Recognizing and Responding to Overt Racism Towards Medical Trainees: Using the IRES Tool and Scripted Language

Medical educators feel ill equipped to respond to racism directed towards trainees. Available tools for responding to microaggressions rely on clarifying questions or aligning with the aggressor, which may add to the harm experienced by the target. We aimed to provide methods for faculty to recognize and respond to overt racism so that trainees feel supported in the clinical learning environment.

We created a faculty development workshop with didactic and experiential learning components based on Kolb's theory for program leadership to teach how to respond when racism was directed towards trainees. In the didactic session, we shared the IRES (identify, respond, end, support) tool we created to respond to overt racism. Participants took part in two small-group case-based practice sessions with group debriefing, followed by a postsession survey.

Over 2 years, we held two sessions with a total of 43 faculty participants. Postsession survey response rate was 74% and showed a 1-point Likert-scale median increase (p < .001) in ability to distinguish the strategies for addressing overt racism versus microaggressions, confidence in responding to microaggressions versus overt racism, and ability to debrief learners. The majority of participants noted that scripted language was a valuable tool to promote upstander behavior.

Participants appreciated this novel framework for responding to racism directed at trainees in the learning environment. Providing scripted language and being able to practice in a safe environment were particularly important. This training can be adapted to include residents, fellows, and other disciplines.