Below is a transcript of the following Academic Medicine Podcast episode:
Experiences of Trainees and Physicians from Minoritized Communities
October 4, 2021
Read more about this episode and listen here.
Toni Gallo:
Hi everyone. I’m Toni Gallo. I’m a staff editor with the journal. Every year, Academic Medicine publishes the proceedings of the annual Research in Medical Education sessions that take place at the AAMC’s Learn Serve Lead meeting. This year, there will be on-demand presentations of the RIME papers, available through the Learn Serve Lead virtual meeting platform, and live Q&A sessions with some of the authors. The RIME papers themselves including the ones we’ll be talking about today are available now to read for free on academicmedicine.org, and the full RIME supplement including the abstracts will be available in November. Like last year, I’ll be talking to some of the RIME authors on this podcast about their medical education research and its implications for the field.
Toni Gallo:
Last month, I spoke to Drs. Mahan Kulasegaram and Jesse Burk-Rafel about using machine learning in residency applicant screening. You can find that episode in our archive. For the second of these conversations, I’m joined today by RIME committee member Dr. Javeed Sukhera and we’ll be talking to Drs. Taryn Taylor and Nicole Winston, who are coauthors on “When No One Sees You as Black: The Effect of Racial Violence on Black Trainees and Physicians.” Also, joining the conversation are Drs. Tim Mickleborough and Tina Martimianakis, authors of “Reproducing Whiteness in Healthcare: A Spatial Analysis of the Critical Literature on the Integration of Internationally-Educated Health Care Professionals in the Canadian Workforce.” And I’ll put the links to both papers in the notes for this episode.
Toni Gallo:
So let’s start with introductions. Javeed, could you go for first?
Javeed Sukhera:
Absolutely. So I’m so excited to be here and thanks to everybody for listening in. My name is Javeed Sukhera. I’m the incoming chair and chief of the Department of Psychiatry at the Institute of Living in Hartford Hospital in Hartford, Connecticut where I will have affiliations at the University of Connecticut and Yale University. Coming to Hartford from Western University in London, Ontario, Canada, where I served as an associate professor and a scientist at the Center for Education Research and Innovation. I’m a practicing child and adolescent psychiatrist and a PhD scientist with a research program that focuses on approaches to addressing stigma, bias, and equity in medical education.
Toni Gallo:
Thanks. Taryn and Nicole.
Taryn Taylor:
Thank you so much, Toni. It’s such a pleasure to be here. My name is Taryn Taylor. I’m an assistant professor of both pediatrics and emergency medicine at Emory University School of Medicine. And I am very passionate about this and so glad to have this safe space to have these conversations.
Nicole Winston:
Hello, I’m so excited to be here as well. My name is Nicole Winston. I’m an assistant professor at the Medical College of Georgia in Augusta, Georgia. I wear several hats at our university. I’ve been highly involved in our curricular redesign where I teach both in the case-based learning and design the cases and our simulated cases as well. Really excited to be here. Also on the research side, I’ve had the opportunity to work several years now with Dr. Taryn Taylor and Dr. Tasha Wyatt, as well as Dr. DeJuan White, where we’ve published on professional identity formation in those historically excluded in medicine. And I look forward to the conversations today.
Toni Gallo:
Thank you. Tina, Tim.
Tina Martimianakis:
Hi everyone, I’m Tina Martimianakis. I’m from the University of Toronto Department of Pediatrics. I’m the associate director of the Wilson Centre and a scientist there. And my program of research is around issues of governmentality and how they affect professional identity. And what I mean by governmentality is the way in which we govern our educational and practice spaces with institutionalized ideas. So the way culture filters into how we socialize and then the structure and practices that go along with and reinforce those ways of thinking as dominant. And it’s a real pleasure to have worked with Tim on this particular project. Over to you, Tim.
Tim Mickleborough:
Thanks, Tina. Again, it’s a pleasure to be here. I am a postdoctoral fellow at the Wilson Centre, and I study professionalizing systems, in particular professional identity and using international professionals as a case study.
