What’s Chats for Change?

Beginning in the fall of 2018, the Department of Medical Education at the Icahn School of Medicine at Mount Sinai launched “Chats for Change”—a series of interactive sessions that spark dialogue centered on racism and bias in medicine.

 

 

Chats for Change is built on the notion that in order to respond to racism and to be anti-racist we must engage in dialogue, learning and action. The idea of Chats for Change was developed in response to medical education staff, students, and faculty who wanted dedicated time to engage in a dialogue as a community and deepen our collective understanding and ability to address racism.

By participating in Chats for Change, we offer an opportunity for attendees to explore key concepts related to racism and bias and uncover who they are in relation to others. Even though the dialogue is structured, the expectation is for attendees to express themselves from their own lived experiences and listen for deeper understanding and insights that will promote learning and unlearning.

We invite all faculty, staff, trainees, leaders, students and others within the health system to join us and engage in dialogue as we work towards a common understanding and contribute our best thinking, knowing that other peoples’ reflections help to improve our thinking. We are committed to helping each other reveal our assumptions and biases for self-revaluation.

Did You Know?

The Department of Medical Education launched two versions of Chats for Change:

One that’s offered to all faculty, staff, and students within the Mount Sinai Health System, and

Another that’s offered nationally—to all within the medical education and healthcare communities.

Inside the Student Healing Circle: A Lesson in Dignity

After many months of online lectures, tele-health physical exams, and learning how to cope with the responsibilities of becoming a health professional during a pandemic, I ventured out back onto the hospital wards for the first time this week. I went to a cardiothoracic unit where most patients had recently undergone an invasive procedure and were being closely monitored during their recovery.

When I first introduced myself to my assigned patient, I explained that I was a second-year medical school student there to practice my history-taking and physical exam skills, and that I hoped to spend the next hour with him getting to know him better. He interrupted me before I could finish, “Excuse me, miss, let me find you a chair to sit in. I don’t know where they all went,” and proceeded to press his “call” button to alert the floor staff that he needed assistance. 

He inquired about the chairs to the nursing staff on the floor with no resolve, and so I took a comfortable stance and began my interview. In common practice, I began by inquiring what had brought the patient in initially. I learned about his medical history, which was largely uncomplicated until the summer of 2020, and we shared about how God grants us the gift of forgetfulness to allow us to endure pain. Time after time in our conversation, he would express his frustration with his missing chairs. In the end, this elderly Black man sat in front of me with an assistance device working to keep him and his heart alive, and an infection that had kept him in and out of the hospital for 3 months now – and still, he was the most upset about the chairs that were missing from his room. He was most concerned about his dignity as a patient. 

Donna Hicks, a renowned expert on the role of dignity in conflict, defines dignity as the internal state of peace that comes with the recognition and acceptance of the value and vulnerability of all living things. As social beings, our survival is linked to the quality of our relationships, and honoring dignity in ourselves and others is the foundation of any functional, healthy relationship – whether it be with our patients, our peers, family, friends, etc. However, our evolutionary legacy of self-preservation and systemic oppression often puts us at risk of violating our own and others’ dignity.

My patient, Mr. L spent most of his days in the hospital bed longing for a genuine conversation, and in many ways, the chairs represented connection for him – one that we all crave and are deserving of. Not surprisingly, no one bothered to get a chair and the moment stuck with me. In the Hippocratic oath, we, as health professionals, vow to “remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.” As a physician-in-training, medical school has often made me question my own dignity and reckon with how I/we see and acknowledge the dignity of those we interact with every day. We assume the responsibility for managing patients’ care while frequently serving as leaders to apply our unique knowledge-base, skills and training, and to do no harm. Yet our biggest challenge seems to be the most simple one— treating one another with dignity. 

