• Commitment to DEIA does not prevent mistakes

While positive associations in patient satisfaction, adher­ence, and clinical outcomes have been shown with racially, culturally and linguistic concordant providers [5], parity in populations served and healthcare team demographics is not sufcient to eliminate oppression and bias. It is important to explicitly state that we must strive to go beyond diversity in the workforce. Initiatives focused on equity, inclusion, and anti-oppression frameworks are equally important. In order to address the active roles that oppression, inequities, and exclusion play in medicine, we must address them directly.

and utilize it without feeling defensive or threatened. Residency leaders must become accustomed to hearing pain­ful feedback, managing their defensive reactions, listening with humility, and partnering with impacted individuals to make changes.

We are tired… When we tell you that you have commit­ted a microaggression, there are two ways to respond: 1. I am sorry for the harm I caused and 2. Thank you for telling me. That is it. Please choose one of those two ways to respond. Aspirationally: We hope that we will get to a place where we do not have to name microaggres­sions, and where bystanders can name them instead.

any questions, disagreements, or uncertainties, and commit to reading, role-playing, or other learning strategies to prevent recurrence.

A group of 4–6 core faculty members with diverse racial identities and backgrounds came together to make a faculty development plan. This group approach to curriculum building was invaluable for developing buy-in throughout the faculty, offering support and thought partnership for one another, and ensuring that no single person carried the work of managing any resistance to the changes recom­mended. After identifying six core topics (introduction of critical race theory; identity, power, and privilege; uncon­scious bias and microaggressions; allyship, accomplices, and co- conspiratorship; stereotype threat and mentorship across differences; and structural competency and white fragility), we required faculty members to sign up to teach one of the six topics to the rest of the faculty group. These faculty teaching teams of 3–4 members received coaching from our consultant for an initial material review and sub­sequent content development. Our DEIA approach is rooted in dialogue, reection, and loving accountability, and all faculty members were required to attend these trainings. Before each session, participants were assigned readings and reective tasks, ensuring that when the faculty con­vened, they were prepared to enhance our collective under­standing and development. For example, for one session each faculty member reviewed their recent evaluations of white and black, indigenous and people of color (BIPOC) residents looking for bias. During the session, the time was spent discussing and reecting on our ndings and, as an action plan, engaging in collective accountability for change. Each faculty teaching team received feedback from our consultant before presenting the topic to the residents. This strategy enabled all faculty members to achieve the necessary understanding to lead discussions, minimized the minority tax by involving faculty from all backgrounds in teaching this content, and facilitated the creation of a cur­riculum that extended across 3years of residency.

ing to protect faculty time to revise and grow this curriculum.

phenomenon? Have you eliminated inadvertent stereotypes? Have you addressed and centered health disparities

pertaining to your topic? Do your materials disrupt oppression at the individual,

can increase diversity. The ACGME provides a toolkit to support residency programs in implementing holistic review [11].

more reticent on clinical rotations because of cultural norms and not because of lack of competency [13]. This dynamic can initiate a tangible cascade on performance, as theorized by Teharani [15] where minor variations in perceived clinical performance result in signicant differences in grades and awards. Such disparities can profoundly affect residency selection and perpetuate challenges in retaining diverse fac­ulty in academia. Even the Dean’s letter, which provides nar­rative feedback about medical students’ clinical performance, has been shown to contain systemic bias, with white and male applicants consistently being described with more superlative language than BIPOC or female applicants [16]. Reviewing these data together as a committee can serve as an anti-oppressive check-in prior to the selection committee process.

Leadership at our teaching clinic, the Family Health Center, deserves credit for seeing beyond these barriers and counter­ing the status quo.

Patients involved in the selection process expressed sur­prise at the genuine interest shown by applicants in hearing their opinions regarding what they seek in their doctors. They described the benets of getting a glimpse at the human side of their future doctors. Such involvement may help to level power hierarchies that can leave patients feeling less empowered and without a voice in how they want to experi­ence health care.

Holistic application review and requiring diverse repre­sentation on the selection committee can also improve diver­sity when hiring faculty. Advertising positions in settings that specically focus on underrepresented applicants, hav­ing a DEIA-focused committee review all hiring plans, and deliberate cohort hiring [19] can also be effective strategies. It is equally, if not more important, to focus on creating a work climate and professional experience that is satisfying, enriching, and promotes faculty retention.

sations that may be difcult to have in mixed-race settings. The purpose is to create a safe and supportive environment where individuals can reect on their personal biases, con­front internalized racism, and work toward dismantling sys­temic racial inequities.

Racial afnity group caucusing is not about segregating individuals, but rather, it is a proactive step in building an inclusive and anti-racist community. By acknowledging and addressing the specic experiences and challenges faced by different racial groups, participants can develop a better understanding of themselves and their peers. Unlike employee resource groups or workplace afnity groups, racial caucusing follows a curriculum that invites partici­pants to actively engage in the process of learning how rac­ism has been internalized, how it is perpetuated through one’s own behaviors, and preparing to take action to mitigate and interrupt racial bias and harm. Racial caucusing serves as a platform for groups to delve deeper into the different facets of internalized racial oppression (IRO), which encom­passes the multifaceted ways in which institutionalized white supremacy adversely impacts everyone. These insights are a crucial part of the larger effort to create more equitable and anti-racist organizations and society.