Toni Gallo:
Well, thank you all for joining the podcast today. So our discussion is going to focus on the research that all of you have done on the experiences of trainees and physicians from minoritized communities in the United States and Canada. And we’re going to talk about creating safe spaces to discuss bias and discrimination, how professional norms may be harmful to those from minoritized communities, and how to foster an inclusive learning and practice environment. So Javeed, could you get us started with some context for our discussion?
Javeed Sukhera:
Absolutely. So this area of research is one I’m very familiar with, and I’m also familiar with being a little bit lonely in this space, but as we’ve seen in the past year, we’ve experienced a reckoning where it’s clear that academic medicine cannot look away from the inequities that plague us and the human cost of our inaction. There’s several articles in this year’s RIME supplement that highlight a central tension to some of this work. What we know is that there’s often a tendency to oversimplify the problem as well as potential solutions. We all know that we can’t fight a problem we can’t name, and we can’t cure a disease by treating its symptoms.
Javeed Sukhera:
So it’s important for medical education research to seek a deeper understanding of topics like inequity, racism, and injustice. And the papers by all of you are excellent examples. I’ve had the privilege of reviewing them in detail as part of being on the RIME Committee. They’re excellent examples of thoughtful, innovative, and deep research that doesn’t just simply look at something at the surface but takes the line of inquiry further, uses innovative methodology to help generate knowledge that I believe can have very important implications for equity and justice in our space. So I look forward to the chat today.
Toni Gallo:
I’m hoping we can start with Taryn and Nicole’s paper. And could you just tell us a little bit about what your study was and maybe some kind of key findings that you had?
Nicole Winston:
Taking us back to, it was, I think in May and June of 2020, we were obviously in the middle of the, I guess, the start of the pandemic and with everything going on in the news, we basically wanted to talk with both Black and African-American trainees and physicians and allow them to talk about what was going on in the news and how was that affecting their ability both to train and treat patients. So we reached out to several of our past participants who had been on our professional identity formation research previously. And then we used what’s called the snowball method to identify additional participants to provide several kind of open-ended questions for them to discuss how everything in the world was affecting their training. And like I said, also how it was affecting their ability to treat patients.
Nicole Winston:
So in this case, we were able to interview about 19 participants, 7 of those who were in training and 12 of those who were attending physicians. And they talked about, like I said, how the world’s events were affecting their day-to-day lives and also affecting their ability to practice medicine. And so then we took those interviews and, as with all qualitative research, transcribed them and then looked for themes. And we used the theory of racial trauma to look for instances of how the world’s events were affecting their ability to train.
Nicole Winston:
And then when we looked at the data, we organized it as to how the causes participants cited of when they were feeling unsafe, the conditions that they talked about that produce these feelings and then the ultimate consequences of those feelings on both their education and practice.
Taryn Taylor:
Yes. Thank you, Nicole. And Toni and Javeed, there are a few predominant themes that emerged and one of which was this pervasive feeling of helplessness among Black physicians and trainees who they themselves may not have been the direct recipient of these racial injustices but their social identities are tied to the communities that were being targeted. And so as such, Tina, they had this feeling of re-traumatization because each unjust event reminded them of how unsafe they were living in a racist society. And, Tim, this wound that they experience, they never really got to heal and recover from. And we describe it as a long-term grief due to patterns of racial violence that are continually repeated.
Taryn Taylor:
One individual actually described it as feeling like you’re suffocating for a long time. And then this, Toni, was compounded with the burden of having their social identity go unrecognized in their professional environment. And, Javeed, I’m sure you could understand that how impactful this was as their colleagues seemed to think somehow that Black physicians were exempt from these racially motivated traumas in society. Yet these Black physicians clearly recognized that their professional status was not protective at all. Additionally, these physicians and trainees did not feel empowered at all to make the necessary antiracist changes within their professional community because the power to institute change for the oppressed most often lies at the hands of the oppressors.
Javeed Sukhera:
So something about this study that really struck me, I mean, I really appreciate the way that you frame things, the way that you used racial trauma to help us understand this idea that it wasn’t the direct recipient, the indirect effect of the public discourse of the public images was quite significant. And I think I know personally and professionally that there’s implications for this in terms of work, in terms of cognitive load for learners, for faculty. So what implications do you think this finding has for how organizations can structurally be better at supporting Black members of our academic medicine community?
