“Say their names:” Thoughts on residency leadership response to police brutality and social injustices

INTRODUCTION

As Black emergency medicine (EM) residents at Emory, we have deeply considered the ways in which residency programs can address police brutality and social injustices. As one of the more diverse residency programs in the country, Emory has a rich history of community engagement and involvement in social justice.¹ Over the past 10 years, with the increased prevalence of social media, we have witnessed countless cases of police brutality and overall systemic racism that seem to be woven in the fabric of American society. The pain and hopelessness associated with witnessing recent events of racial injustice, compounded by working through a pandemic, is overwhelming. This is particularly challenging during residency training, a vulnerable time in a provider's career. Indeed, the stress of racism has detrimental effects on the cellular level and is associated with increased overall morbidity and mortality in African Americans.², ³ As such, systemic racism is a public health crisis⁴, ⁵ that should be addressed by residency programs across the country, not just for the health of the patients they serve but also for the health of their residents. Responsible for training and shaping the careers of young doctors, residency leadership is in a unique position to make a difference in addressing racial injustice and its impact on their residents. Reflecting on our experience at Emory, we have identified ways in which leadership can address these concerns though education, community engagement, and diverse leadership.

BREAKING THE SILENCE

Conversations around systemic racism and police brutality are painful and bring about palpable tension and discomfort in large group settings where the people most affected usually do most of the talking. Too often, residents of color, specifically Black residents, are met by silence from their White colleagues and supervisors, which can cause alienation and miscommunication.⁶ Therefore, it is crucial for residents of color to immediately hear from program leadership when these incidents arise. After the murders of George Floyd and Breonna Taylor, Emory EM leadership was swift in their response with both residency‐wide emails and individual messages to Black residents to acknowledge these tragedies. This was of critical importance; it immediately dissipated tension and created a more comfortable atmosphere in which to have difficult conversations. Leadership also created space and time for an intern classwide discussion guided by a senior‐level psychologist on confronting these difficult conversations. The effect of this was twofold; it communicated that leadership considered these issues important, and it allowed residents to debrief about what they were experiencing. It was especially useful for non‐Black residents to listen and understand the different perspectives and experiences of police brutality and racism.

Residency leadership in programs across the country should strive to create a sense of solidarity among residents and faculty. The elements that must shine through regardless of the form it takes are recognition, acknowledgment, receptiveness, resource provision, and action. This means being intentional about expressing recognition of current events in a timely fashion. It also means acknowledging that we should collectively be distressed by what we are witnessing versus isolating the group directly affected. This can easily take the form of a residency‐wide email, town hall, or dedicated segment during weekly conference. Leadership can research avenues of support in place by their home institution and take the added step of creating support through their department, whether through class wellness days initiatives driven by residents. Visibility as an active supporter is also key. Emory EM leadership were present at the White Coat for Black Lives peaceful demonstrations outside the hospitals in solidarity with residents and staff which communicated their commitment to ending racial injustice. The public, the residents, and prospective trainees need to see the commitment of the residency program to addressing these injustices.

SHARING THE BURDEN OF EDUCATION

Residency leadership can and must create spaces for open dialogue and develop resources to further educate our learning communities. While it is important that we have a voice, the burden of Black residents’ lived experiences and working in largely nondiverse environments makes having to be the sole voice in these conversations a trigger for further stress and trauma.⁷ When viewing the publicized deaths of Black individuals such as George Floyd, Sandra Bland, Philando Castile, and in our own backyard, Rayshard Brooks, emergency physicians bore witness to the last moments of these people's lives. As much as we pride ourselves on our trauma training, we must recognize how the trauma impacts individuals in the communities we serve. As Black providers, we tend to be impacted on a more personal level by many of these deaths and injustices, having to shoulder the stressors that come with constantly seeing Black deaths. Although Emory EM leadership had an adequate response to what was happening, the onus of educating others about police brutality and systemic racism fell on the shoulders of the residents and faculty of color who were already dealing with increased stress. At the peak of the police brutality protests, Black faculty and residents at Emory EM created videos to talk about their experiences with police brutality and racism, an unfortunate but constant reality that has shaped a lot of their lives and careers. These videos were shared in our weekly conference and social media outlets and were powerful catalysts in creating discussion around these sensitive topics.

Discussions with many of our non‐Black colleagues at Emory has revealed that although many seek to be allies, they are unsure of where to begin. Allyship begins with education and acknowledging that you may never experience the oppression that you are fighting against.⁸ With further education, non‐Black colleagues can gain the skills and knowledge needed to stand up and support Black communities. Other programs nationwide can begin this education by providing avenues through which residents can learn about the history of institutionalized racism and its effects on health outcomes.⁸, ⁹

COMMUNITY ENGAGEMENT

As physicians with a social obligation, we have a platform that can help amplify activism and back thought‐leaders looking to directly engage and seed change. There needs to be a public health component built into the graduate medical curriculum focusing on cultural competency, challenges specific to the local community, and the services available to combat those challenges.¹⁰, ¹¹ Additionally, programs can foster and encourage service opportunities for residents to directly engage with these communities. As frontline providers, we care for the most vulnerable populations from the undomiciled to the incarcerated, many of whom are victims of police brutality and systemic racism. It is imperative that residency programs take time to learn the history of the communities in which they train by directly engaging in the communities. Recently, our residents volunteered with Food4Lives, a nonprofit organization dedicated to serving the undomiciled, which was a great way to be directly involved in the community. Residencies may also march in and provide health care services at protests, adding their voices to calls for police reform. Residency leadership can support these activities by taking a clear and unequivocal stance on racial and social injustices, providing opportunities and time for residents to engage in community outreach, including educating residents and the larger community about how implicit biases and racism infiltrate health care to cause health disparities.

DIVERSE LEADERSHIP AND MENTORS

Residency programs have the power to both diversify the physician workforce and support their trainees of color. Decisions about hiring and promotion should ensure that residency and departmental leadership are diverse.¹² The program must recruit a diverse class and also actively work to support, retain, and promote that class. One way of doing so is to celebrate that diversity through affinity groups that encourage residents of color to promote projects and initiatives meaningful to them. Leadership can also work to recruit and retain a diverse faculty.¹² This is important to match residents with mentors who understand their unique background. Residency programs often use diverse residents to recruit more diverse residents. Black residents and other residents of color are often front and center at recruitment events, interview days, and diversity days and on hand to answer questions. All of this work is in addition to the stress and time commitment of residency. If residency leadership wants to support their diverse residents, they must do so by not putting all the diversity and inclusion work on only diverse residents or acknowledging it as a legitimate time commitment that can fulfill some residency requirements. Residency leadership and department leadership should sponsor diverse faculty and residents in all aspects of education as it pertains to research projects and grant applications.

CONCLUSION

Residency training is a foundational time in a young doctor's career and it is important that residency leadership, faculty, and residents do more to educate themselves and others to foster an environment that is inclusive and reflective of society. Our experience at Emory emergency medicine is by no means the perfect model; however, we hope that our perspective can serve as a guide for residency leadership who want to do more to support their residents of color and to work toward dismantling systemic racism.

CONFLICT OF INTEREST

The authors have no potential conflicts to disclose.

AUTHOR CONTRIBUTIONS

All authors contributed equally to drafting and critical review of the manuscript.

Gwanyalla NK, Asker S, Abazaid N, Aromolaran K, Jackson T, Okpere H. “Say their names:” Thoughts on residency leadership response to police brutality and social injustices. AEM Educ Train. 2021;5(Suppl. 1):S149–S151. 10.1002/aet2.10665