An anti-racism task force is working to create opportunities that will respond to the needs of staff in the division of general medicine following a series of anti-racism forums and surveys.
“Hopefully, this can inspire others in the department of medicine to work toward similar activities and believe that it can be done, and done well, despite the COVID restraints we have,” said Christine Gladman, MD, medical director of the UNC Internal Medicine Clinic.
GIM’s All-Hands meetings have always been the way to bring together general medicine faculty, clinic staff and administration, keeping everyone informed and on the same page when it comes to patient care. But after the death of George Floyd on May 25, 2020, All-Hands became the forum for a new conversation.
“It was a frustrating time and feelings were very raw. I was receiving frantic emails from many people in our community, and we’d reached a point where we couldn’t pretend anymore,” said Crystal Wiley Cené, MD, MPH, associate professor of medicine in the division of general medicine and clinical epidemiology and system executive director of health equity for UNC Health.
“It was time to talk about the real experience that Black and Brown people and other minorities live with every day. These are people who come to work showing a face that’s not realistic. Then, they go home to be something else.”
Cené says choosing not to talk about it, as if everything was ok, was perpetuating the problem, and she was mindful of the nuances in bringing different people together, with each seeing through the prism of their own life experience.
All Hands – June, 2020
With support from Darren DeWalt, MD, MPH, chief of the division, Cené started the first conversation at an All Hands meeting on June 18, 2020. Staff of color met beforehand, to express their own emotions in a safe space, and process recent events. Then, as a division, All Hands was the forum for a larger conversation, introduced with specific guidelines and expectations. Here, Cené defined racism, she shared examples of it, and she helped people understand it through allegory. A small group breakout followed, with some in person and some virtual, and this gave participants the chance to go further, to collectively 
process their thoughts, to talk about how they were managing their feelings and to consider the best way to support each other.
Anti-Racist Task Force
Led by Dr. Cené, an anti-racist task force was formed after the meeting, and included Seth A. Berkowitz, MD, MPH, who has conducted a number of studies on health-related social needs and their association with health outcomes, as he seeks to advance health equity. Berkowitz described general medicine’s All-Hands work as an opportunity to think about, as a group, what it means to be an anti-racist division.
“We are hoping to address interpersonal racism that members of the division may have experienced, and to examine whether any policies and practices within the division might contribute to a system that results in more advantages for some racial groups than others,” Berkowitz said. “We want to make changes that interrupt the reproduction of structural racism and by doing that, we hope to help division members, our patients, and our community confront racism as the public health crisis it is.”
Other members of the GIM task force include: Carol Golin, MD, Crystal Wiley Cené, MD, MPH, Gaurav Dave, MD, DrPH, MPH, Shayla Mitchell Bigelow, Anna Elyse Harden, Tamara Saint-Surin, MD, Hannah Coletti, MD, MPH, Jasmine Prevost, and Neshaunda Raines.
“In order to do better, we have to be better and what better way to lead by example than having a task force to guide us,” Raines said. “I am excited that we are able to focus and educate others on this topic within our division.”
Anti-Racist Survey
The task force created an anti-racist survey, sent to the entire division asking for anonymous responses. Staff were asked to respond to questions like: How do you define racism? Have you witnessed or experienced it in our division? With a patient? A co-worker? Or, in the structure of our division? Other questions invited solutions. What would it mean to be anti-racist? How can we respond? What are the barriers in our division?
All Hands – February, 2021
Cené shared the results from the approximately 60% who returned the surveys, on February 25, 2021. This meeting was a time for coalescing and identifying clear action steps. Participants were asked to answer two more questions in their breakout groups:
- What are the top two priorities that you think we need to address in our division/clinic, based on the survey themes?
- What specific actions should we take to address your priorities?
From this meeting, participants identified several priorities and specific actions the division should take, including: providing more support for Spanish-speaking patients (e.g., having bilingual MyChart functionalities); updating and enforcing policies to handle racist behavior by patients towards clinicians and staff; and the need for continued education and training on racism and how to become good allies to minority groups. Some also asked for training in how to recognize and address microaggressions, the everyday, subtle, intentional, and oftentimes unintentional, interactions or behaviors that communicate bias toward historically marginalized groups.
Next Steps
Now, the task force is working to create opportunities that will address these needs. Christine Gladman, MD, medical director of the UNC Internal Medicine Clinic, says the work can be a model for others to follow.