Facilitators Guide
Course Framework
This Facilitator’s Guide is designed to assist with teaching the content of the online curriculum of Closing the Divide: Building Trust by Addressing Bias in Medicine. With this curriculum, we provide a framework for how to respond internally and externally to encounters marked by biased behaviors in the clinical and nonclinical settings. The website curriculum includes definitions, videos, resources, and the Clear the AIRR framework. These tools will assist with creating a platform for honest, open discussions about the presence and impact of biased behaviors, micro- and macroaggressions in both clinical and nonclinical settings in medicine. Below you will find:
- Curricular overview with video modules
- Clear the AIRR framework
- Teaching session instructions
- Scripts for role play, PDF, and PPT slides to download
Curriculum Overview
On the website, you can access five modules that address a variety of biases and aggressions common in the clinical and nonclinical settings in medicine related to:
Clear the AIRR
Each module has a short video demonstrating a real-life scenario that learners may encounter. The video actors demonstrate how to use the Clear the AIRR framework to respond to the situation. The Clear the AIRR tool supports and empowers the healthcare team to respond when experiencing or witnessing macroaggressions and microaggressions or other biased behaviors.
ASSESS
Assess the patient and environment. Ensure the safety of both the patient and yourself. If you are concerned about physical harm, be mindful of the position of your body in relation to the patient and to the door. Be able to leave the room quickly if needed. It is acceptable to leave and return with appropriate personnel to ensure you are safe and the patient is safe.
IDENTIFY
Seek to understand the patient’s perspective and the underlying cause of the behavior being displayed. At times it may be helpful to name the emotion or behavior that is being displayed.
RESPOND
This is your opportunity to provide your perspective and the goals of the encounter. There are times when you have to be more direct in naming the specific behavior while clearly stating the standards for continuation of the encounter. Refer to the video portion of this module for useful phrases for these encounters.
REPORT
Debriefing and reporting the encounter ensures the person subjected to the behavior has a safe space to process the experience. This also allows hospital systems to track these types of behaviors and create policies to address them. Refer to the video portion of this module for specific reporting methods.
Suggested Teaching Session
In both large and small groups, we suggest that you incorporate the website videos into your teaching session. We provide key portions of the scripts below.
Preparing for the Session
Review and familiarize yourself with the curriculum on the website.
Preview the five module(s). Determine which module(s) you plan to incorporate into your teaching session.
Review the Clear the AIRR framework and become comfortable with the examples.
Create a 5-10 minute didactic slide set. Include an introduction and set ground rules. Create background materials from the resources page with definitions and reading materials.
Review the reflective questions in the module. Consider possible answers that may be given by the participants. Be prepared to support and guide the discussion. Be prepared for uncomfortable moments. Consider inviting an expert guest or trusted colleagues.
Create a slide or handout that lists how these behaviors should be reported at your institution.
Providing the Session
The table below outlines a suggested timeline for a 1 hour teaching session. Each video is 5-7 minutes. Determine how many videos the group will watch together based on the time you have and how you decide to spend it. Ensure you have planned enough time for debriefing the video(s) and for participants to role play the AIRR framework, especially the “Respond” component.
5 Minutes: Introduce the topic. Set ground rules for safe, open and honest discussions.
10 minutes: Discuss background of microaggressions and macroaggressions (see resources page). Include definitions.
15 – 30 minutes: Play video(s). Debrief the video using the discussion questions provided in the associated module. See “Reflection questions for discussion” below.
15 minutes: Allow learners to role play the AIRR framework. Ensure time to practice how to “Respond” to scenarios.
5 minutes: Describe options for reporting that are available at your institution.
5 minutes: Summarize key points. Consider assigning a reflective exercise or require learners to independently view other modules.
Reflection Questions for Discussion
What did you see in this scenario? Describe the micro or macroaggression?
What are some of the thoughts or questions that came to mind as you viewed this encounter?
What additional factors could have influenced the patient’s (or individual’s) aggressive behavior?
Have you ever personally experienced the behavior directed towards yourself?
Have you ever witnessed the behavior directed towards a colleague?
