Responding to anti-Black racism in clinical supervision: using simulated encounters to develop a behavioral typology

Abstract

Context Racist interactions in clinical practice remain a pervasive reality for Black healthcare providers. Supervisors charged with the oversight, protection, and support of their racially minoritized trainees are often inconsistent in their approach and have limited guidance to inform their actions. Methods We designed an empirical study in which experienced supervisors responded to seven short, videotaped interactions between 1) a simulated participant (SP) and different clinicians-in-training; 2) the trainees and their respective supervisors; and 3) the trainees and their supervisors together with the SP. The clinical exchanges exemplified different types of racist (entrenching) or antiracist (uprooting) behaviors. After viewing each clip, participants shared their reflections before joining together for a structured debriefing. Using a thematic-phenomenological qualitative approach, we analyzed the corpus of free-text entries and debriefing transcripts. Results We recruited 52 participants into five two-hour-long sessions. They developed a behavioral typology for supervisors facing anti-Black racial injuries involving learners under their oversight. We organized supervisor behaviors into five interlocking domains, each with a range of possible responses: 1) Gradation: from conciliatory to confrontational; 2) Explicitness: from eliding to naming; 3) Ownership: from individual to shared; 4) Involvement: from deferred (excusing) to cotemporaneous (including); and 5) Stance: from protective to paternalistic. Conclusion A behavioral typology can serve as a rubric for supervisors to engage in reflective practice and for medical educators to inform faculty development initiatives to fight anti-Black racism in clinical practice. In addition, the typology can serve as a framework for facilitated discussion among healthcare providers who may have experienced or witnessed anti-Black racist interactions.