The power of dignity gives us the awareness and skills to avoid unknowingly harming others, while allowing us to recognize the fullness within ourselves and our relationships. Racial healing, which is grounded in indigenous circle and community-sustaining practices, recognizes the need to speak truths about past wrongs, including those created by individual and systemic racism, and to address the present consequences. It is an experience and a tool that can facilitate trust and build authentic relationships as we draw on our stories to learn from and with one another about how we can heal, rather than cause harm to ourselves and others.

Every month in our circle, we cultivate and harvest wisdom about what is on our hearts and what dignity feels like. Even if we feel a lack of dignity, in our healing circle we can garner the capacity to imagine what it might feel like together and continue to share that practice in our profession. Join us for our next racial healing circle on Friday, March 19 as we stitch together moments of vulnerability to remind each other of our own value and dignity in a safe space.

A community poem, generated from the collective wisdom in our circle and prompts from our Healing Circle session held on February 19.

Dignity feels like

Groundedness

Anchoring

Sureness of self

Curiosity, 

Respect from others,

Feeling physically full,

Nakedness

Authenticity

The power of imagining what it could feel like.

 

My relationship and sense of belonging is grounded in dignity when

It has a name

We are dignified over the conflict over it and the need for it

When it’s chosen and unchosen;

Like the dignity of a child or newborn.

May You Be Happy.

May You Be Safe.

May You Be Well.

 

I will recognize the fullness in myself and others by

Appreciating that there is no right answer and we are figuring it out;

Holding fullness with mystery,

Feeling expansive

Even in our own family, with strangers and those we can count with our fingers,

Expressing gratitude.


This post was written by Jennifer Dias, a second-year medical student at the Icahn School of Medicine at Mount Sinai. 

On the Pulse: Desegregating Healthcare Systems

What does a desegregated health care system look like and how can we get there? This was the theme for the Chats for Change on March 2, 2021.

We gathered.

Nearly 100 students, faculty, care providers, hospital leadership, and administrators gathered to share their perspectives and knowledge on the issue. We had representation from across Mount Sinai’s campuses as well as folks from other institutions in NYC!

We framed the conversation.

We began our conversation by setting a common framework for the dialogue by defining segregated care: the separation of patients based on insurance status. This exists when patients who have public insurance are seen by different physicians, in a different location, or at different times than patients with private insurance. This segregation by insurance negatively impacts patient experience and how students learn about medicine. This separation occurs both within institutions and between the public and private hospital systems. 

The systemic effects of racism, white supremacy culture, and capitalism are embedded into differences in insurance status. As a result, by segregating by insurance, we are segregating patients by race. One-in-four non-elderly New Yorkers have medicaid, and among those Medicaid enrollees, white people are under-represented and people of color or over-represented. Segregated care perpetuates racism and inequity.

As the theme suggests, our goal was to imagine a desegregated, equitable system, which requires us to move beyond the way the system is currently set up. So we moved on to brainstorming the different avenues of care in New York City to acknowledge what is currently in place. Responses ranged from the community health centers, urgent care, private practice, to the internet, with hospitals making up the overwhelming majority. 

We dialogued

In small groups, we discussed the following questions:

  1. What would a desegregated system look like across NYC, assuming there are truly no boundaries? 
  2. Who might benefit from a desegregated health care system?   
  3. What is an immediate actionable change that can be made to bring us closer to a desegregated system? 

The point wasn’t to be bogged down in the barriers. The point was to envision a better future. As such, we framed the conversation as aspirational. Our dialogue didn’t need to be feasible or realistic. We focused the purpose on envisioning who and how people would benefit from a desegregated system and what that would look like, rather than how we would get there. Then, we spoke about changes that could be made to get us closer to what we envisioned. 

