This article uses Wendy Moore’s concept of White institutional space to explain why Black people experience ostracization, microaggressions, and other forms of othering in predominantly White institutions. More than five decades since the official end of Jim Crow, Black people report Whites treating them as though they do not belong in predominantly White institutions. It is as though Black people are still integrating White spaces, even when other Black people are members in those spaces. Drawing on sociology, psychology, and education literatures and our own ethnographic research, we argue that Black people feel like they are integrating White institutional spaces because they are. White people have constructed a three-part system to protect the Whiteness of spaces as people of color struggle for increased membership in historically White institutions. The first part of the system is physical segregation, accomplished primarily through residential segregation and institutional siloing. The second part is segregation via microaggressions that ensure that only a few people of color enter White institutional space, that the few who enter are unlikely to disturb White institutional space, and any people of color who no longer consent to White normativity are quickly discovered and excised. Finally, Whites use cognitive tricks like subtyping, which define colleagues of color as special exceptions to their otherwise undesirable racial groups. Through a fictional chronicle, the authors demonstrate how White colleagues use physical separation, microaggressions, and subtyping to maintain the Whiteness of their White institutional space.
The aim of this study was to analyze themes related to explicit bias in patient-doctor relationships among fourth-year medical students. Class cohorts between 2013 and 2016 taking an online elective, "Self and Culture," submitted reflections about explicit bias. Thematic analysis was conducted on 283 student submissions totaling 849 entries until saturation. Themes included explicit bias toward patients with obesity, those who smoked, those from low-socioeconomic conditions, and, to a lesser extent, race/ethnicity. Themes related to the patient-doctor relationship included a negative impact on the relationship itself, trust, treatment of the patient, and patient experience. Themes related to making a positive impact included seeking positive treatment of the patient, understanding patients' circumstances rather than making assumptions, partnering with the patient, and education. Furthermore, researchers noted external versus internal attribution of the bias. Some students used neutral language to explain explicit biases, whereas fewer used internal attribution language. Results demonstrated that this type of reflection promoted personal insight, and faculty members should be trained to ensure successful crucial conversations about the impact of assumptions and biases on patient treatment, care plans, and health disparities. Finally, the curriculum should be intentional, providing experiences with marginalized populations to develop cultural humility and empathy.
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