Nicole Winston:
I think one of the ways, and I know we’ve talked about this a little bit, is really creating not only the space but also the opportunity to talk through these feelings, to take time off if necessary to kind of grapple with things that are going on. Many of the participants that we talked to, talked about there were instances where their institutions did allow for this and provided those opportunities to have those conversations. And in a way, many of the participants felt like it was part of the healing process.
Nicole Winston:
So I think we can build upon that and recognize that that’s likely not happening at institutions across the United States. And so if we can learn from that, use those opportunities to create conversations where they do feel safe to talk about these feelings of helplessness, this idea of racial trauma and how it can perpetuate into the practice of medicine, creating those spaces, I think, and carving it out for them will be incredibly helpful in the future.
Taryn Taylor:
And, Javeed, I appreciate you recognizing the cognitive load aspect. Many of the individuals interviewed talked about the exhaustion that they experienced. And so as Nicole mentioned, having the safe space to be able to have these conversations number one. But I think also number two, in moving forward in academic institutions, recognizing that the initiatives and the programs that blossom out of these conversations, the burden of that doesn’t necessarily have to all weigh on those minoritized physicians who already are experiencing, as you mentioned, that heavy burden and that cognitive load.
Javeed Sukhera:
Yeah, absolutely. It’s super important and the study gives a very rich poignant description of what that looks like and sounds like. So switching gears a bit if we turn our attention to Tina and Tim. One of the things I really appreciated about your paper is you use some pretty innovative methods. Can you share with our audience a little bit about your unique methodology? You did a combination of critical review and a spatial analysis. So I’d love to hear more about what you did and why you chose this approach.
Tim Mickleborough:
Sure. So the focus of the research is to address that gap that Javeed had talked about a few minutes ago about the gap in understanding the root causes and structural forces that make bias and discrimination in health care possible. So in this paper, we look specifically at the integration experiences of internationally educated health care professionals or IEHPs in the Canadian workforce and their marginalization. So a spatial analysis was a unique methodology to understand this topic as this is an enduring problem in health care.
Tim Mickleborough:
I think studying this problem through novel approaches provides dimensions that have not been explored in health professions research. So I’m a pharmacist, I’m a social scientist and also an educator of international professionals. And so I study their integration identity experiences and their racialization in the workplace is part of their professional reality but how that racialization is experienced spatially is very interesting. It’s through the concrete. Something that is real. Who’s working where? What words are somebody working on? Who works in the nursing homes? Who works in the privileged spaces of health care?
Tim Mickleborough:
For example, one participant in a study on international pharmacist identity kind of described this process and he was evicted from 4 different pharmacies in rural Alberta. And he said they managed to make your life miserable until you run away. And that’s what they did systematically. And it’s interesting that it wasn’t just one time, but there was a process in place that evicted him 4 times. This man who comes from Egypt, who was fairly Westernized, he’s been in Canada a long time, but yet Islamophobia had prevented him from becoming part of that professional space.
Tim Mickleborough:
So really, I think a spatial analysis helps us understand who’s in places rightful citizens? Who belongs to spaces and who’s evicted? And why are they evicted? I don’t know if you have anything to add to that, Tina.
Tina Martimianakis:
Thanks, Tim. I think the one thing that really strikes me from this particular approach is the fact that we’re able to see ways in which professional identity and social identity are very much intertwined. So when we think that achievement is only linked to educational progression or in this case re-credentialing that you’ve arrived, that you’ve achieved. We missed the points in which even within our educational system, we’re setting up individuals for struggle and potentially failure because we haven’t addressed some of the conditions in which they might automatically become peripheralized in the workplace.
Tina Martimianakis:
And when I say automatically become peripheralized, I’m not citing intent here. Often, it’s not polemics between individuals. We’re not studying this with this particular approach. What we’re looking at are the social conditions that give rise to practices and routine activities that end up cultivating cultures that favor some groups of individuals over others. And we see a repetitive pattern in this in health professions education. And partly because we have spent many, many years separating what we think of as a professional identity from the background people bring when they come into health care education. And I think that’s an important lesson for us who are involved in the current education of health professionals.
Tim Mickleborough:
I think I’ll just speak briefly just how we did the study. Again, this is another interesting way of doing a review was to do a critical literature review of the critical literature on IEHP integration. So basically we looked at articles that use critical approaches or antiracist or post-colonial approaches and excluded those that were mainstream that looked at integration without looking at power relations.
