Reflective Practice 101 
Racism

Background

“There is a strange kind of enigma associated with the problem of racism. No one, or almost no one, wishes to see themselves as racist; still, racism persists, real and tenacious.” – Albert Memmi, Racism

Discussing race and racism can feel taboo.  On a societal level, this may be due in large part to our national mythology that (1) describes our populace is as a “melting pot”[ii] in which we are all merged into a single unified entity and (2) tends to avoid discussions of the many historical injustices committed as a consequence of racism in our relatively short existence as a nation.  On a personal level, engaging – and by that I mean truly, openly, and honestly engaging in a discussion about racism – is often challenging.  Such engagement requires each of us to start by exploring our own racial bias and that of our family of origin and the community in which we grew up.

This can be tough work – and partly because the national dialogue around this topic has become heated, divided, sometimes partisan…the opposite of what we are trying to model here — of being open, empathetic, reflective. We may feel guilty when thinking about our own actions in the past, we may feel disloyal for critiquing the actions taken and words said by our families and friends who have given us so much, and we may feel anxious wondering what others will think of us if and when we share.  We may not even feel like the conversation applies to us at all or somewhat fatigued by issues of political correctness. But always at  the heart of something that feels hard is the ask that we consider why it feels hard, and why it feels easier not to engage. In short, for most of us, the challenge of this critical work, is that it asks that we be vulnerable and that, if you’ve noticed, is anything but what we’ve be conditioned to be.

This session, focusing on race and racial bias, begins with a panel of folks who will both share with you stories describing their own racial biases as well as the bias they have witnessed/experiences in the healthcare arena.  In these narratives, you will hear about macro-aggressions and micro-aggressions and how significant an impact each can have. The narratives are important because it is only in recognizing our biases and examining the impact they have on our interaction with patients that we can see how we might start to make change. Health disparities and outcomes based on race are well documented, and it isn’t happening just because people aren’t aware of their biases or previous transgressions.

We, as military providers, who care for a community composed of people from nearly every race, religion, gender, age, and from a wide array of cultures, have an opportunity to have the conversation that many are unwilling to have in the name of making patients better. Let’s have the courage to have that conversation.

I thank you in advance.

[ii] More recently this term has been replaced by the term “salad bowl”

Panelists

• Dr. Charmagne Beckett, CAPT, USN, is a physician of internal medicine and infectious disease. She is currently Officer in Charge of the Navy Bloodborne Infection Management Center (NBIMC).
• Dr. Theo Stokes, CDR, USN is a neonatalogist at Walter Reed and currently President of the Medical Staff.
• Dr. Jason Higginson, CDR, USNR is a Maynard Distinguished Scholar of Pediatrics and Chair of the Department of Pediatrics at the Brody School of Medicine at East Carolina University. He is a neonatologist.

Objectives:

By the end of this session on Racism, you, as the learner, will be able to:

1. Thoughtfully examine:
   • your own racial biases
   • your reactions to racism you observe
2. Identify:
   • the sources of your own racial bias
   • the sources of your reactions to observed macro- and micro-aggressions
3. Explore these sources in order to better understand your reactions and account for them in the context of future clinical care.
4. Identify the positive and negative implications of the reactions identified above.
5. Develop a realistic plan to mitigate the negative and enhance the positive implications of the reactions you identified above.

Assignment

Reflective Essay (R.S.I.R. format)

Reaction: As stimulated by the panel and supplemental resources, identify at least two (2) reactions to topics discussed by the panelists and/or in the readings about racial bias.

Sources/Your Story: Explore the sources of these thoughts, feelings, and reactions.  Consider how your own racial biases might contribute to health disparities or how it may have contributed to a poor patient interaction. Your sources may include one or more of the following:

• your perceptions of how race was viewed in your family of origin and the community in which you grew up
• your perceptions of how race was viewed among your peers and in your community during your early adult life
• your experiences to date discussing and considering race/racism and the impact it has on society at large and on your own personal relationships
• your perceptions of how race is viewed in the military and medical communities

Please be specific and write  in the first person.

Implications: For each reaction in your Reaction section, identify and examine both the positive and negative implications of those reactions for future patient care.

Review:  You’ve named your reaction and your context — so what is your bias or assumption with regard to this topic?  What surprised you about the topic? As you think about your reflection above, what have you learned about yourself?