Five Essential Steps for Faculty to Mitigate Racial Bias and Microaggressions in the Classroom

INTRODUCTION

On May 25, 2020, George Floyd was murdered by a police officer—a seminal incident that shook the nation. The weeks of worldwide protests that took place in the aftermath of his horrific death as well as the murders of Breonna Taylor, Amaud Arbery, and countless others reflected resistance to the violent treatment of Black people by law enforcement across the United States. During this racial reckoning, the COVID-19 pandemic also unveiled the stark racial disparities in our health care system through disparities in rates of infections, deaths, and immunizations. Many will remember 2020 as the year of the COVID-19 pandemic or the year we worked from home, but others will also remember this historic time as the year when the nation realized it could no longer turn a blind eye to the ongoing pandemic of systemic racism.

The American Association of Colleges of Pharmacy (AACP) has long supported equity, diversity, and inclusion.¹ This past year, there was a renewed fervor for discussions on wide-ranging topics in this arena, from diversity, equity, and inclusion to privilege, anti-racism, implicit/unconscious bias, and the social determinants of health, with many sessions provided by pharmacy professional organizations. Through this programming, there were numerous calls to action for pharmacy educators to become more aware of biases and recognize the existence and effects of systemic racism. However, as educators know, the steps in Bloom’s taxonomy that follow knowledge and understanding are application, analysis, evaluation, and creating.² In other words, now is the time for action.

Action steps to address systemic racism in pharmacy practice have been suggested, but the role of pharmacy education, specifically in Doctor of Pharmacy (PharmD) programs, in disseminating racial bias deserves further consideration.³ Educators must recognize the pharmacy curriculum itself is an instrument that can propagate or discourage systemic racism.⁴ For example, studies have shown that the medical curriculum has historically oversimplified race and disease presentation, contributing to diagnostic and treatment bias.^4,5 Studies have also shown that despite expressed commitment to caring for the medically underserved upon entering medical school, medical students display increasingly negative attitudes toward the medically underserved during the four years of medical school curriculum.⁶ While research on this topic in pharmacy is scarce, an exploratory study of the experiences of underrepresented racial minority pharmacy students found that they felt the curriculum “perpetuated the social hierarchy” and was a “continuous representation of White people.”⁷ This bias in curriculum is likely transmitted unconsciously, without malicious intent. The learning environment is impacted by the didactic curriculum as well as the “hidden curriculum,” namely the curriculum of unplanned values, beliefs, and norms that is learned by students all the same (ie, “unwritten rules”).⁸ Nevertheless, the way race is portrayed in pharmacy school can have unintended consequences of negative classroom experiences.

Students’ experiences of racial microaggressions in health professional programs have also been described.^9,10 Microaggressions, defined as a subtle, powerful, and often unintentional form of discrimination, have implications for the wellness and success of students of racial/ethnic minorities.¹¹ Types of racial microaggressions are wide-ranging and include assumptions of lesser intelligence, of criminality or dangerousness, or that one’s cultural background and communication styles are pathological; they also involve environmental cues of being unwelcome or devalued.¹² Microaggressions like these and other understated indignities reveal biases and send messages that cumulatively result in students feeling “othered” and out of place.¹² While microaggressions have begun to be acknowledged in the pharmacy learning environment, specific guidance on mitigating racial microaggressions in the classroom has not been provided. It is important to recognize that pharmacy education has historically been predominately White. In the United States, underrepresented minorities account for 33% of the population but only 17% of all students enrolled in PharmD programs.¹³ The profession is lacking in diversity, not only in student pharmacists but also in pharmacy faculty.¹³ This has the potential to further marginalize students beyond society’s daily impact. Students historically navigate through these isolating experiences alone or by leaning on one another through systems of social support, but faculty also have an opportunity to work to improve the classroom environment through intentional efforts to reduce the dissemination of bias.^7,14

This paper aims to suggest actionable strategies pharmacy educators may use to mitigate or prevent the microaggressions triggered by these negative classroom experiences. The perceived biases and microaggressions described in this paper have been exhibited by well-meaning educators and genuinely nice people. These experiences have also been reported in other areas of higher learning. However, it is our specific aim to frame these concepts in an actionable and practical manner.

In Appendix 1, five experiences of racial biases and microaggressions in the classroom are combined with suggested action items to provide a guide for pharmacy faculty. This guide includes a list of things to avoid, essentially a “what not to do” list, supported by examples; it also includes recommendations for what to do instead, a “how to do it differently” list. It is our hope that this Commentary will challenge faculty in self-assessing their teaching, to prevent propagating racial biases and create better learning environments for future pharmacists.