Tim Mickleborough:
So we kept track of thematic patterns and 4 themes developed. So credential non-recognition, re-socialization, discrimination, and surveillance. But the analysis didn’t kind of capture the space and identity work that we were looking for. So we basically re-conceptualize each of those themes using concepts related to space, ones that we’ll talk about today such as pure space or peripheral space. And then that theme of discrimination turned to workplace racialization and spatialization to capture that workplace hierarchy.
Toni Gallo:
Tim, I wonder if you could dig a little bit into the results that you found. What were some of the themes and Tina mentioned looking at kind of systems levels and systems processes and policies. Maybe you could just kind of give us some highlights from what you found when you did your analysis.
Tim Mickleborough:
Absolutely. So whiteness is that dominant discourse that organizes social relations in health care spaces. So in places, domestic graduates as rightful citizens while IEHPs are marginalized. But this whiteness discourse, if you nuance it, is supported by discourses of Canadianness. So we describe that as knowledge produced in Canada but also local specific discourses. And then also the discourse of foreign trainees. So these operate together to create pure and peripheral spaces. So this idea of Canadianness constructs pure spaces.
Tim Mickleborough:
So professional spaces are elite spaces. So these are spaces that reproduce privileged identities and social status. So they have to be protected to prevent that loss of privilege and respectability. So within the professions, there’s mechanisms of social closures. So credential non-recognition, resocialization. These are mechanisms that keep out the other and the others constructed as a threat by their foreign trainees. But these are of course social constructions, they’re not secure, and they must have constant surveillance in order to maintain those privileged identities.
Tim Mickleborough:
So then you have ways of within the professions of workplace racialization, spatialization, this kind of acts to maintain that pure space by creating peripheral spaces, by organizing different into spatial and racial hierarchies. And then you have surveillance that keeps IEHPs in these spaces through monitoring the workplace performances and also surveillance of accents. I don’t know, Tina, if you have any additional comments.
Tina Martimianakis:
I think it’s also important to appreciate the reasons behind these mechanisms in any profession. So when we say the purity of space especially in professional spaces that are unprivileged around an expert body of knowledge, one of the rationales behind credentialing and the whole process of training is to ensure quality. And these processes are rationalized as a protection to our society and to maintain a level of care that is expected in the Canadian setting. They’re there as a potential quality check, but what happens when you set up immediately suspect anyone who is trained outside of the Canadian context you run the risk of creating the conditions in which we reproduce the inevitable bias. It’s always in any of our assessment processes and you might systematically create the conditions of continued peripheralization even though they have achieved that quality check.
Tina Martimianakis:
And this is why I feel that Tim’s original study where we started noticing this effect along with this paper opened our eyes to that potentiality. And they demand a different way of thinking about assessment that it’s not only in the moment of judging whether someone is ready to practice but it could continue for many years afterwards that the fact that you had to go through this judgment in the first place is just carried. It just creates a cloak of stigma that you can never shed.
Tina Martimianakis:
So I think that’s one of the things that have struck me as an educator, that how do we eliminate that from a process of that we need. We’re not saying the study is not here. It’s not trying to say that we have to dismantle this, but we need to be working with these approaches to maintain quality in health care education and health care practice without creating the conditions for discrimination.
Javeed Sukhera:
Yeah. So as many of us know, although that cloak can be invisible, those of us who wear it, it can be quite itchy and it can be quite hot and quite uncomfortable. So 2 of the things that I think intersect between both studies are this idea of safety and the idea of space. Something I’ve talked about a lot is, I think sometimes we over idealize the idea of a safe space and I think we should critically challenge that because really safe spaces don’t exist. If a space is safe for me, that doesn’t mean it’s safe for someone else.
Javeed Sukhera:
So I often think about a discourse around brave spaces and I’d wonder from all of your perspectives, what can we all do to help foster brave spaces, to have these critical conversations and move towards justice in meaningful and tangible ways?
