Meet the residents who are making the learning environment safer for Black trainees
Dr. Teresa Semalulu and Dr. Ekua Agyemang share their experiences volunteering for the Accreditation Working Group to address Anti-Black Racism (AWG-ABR)
Launched by the Canadian Residency Accreditation Consortium last June, the AWG-ABR brings together trainees and physicians from across Canada. Together, they are working to identify strategic levers in the accreditation process that can transform the postgraduate learning environment into one that is free of all forms of racism, though their particular focus is on anti-Black racism.
AWG-ABR presented the six key pillars of work to various CanRAC committees in February 2022, which were enthusiastically received. Currently, the working group is drafting the proposed recommendations based on these pillars of work — such as new pathways for safe reporting for Black trainees and anti-Black racism training for faculty and other postgraduate medical education stakeholders — to present at the meetings of the residency accreditation committees of the three colleges in May 2022 for feedback.
Related: “Creating a safe learning environment for Black trainees” (Royal College Newsroom)
In the Q&A that follows, two resident AWG-ABR contributors share why they got involved and why anti-Black racism principles matter.
Teresa Semalulu, MD, MPH, is a second-year Rheumatology fellow who recently completed her Internal Medicine residency at McMaster University. She’s a founder of Black Physicians of Canada (BPC), an advocacy organization that provides mentorship, community and support for Black physicians and trainees.
Ekua Agyemang, MD, MPH, is a PGY-4 in Public Health and Preventive Medicine at the University of Alberta. She also serves as the Resident President on the BPC Board.
How and why did you get involved with the working group?
Dr. Semalulu: Dr. Hadal El-Hadi and I founded BPC and it was one of our goals to make changes in training for Black residents. We met with the Royal College early on about this topic and the working group is the result of those discussions. We’ve had lots of leadership in this space along with residents who are leading these efforts.
Dr. Agyemang: Speaking with Black medical student associations throughout Canada in my BPC role, I realized there was a lot of anti-racism effort happening at the medical student level but not at the residency level. There is a need for reform to ensure that momentum isn’t lost when those students enter postgraduate training. We have quite the motivated group and we hope to leverage our knowledge and experience to affect structural change.
How can the training environment be unsafe for Black residents?
Dr. Agyemang: As a Black person, apart from the fact that you are doing the same work as everyone else, you also deal with a lot of things that others don’t see or think about such as patients refusing to talk to you because you are Black or because they think you’re incompetent.
Residency can be a hostile work environment if your peers and instructors don’t have any anti-bias training and they don’t understand why you’re feeling isolated or uncomfortable. It makes it hard to promote open discussion about these experiences or to advocate for yourself.
For many Black residents and trainees, they’re the only Black person in their program. Due to lack of representation, there aren’t people that you feel you can discuss certain issues with or compare events with, and you end up internalizing a lot of your experiences.
Dr. Semalulu: Black residents expect to experience micro and macro aggressions, and these affect us emotionally. The danger is that these experiences, along with systemic issues, limit our progression through a program. It’s extremely challenging to recognize early on and to find support when you experience racist situations.
What does success look like to you in addressing these systemic issues?
Dr. Semalulu: Two points: first, having people recognize anti-Black racism is a major issue in public health and understand its impact on how Black people navigate the world and medical training. It hasn’t been acknowledged and is often brushed to the side. It’s only really since the murder of George Floyd that people have been able to say ‘oh, my gosh. This is real.’
The second point is once you recognize there’s a problem, you can develop solutions. An example is accreditation bodies collecting race-based data and using that information to create reporting mechanisms to ensure Black trainees can navigate their learning in the safest way possible.
Dr. Agyemang: For me, it would be changes in the Canadian Excellence in Residency Accreditation (CanERA) national survey for residents. Currently, there are questions that ask whether you feel you’re receiving adequate resources for training but the psychological safety aspect with regards to racism isn’t present. By adding these questions, trainees can feel heard while identifying possible racist incidents for the program to investigate further.