IN MEDICAL TEACHING where we still only see pathologies presented with phototypes 1-2!!!
Royal College Communications | March 9, 2022
Racism is experienced in unique ways by different groups. For this reason, when addressing different types of racism and discrimination, one size does not fit all. Addressing anti-Black racism within accreditation is one step on our journey towards creating safe learning environments for everyone.
| March 6, 2022
Thank you for your kind words. It is a pleasure and an honor to be part of this work. Credit to the incredible residents who are giving of their time, energy, and perspective to inform this urgent and important issue.
| February 28, 2022
How is anti-Black racism different from other forms of discrimination?