Tina Martimianakis:
I think if it’s okay, I’ll start. I’ll start by saying that this is a small thing. It’s a shift in our thinking that when we’re recreating the conditions for socializing people to the Canadian way or to the American way, to help them fit in, we might be missing an opportunity to learn from their vast experiences before coming to our health care sector. So in our particular study, what’s quite obvious is that when we’re thinking about integration, it’s a one way process. It’s looking one way. What do you bring into the Canadian health care market and health care social space and is it up to par? And if it is, and this is what you have to do in order to be able to function.
Tina Martimianakis:
But do we spend the time to get to know who’s coming, who’s attracted to the health care context, the Canadian health care context? So what did they bring with them? What does that other knowledge that we ended up making invisible in the process of resocialization. And there are a lot of things that we can learn. And I know from other studies that focus on people’s global health experiences and other globalization related research that when we go out to other sectors, we come back and we enrich from this knowledge of working in other spaces, what we do locally. So why is it that we’re eliminating that opportunity from individuals who are moving into our health care sector to inform our educational process?
Nicole Winston:
And I would add to that, in particular, when you think of the results of our study, when we think of trauma informed care. So when individuals, and we first need to recognize that many of those in health care have had some type of trauma in their life in particular for our study, more racialized trauma. And so one of the models that we talk about in our study and we advocate for when we discuss this presentations is the open the front door model. So it’s a way for particularly those in the majority population to reduce the amount of microaggressions that are happening all the time, unfortunately in our, not only in society, but in our health care systems.
Nicole Winston:
And what that is is when you observe a microaggression happening, you actually talk about it. So “I noticed this happening.” The next part is think, so “I’m troubled by this and I think that others may be troubled as well. I feel that this event is becoming commonplace.” And then finally you talk about your desire or what you would want to change, that you reduce the amount of these microaggressions happening.
Nicole Winston:
So I think as a part of this, it’s these small incremental changes as we’ve been talking about that can really, just a few years down the road, transform what we see and what we feel in our health care systems.
Tim Mickleborough:
I’ll go next. I really like that word brave space. I think that’s an interesting way of looking at safe spaces. As you said, the safe space for one may not be a safe space for another. I just wonder for international professionals, how safe these spaces can be. Thinking about workplace precarity. Considering how much time and energy and effort went into getting relicensed. Are they making themselves more vulnerable? I think may be in a large institution or a hospital, there may be things in place but I’m thinking about international pharmacists in community pharmacies, working for large retail organizations.
Tim Mickleborough:
Are these managers going to be trained, as you say, in this open the front door model kind of approach. So I think it’s a great idea. I just don’t know how far some professions are lacking in providing these spaces for their international professionals of which pharmacy has quite a few. A third of the pharmacy workforce in Canada is international trained. About 40% in Ontario. And we’re just kind of uncovering those experiences.
Tim Mickleborough:
And some I’ve asked, what do you do when this happens? Well, I talked to my manager, he didn’t know what to do. Unless somebody… Because it’s covert, some of them. Or even when it was overt, the manager said, well, because they didn’t say something personal to you, you can’t do anything about it, but yet they insulted him and his religion and his religion was not personal enough. So I kind of wonder how well are people trained? It’d be great to have these conversations, have these brave spaces, but I think it just, I don’t know, it might make them more vulnerable.
Taryn Taylor:
I agree with you. I really appreciate the phrasing of brave space and agree that many of our, whether it’s international or regional, as Nicole and our study focused on, I think the key here in terms of moving forward is making sure that individuals are educated with appropriate frameworks within which to have these conversations and normalizing, if you will, the fact that they’re going to be a bit uncomfortable and that’s okay, because as we sit with the discomfort in a productive way, that’s where the growth comes about.
Toni Gallo:
You’ve all mentioned professional identity formation both in our conversation today and in your papers. And Tim and Tina, you talked about this idea of Canadianness equals competence and that’s how health care professionals are seen–the more Canadian they are, the more competent they are. And Taryn and Nicole, you talk in your paper about physicians being seen as physicians first rather than Black physicians first. So I wonder if you could all talk a little bit about the idea of professional identity and how there are these norms and sometimes they can actually be harmful for physicians and trainees who are from minoritized communities.
Toni Gallo:
And I think Tina, you had mentioned we need some quality standards, but there are some ways that those standards are actually harming some physicians. So maybe you all could talk a little bit about that.
