Dismantling Structural Racism in Academic Psychiatry to Achieve Workforce Diversity

From Diversity, Equity, and Inclusion to an Antiracism Strategic Plan: An Academic Department of Psychiatry's Journey

The efforts of an academic psychiatry department to embark on an antiracism strategic planning process are outlined, including the establishment of an antiracism task force charged with the development of an antiracism strategic plan. The initial process of the task force is described, recommendations are summarized, and future directions are outlined.

Profiles in Wisdom: A Survey of Leading Psychiatrists to Inform the Diversity of the Future Psychiatric Workforce

Long-standing challenges facing the mental health system require more effective strategies to furnish a workforce whose diversity matches an increasingly diverse population. Current and former system leaders can offer expert guidance informed by their experiences and perspectives. Their professional journeys to leadership in this area provide context and unique insight into issues of justice, including workforce diversity, equity, and inclusion in psychiatry. These experts agree that significant policy changes are needed to improve psychiatric workforce diversity and that implementing change will require that disparate groups together to achieve this goal. Financial considerations must be included in policy and advocacy.

The Role of the National Institute of Mental Health in Promoting Diversity in the Psychiatric Research Workforce

The mission of the National Institute of Mental Health (NIMH) is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure. This mission can only be realized if full participation in the research enterprise is open to all. Nevertheless, systemic racism and other barriers remain significant obstacles to achieving a diverse workforce. To address these barriers, NIMH must ensure a just and equitable funding process, support diversity-focused training opportunities, and encourage research into mental health disparities and other areas of interest to a diverse array of scientists.

Anti-Black racism in clinical supervision: asynchronous simulated encounters facilitate reflective practice

Background Racist interactions in clinical practice remain a pervasive reality for Black healthcare providers. We sought to develop a framework to inform supervisors' actions when confronting racism in clinical practice and protecting trainees under their oversight. Methods We conducted a qualitative study in which experienced supervisors responded to seven short, videotaped interactions between: 1) Black trainees and a simulated patient (SP) in a racist role; 2) the trainees and their respective supervisors; and 3) the trainees and their supervisors together with the SP. The clinical exchanges exemplified different types of racist (entrenching) or antiracist (uprooting) behaviors by the supervisors. After viewing each clip, participants wrote their reflections confidentially; they later joined a structured debriefing together. We used thematic analysis to identify supervisors' behavioral patterns when confronting racist interactions. Results Based on the input of 52 participants recruited into five two-hour-long sessions, we categorized the behaviors of supervisors facing anti-Black racial injuries involving learners under their oversight. We organized supervisor behaviors into five interlocking domains, each with a range of possible themes: 1) Joining: from conciliatory to confrontational in communicating with the aggressor; 2) Explicitness: from avoiding to naming racism; 3) Ownership: from individual to shared responsibility of the event and the response to it; 4) Involving: from excusing to including the aggrieved party when confronting the aggressor; and 5) Stance: from protective to paternalistic in supporting the learner's autonomy. Conclusions Our qualitative findings can provide a framework for facilitated discussion toward reflective practice among healthcare providers who may have experienced, witnessed, or intervened in anti-Black racist interactions. They can also help medical educators to inform faculty development to fight anti-Black racism in clinical practice. The video materials we developed are available for viewing and download and can be used or adapted as springboards for reflective discussion or faculty development activities.

Anti-Black racism in clinical supervision: asynchronous simulated encounters facilitate reflective practice

Background Racist interactions in clinical practice remain a pervasive reality for Black healthcare providers. We sought to develop a framework to inform supervisors’ actions when confronting racism in clinical practice and protecting trainees under their oversight. Methods We conducted a prospective study in which experienced supervisors responded to seven short, videotaped interactions between: 1) Black trainees and a simulated patient (SP) in a racist role; 2) the trainees and their respective supervisors; and 3) the trainees and their supervisors together with the SP. The clinical exchanges exemplified different types of racist (entrenching) or antiracist (uprooting) behaviors by the supervisors. After viewing each clip, participants wrote their reflections confidentially; they later joined a structured debriefing together. We used thematic analysis to identify supervisors’ behavioral patterns when confronting racist interactions. Results Based on the input of 52 participants recruited into five two-hour-long sessions, we categorized the behaviors of supervisors facing anti-Black racial injuries involving learners under their oversight. We organized supervisor behaviors into five interlocking domains, each with a range of possible themes: 1) Joining: from conciliatory to confrontational in communicating with the aggressor; 2) Explicitness: from avoiding to naming racism; 3) Ownership: from individual to shared responsibility of the event and the response to it; 4) Involving: from excusing to including the aggrieved party when confronting the aggressor; and 5) Stance: from protective to paternalistic in supporting the learner’s autonomy. Conclusions Our qualitative findings can provide a framework for facilitated discussion toward reflective practice among healthcare providers who may have experienced, witnessed, or intervened in anti-Black racist interactions. They can also help medical educators to inform faculty development to fight anti-Black racism in clinical practice. The video materials we developed are available for viewing and download and can be used or adapted as springboards for reflective discussion or faculty development activities.

Profiles in Wisdom: A Survey of Leading Psychiatrists to Inform the Diversity of the Future Psychiatric Workforce

Long-standing challenges facing the mental health system require more effective strategies to furnish a workforce whose diversity matches an increasingly diverse population. Current and former system leaders can offer expert guidance informed by their experiences and perspectives. Their professional journeys to leadership in this area provide context and unique insight into issues of justice, including workforce diversity, equity, and inclusion in psychiatry. These experts agree that significant policy changes are needed to improve psychiatric workforce diversity and that implementing change will require that disparate groups together to achieve this goal. Financial considerations must be included in policy and advocacy.

The Role of the National Institute of Mental Health in Promoting Diversity in the Psychiatric Research Workforce

The mission of the National Institute of Mental Health (NIMH) is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure. This mission can only be realized if full participation in the research enterprise is open to all. Nevertheless, systemic racism and other barriers remain significant obstacles to achieving a diverse workforce. To address these barriers, NIMH must ensure a just and equitable funding process, support diversity-focused training opportunities, and encourage research into mental health disparities and other areas of interest to a diverse array of scientists.

Moving Beyond Implicit Bias in Antiracist Academic Medicine Initiatives

The concept of implicit bias has arguably laid the groundwork for uncomfortable discussions surrounding race in academic medicine, but its effectiveness in changing racist behavior and systems remains unclear. Terms like implicit bias, while perhaps more palatable than other concepts to some, may result in confusion and divert time from meaningful reconceptualization and creation of effective antiracism initiatives. This Invited Commentary contends that the term implicit bias is inadequate for addressing racism because it is too broad; does not necessarily lead to a change in racist behaviors; assumes that racism is unconscious, aggressor-centered, and individual-focused; and implies that everyone suffers equally in a racist system. The authors illustrate why terms like implicit bias are inadequate in combatting racism in medicine and suggest alternate terminology to use while engaging in antiracism work in academic medicine.