We aspired: 

Individuals brainstormed and logged in their responses. Here are some of the themes that arose:  

Desegregated care would mean:

  • Equity in access to resources and longitudinal care 
  • Educating physicians to treat a diverse patient population
  • A renewed focus on preventative care
  • All people, regardless of insurance or immigration status, would be able to access care

We brainstormed ways to get there together: 

  • Mount Sinai should/will publicly denounce Segregated Care both institutionally and across NY.
  • Full price transparency mandated to all hospitals/clinics/healthcare systems to promote using money in a more equitable manner. 
  • Lower the debt burden for medical students to prevent the physician financial stress that contributes to segregated care and diversify our physician network.
  • Move towards a single payer model for healthcare. 

We will take action: 

  • Acknowledge and actively address biases. 
  • We will continue the conversation and note differences in our training, work, and community that are grounded in structural racism and segregated care
  • Talk to peers working at different institutions to see how we can work together towards a desegregated, more equitable system
  • Instead of focusing on barriers, we will focus on the immediate actionable changes that can be made. 

We will continue the conversation: 

If you are working on desegregation and integration at Mount Sinai or any other institution, the Segregated Care Work Group would love to hear from you – please email Emily Xu (emily.xu@icahn.mssm.edu) and Paige Cloonan (paige.cloonan@icahn.mssm.edu) to set up a time to meet with us! Please also reach out if you’re interested in working on a project with us! We welcome everyone – regardless of role or institution. 

Do you have any experiences with segregated care as a provider, patient, or trainee (student, resident, fellow) that you would like to share? Feel free to contact us directly, or submit your story anonymously here


This post was written by Emily Xu and Paige Cloonan, medical students and co-facilitators of the Chats for Change session, “Desegregating Care: Imagining an Equitable NYC Healthcare System.”

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On the Pulse: Racism, Assimilation, and Professionalism—Student Council Collaboration

During a recent Chats for Change on Monday, October 19, close to 40 students, staff, and faculty gathered from across the health system and the Icahn School of Medicine at Mount Sinai to discuss how racism, assimilation, and professionalism operate in medicine and science. This was the first Chats for Change co-hosted by Student Council and the Racism and Bias Initiative.

 

To provide a common framework for discussion, the following definitions were provided to participants. While there aren’t “right” definitions, we hoped to at least provide a starting point for further conversations. After presenting each definition, the participants were encouraged to use slido to answer questions on how racism influences science and medicine and define for themselves what professionalism and assimilation means. 

Racism

(1) “A belief that race is a fundamental determinant of human traits and capacities and that racial differences produce an inherent superiority of a particular race. (2) The systemic oppression of a racial group to the social, economic, and political advantage of another.” —Merriam Webster.

Professionalism

(1) “The conduct, aims, or qualities that characterize or mark a profession.” – Merriam Webster; (2) “…the set of standards concerning appearance, character, values, and behavior that mark employees as competent, appropriate, effective, ethical, and respected/respectful.” – Mark D. Davis, Master’s Thesis; (3) “A belief system about how best to organize and deliver health care, which calls on group members to jointly declare (“profess”) what the public and individual patients can expect regarding shared competency standards and ethical values, and to implement trustworthy means to ensure that all medical professionals live up to these promises.” —American Board of Medical Specialities.

 

 

Assimilation

(1) “to absorb into the cultural tradition of a population or group.” – Merriam Webster; (2) “…to accept the new culture wholeheartedly, even to the extent of minimizing or rejecting their culture of origin; this is termed an assimilation strategy” – Knapp et al., “The Dark Side of Professional Ethics”; (3) “Assimilationist: one who is expressing the racist idea that a racial group is culturally or behaviorally inferior and is supporting cultural or behavioral enrichment programs to develop that racial group.”—Ibram X. Kendi, How to Be an Antiracist.  

 

 

 

After providing these common definitions, participants then broke out into small group rooms where they discussed the following questions:

 

  • What are the attributes of professionalism in academic medicine and science?
  • What skills are valued in professionalism, and who decides this?
  • Is the concept of professionalism exclusionary?
  • Are there short or long-term consequences to assimilation? 