How would you respond during an encounter like this?
How would you respond if you witnessed a colleague being treated this way?
Key Portions of the Scripts
The table below provides key portions of the scripts for each module. Consider using these scripts if you do not have internet access for the videos to use in your teaching session. With volunteers or actors, you can incorporate role play. Be mindful that these scenarios are sensitive and may be uncomfortable. Do not put participants in an uncomfortable situation to provide or receive behaviors they feel will be harmful or upsetting. Allow for a safe space with honest and open discussion.
Sexism
| Biased or aggressive behavior by patient | “I don’t know why they let women become doctors these days. You can’t help me like Dr. Matthews has helped me. When is he coming back?” |
| Identify: Seek to understand the underlying cause of the behavior |
“Sir, I see that you are feeling upset that Dr. Matthews is not here to provide care for you and this is making you angry.” |
| Respond: Give your perspective and set the goals for the encounter |
“I recognize it is challenging to be in the hospital and have various physicians and providers participate in your care. I’m glad you had such a positive experience with Dr. Matthews. I can assure you I am here to listen to you and work with you to get you better and out of the hospital as soon as possible. In order to do so, we must maintain a professional and mutually respectful relationship.” |
Racism
| Biased or aggressive behavior by patient | “Where are you from? Are you from Africa? I don’t think they know how to practice modern medicine there.” |
| Identify: Seek to understand the underlying cause of the behavior |
“ I was actually born in Michigan. I’m curious as to what led you to make these comments? ” |
| Respond: Give your perspective and set the goals for the encounter |
“It is inappropriate to make inaccurate generalizations about groups of people from a specific geographical region or of a specific culture/race. ” |
LGBTQ+ Discrimination
| Biased or aggressive behavior by supervisor or colleague | “My goodness! How many more ‘ associations ’ are they going to create for those people?” |
| Identify: Seek to understand the underlying cause of the behavior |
“How would you feel to work in a place where you did not feel welcomed or supported?” |
| Respond: Give your perspective and set the goals for the encounter |
“I imagine that it is hard for some of our faculty to feel welcome and even safe at times because of their identity or beliefs. The new LGBTQ+ Faculty Association is a great idea, and we should support all initiatives that aim to create safe and inclusive environments for everyone.” |
Ageism
| Biased or aggressive behavior by supervisor | “Once your kids get a bit older, you should be able to focus more on your career. I find that most young faculty these days focus on their children, their vacations, you know, their (sarcastic tone) ‘work-life balance’ and ‘wellness’ and are just not ready for promotion as soon.” |
| Identify: Seek to understand the underlying cause of the behavior |
“ I’m really glad we are talking about this, because it’s been on my mind for quite some time. ” |
| Respond: Give your perspective and set the goals for the encounter |
“ I actually do think it’s possible to balance a family and career, and achieve the criteria for promotion. Some of the junior faculty feel overlooked at times and feel we could benefit from more mentorship, sponsorship, and opportunities to develop.” “I’m really excited to work with the department on a process to support junior faculty. Thank you for being supportive of this and listening to my concerns.” |
Religious Discrimination
| Biased or aggressive behavior by colleague | “On our evening shifts together, s/he/they leaves for almost an hour into the shift. I mean you just got to work! Why are you randomly disappearing at the beginning of the shift?” (looks annoyed) “This may be a professionalism issue that needs to be reported! ” |
| Identify: Seek to understand the underlying cause of the behavior |
“You should speak to him/her/them first and gain a better understanding of her/his/their perspective.” |
| Respond: Give your perspective and set the goals for the encounter |
“You should speak to him/her/them first and gain a better understanding of her/his/their perspective.” |
Conclusion
We hope that you find this curriculum helpful and that it allows your learners to better address encounters marked by biased behaviors. Our goal is that this curriculum serves as a platform for honest, open discussions about the presence and impact of biased behaviors in various settings. We encourage you to share this training with your trainees and colleagues. Please help us by completing the brief survey on our website.
More Educational Resources
Our extra resources provide informational materials of diverse views and opinions on various topics.