Tim Mickleborough:
Just to add onto that conversation, Toni. You think about Canadianness as a part of being a professional in Canada, that it becomes a legitimizing discourse before international professionals. This is the influence of globalization on the professions that we govern ourselves as professionals through altruistic discourses, but for international professionals, and this is from Fournier, a sociologist who says you can have all the professional knowledge, but unless you adopt or conform to local customs and beliefs, it’s hard to gain trust from your patients or your clients.
Tim Mickleborough:
So, unfortunately I think this Canadianizing of international professionals is necessary, and this is something my participants, who don’t read Fournier, but they know that this is something they have to do that as well. A participant said she had to tame down her accent. She recognized that this would make her seem less competent to her clients. So they recognize that this is something they have to do.
Tim Mickleborough:
I think the issue is where this part of foreign training comes in. That they could Canadianize themselves. And it’s not just getting licensed, but becoming more Canadian, however you define it. But their foreign training prevents them from crossing over. And I think as one pharmacist from India had said, “I have to prove myself every single day,” that even though he’s licensed and can function fully as a pharmacist, that part of his work is proving himself. And he does this by doing his best, he says.
Tim Mickleborough:
And he says “I do my best for my patients and they may not all recognize what I do, but at least I know at the end of the day, I’ve done my best.” So it’s almost like a professional identity is constructed through these encounters where he has to do his best, and that becomes part of his identity, but it becomes part of that daily grind of proving himself. Unfortunately, there’s just some because of his difference that won’t let him cross over.
Nicole Winston:
Right along the lines that you discussed there. We saw very similar findings in our earlier work on professional identity formation among minoritized physicians, where every single day they felt like they were always needing to prove themselves. Obviously, as training went on, that became less and less kind of a part of their training. Interestingly, early professional identity work, and I know many of you on this call likely know this, it was steeped in whiteness. So when you looked at the literature, it was difficult to see or even hear the voices of minoritized positions or those like I’d mentioned before are historically excluded from medicine, and what our work showed particularly when we were asking these participants, what it was like to be in this space and to practice medicine when so much was going on in the world, is that all of our identities are integrated.
Nicole Winston:
And I know it was mentioned before, and we mentioned it in the paper so much of what has been talked about in the past is you’re a physician first and then your other parts of your identity come second. That’s really not true. We bring really our whole selves not only to the practice of medicine but into the practice of pharmacy, being a pharmacist myself. And we’re starting to see more and more how all of this is integrated together. Not only racial identities but gender identities, sexual identities, and how all of these are integrated in what then is presented and what and how medicine is practiced.
Taryn Taylor:
And I think one of the important things to mention is that when your professional community doesn’t recognize the fact that your social identity is inextricably linked to your professional identity and that area goes underappreciated, that has such far reaching impact. It has impact on faculty and faculty promotion. It affects the availability of appropriate mentorship. It affects the pipeline for younger learners and ultimately it has the impact on health disparities for minority populations. And so when we think about this professional identity formation and we can’t think of it in a vacuum in terms of just kind of this very academic discussion because it has such far reaching impact.
Tina Martimianakis:
Yeah, exactly. And I think another dimension that often gets underplayed when we see identity work in health professions education is that expertise is seen as a neutral. Yet the way we package expertise and the way we deliver expertise is a political construction and very much dependent on the social relations that are in the particular context you’re working in. And that’s why we have these experiences. It’s not because the social is now more of a focus in the health professional space. It’s also because it’s conceptually divorced from how we think of expertise and that these values and the cultural upbringing and the worldviews that we have in relationship to what constitutes science, what constitutes rigor, what constitutes some systematic, how you deal with errors, how do you respond to progress, how do you assess…
Tina Martimianakis:
Those things are also socially constructed. And unless we understand how we do that and how we embed what we’ve been referred to as this White Eurocentric approach that dominates health professional spaces, then we can’t understand that we won’t be able to put in place corrections to the system. Right? And we need to learn from those who have lived experience. And I find the biggest irony in the work that we did together with Tim is that when the participants say, your mistakes are never forgotten and your international training is blamed for routine errors, that your so-called Canadian trained colleagues will never have to experience.