 

After coming back to the larger group, participants were able to share out some of their conversations during the small group sessions. Some people shared how they’ve seen professionalism benefit white men and hold back women and BIPOC; from elitist language to physical appearance being qualifiers. There was also a fruitful conversation about whether the concept of professionalism would always be inherently biased and how we could reframe the definition to be more inclusive. Others reflected on the culture at Mount Sinai and ways in which they’ve found it to be more welcoming than other institutions. 

As with every Chats for Change, the session ended with an opportunity for folks to share what they needed to learn and unlearn. While the responses to this prompt varied, it was clear that giving folks the space to reflect on these aspects of academic medicine and science that are rarely discussed helped spur reflection.

Student Council was grateful to have the opportunity to partner with RBI on this Chats for Change and looks forward to hosting another one soon. You can read more about Student Council’s work on racial equity here.   

A Place for Anti-Racism in Crisis Response

During the Special Edition Chats for Change on Tuesday, April 21, seventeen staff, students and faculty from across the health system and the Icahn School of Medicine at Mount Sinai (shout out to Mount Sinai Queens and the Corporate Offices) began to brainstorm the strategies, actions, and practices that challenge and counter racism, inequalities, prejudices, and discrimination based on race during this public health crisis.

It started with a check-in.

Like most Chats for Change, we kicked things off by checking in and finding out why folks have joined the session. The top four reasons were justice, change, action and education.

We got on the same page.

To get on the same page, the co-hosts provided a frame or collective understanding of an anti-racist crisis response. It’s hard to engage in a productive dialogue when there are so many interpretations and definitions. Here are the definitions we used (these aren’t the “right” definitions, they are what we used for this session and may change over time):

Crisis response defined: Crisis Response refers to all the advance planning and actions taken to address natural and man-made disasters, crises, critical incidents, and tragic events. Ideally, crisis management practices are engaged before, during and after a crisis.

Anti-racism defined: Anti-racism is the practice of identifying, challenging, and changing the values, structures and behaviors that perpetuate systemic racism.

Racial equity defined: Racial equity is a component of anti-racism. It is the condition that would be achieved if one’s racial identity no longer predicted how one fares.

Identified what we are witnessing and experiencing now.

In order to identify the strategies, actions or practices that counter racism during this crisis, we first examined what is happening now. Here are two of our insights that either counter or perpetuate systemic and individual racism during this crisis:

  • “Wearing a face covering (I understand and support the reason and importance but it does perpetuate racism)…not equally safe for all to do because they may be targets of racism/suspicion.”
  • “Focusing on those who are most in need and equity instead of being fair (counter)”
Dreamt what could be and the challenges to implement.

We spent most of the time in small break out rooms brainstorming an ideal anti-racist crisis response. What would it look like? Who are the people and/or groups involved? What are the mindsets, strategies, actions and/or practices? What would happen before, during and after the crisis? What challenges or roadblocks might you encounter if you implemented your ideal anti-racist crisis response?

These are some of the actions, strategies and practices that we dreamt of:

  • “Centering equity in crisis decision-making, response and recovery.”
  • “Anti-racist response doesn’t try to get things back to normal; it’s about building a better system for next time.”
  • “Practices to tap into the heart, not just the mind. This isn’t an intellectual exercise.”

Here are some of the identified challenges:

  • Resistance
  • Power hoarding
  • Transparency: Who makes the decisions? Who is at the table? Who holds those in power accountable?
Next steps.

This Chats for Change was just the initial brainstorming session. A smaller group of students, staff, and faculty are continuing the work to formally develop a framework that could be shared more broadly within the Mount Sinai community and with other medical schools and teaching health systems. If you want to get more involved, please reach out to Leona Hess. Stay tuned for updates as we dream into and actualize an anti-racist crisis response.

In the meantime, check out the upcoming Chats for Change schedule.

Special thanks to everyone who contributed to this body of work and shared their stories.

About the Author

This post was written by Leona Hess, PhD, Director of Strategy and Equity Education Programs.