Tina Martimianakis:
So the fact that you’ve, what I was alluding to before, the fact that you’ve passed your exams, you’ve gotten relicensed, doesn’t count in the same way as if you were born into the system and you came through the system from the start, and then this notion that Canadian experience, when does it actually start? You mean, the immigrant experience is not the Canadian experience? I would actually argue back that that is notoriously what makes us Canadian. That this attitude that you come into a fully formed Canada, when it’s constantly being built on this settler mentality, generation after generation. It erases all of our history of nation building and how it’s implicated and what now dominates in health professional spaces. So that is also the Canadian experience and that’s very much part of the problem.
Javeed Sukhera:
There’s so many things in my head right now, and I’m trying to think of how to get it all into this quick bite. And I just don’t think that’s possible. Right? There’s so much that we still need to do. That we still need to understand, that we still need to learn and unlearn. But as you all talked about, this is more than just something professional. It’s about personal and professional. I think for many of us, this is personal. It’s more than just a trend or an interest that might be purely academic. It’s really about the basic ability to live and work with dignity where your humanity is respected and valued or not.
Javeed Sukhera:
So there are lots of people stepping into this space. Lots of people interested in doing research in this area. Maybe if each of you could give me a very sort of concise tip for anyone who’s interested in tiptoeing into researching this area particularly if they’re not so familiar with critical social science. What advice would you have for them if they want to do this type of research?
Tina Martimianakis:
I’m just going to jump in there and say, if you can only study one thing, study intersectionality. I think that in and of itself, that framework, it blows your mind in terms of how these intersections come into play within the individuals and within attractions of individuals. So I think if you only got to choose one, go there, that’s a great introduction to how power relations factor into both structure, culture, and day-to-day interactions.
Tim Mickleborough:
I think I’ll jump in next. I think, think about space. I think for me, as someone trained in positivism, as a pharmacist, switching to the social sciences, being White, not having these experiences that we’re talking about, I’m kind of the Canadian Canadian type of thing, that I can go into a space and be accepted and not think about it. But I think it does require a lot of reflexivity and thinking about space and who belongs and what is my role in reproducing this. As an educator, I educated international pharmacists for resocialization, looking at these critiques that we read, I was involved in reproducing that social order. So I think thinking about and being reflexive and thinking about space is essential.
Taryn Taylor:
I think as you mentioned, Javeed, there’s so many things in my brain as well and so many areas to explore under this larger umbrella and it’s easy to get inundated and overwhelmed and perhaps to even feel as if your contributions aren’t enough and don’t matter. And so I guess my piece of advice would, borrowing from Tim’s verbiage, is to look at your own space and look at the challenges that exist in your own context and choosing to approach that one bit first. And then once you have laid the groundwork in that area, continue to build and go from there.
Nicole Winston:
Yeah. And then finally for me, thinking about what all has been discussed, particularly for this last question is, once we are in these brave spaces, to listen. So much of the qualitative research processes, creating the questions, allowing then the participant to kind of discuss things, but to really listen to what things are going on and listening to those lived experiences, because the reflexivity part of that is for me these past 2 or 3 years, I almost feel completely transformed in my ability to navigate these spaces and allow for individuals to talk about their experiences.
Nicole Winston:
So for those interested in this area, the key is really listening to your participants and to those around you to hopefully create some great change.
Tina Martimianakis:
A big thank you for organizing this conversation.
Tim Mickleborough:
Thank you so much.
Javeed Sukhera:
Thank you all for all the work that you did and for doing it so thoughtfully. We have to keep it up and dig even deeper. It’s not a box we can check or a workshop we can take. This is ongoing arduous everyday work. So look forward to continuing to engage on a topic.
Toni Gallo:
Remember to visit academicmedicine.org for the latest articles from the journal, as well as our complete archive dating back to 1926. You can also access additional content, including free ebooks and article collections. Subscribe to Academic Medicine through the subscription services link under the Journal Info tab or visit shop.lww.com and enter Academic Medicine in the search bar. Be sure to follow us and interact with the journal staff on Twitter @acadmedjournal and subscribe to this podcast through Apple Podcasts, Spotify, or wherever else you get your podcasts. While you’re there, leave us a rating and a review. Let us know how we’re doing. Thanks so much for listening.
