Practice management: Does your staff need diversity training?

“This is a somewhat complex area,” said Dr. Gary Bloch, a family physician with St. Michael’s Hospital and Inner City Health Associates in Toronto. His FHT has embraced EDI training and education for the staff of about 250. “There isn’t really one way to approach diversity training.”

Some doctors are not feeling a need for formalized diversity training. “We do it by hiring diverse staff of every colour, religion, nationality and sexual orientation, which hopefully goes further than mere words,” said Dr. Benjamin Barankin, dermatologist, and medical director and founder at the Toronto Dermatology Centre.

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“We have not been asked nor sensed the need to get formal training in this matter as far as concerns are raised or situations that have occurred,” continued Dr. Barankin. “If a clear issue arose at our clinic, that might be the right time and impetus to go about discussing the matter—possibly with the help of professionals.”

Some physicians see the need for only leaders to get training, while others are starting to see its importance for all staff for a smooth-running clinic with happy staff and comfortable patients.

Available resources include online guidelines or articles through medical colleges and provincial associations; there are robust training programs from organizations that support racial equality; and in-person and online workshops and one-on-one training from private consultants who specialize in EDI.

No matter the approach, change doesn’t happen overnight and learning never stops.“Anti-racist, equity, diversity, inclusion, reconciliation and cultural safety—all that work requires an ongoing commitment by an organization and its staff over many years,” said Dr. Bloch. “I would never want to give the impression that change can happen through one course or workshop.”

That said, there are certain resources that are widely used and recommended for leaders and staff to address antiracism, diversity and cultural safety.

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CULTURAL SAFETY

“The resource that I have found to be phenomenal and a number of healthcare workers have used is the San’yas Indigenous Cultural Safety course,” said Dr. Onye Nnorom, a family physician and public health specialist serving the Greater Toronto Area’s Black communities.

“It is the most easily accessible and well-studied module on cultural safety (covering) Indigenous history and its relation to the healthcare system. It is moderated by an expert facilitator and is excellent.”

The San’yas Indigenous Cultural Safety course (www.sanyas.ca)—also highly recommended by Dr. Bloch—is an online training program designed to enhance self-awareness, and strengthen the skills of those who work both directly and indirectly with Indigenous people. The goal of the Indigenous Cultural Safety training is to develop understanding and promote positive partnerships between service providers and Indigenous people. The course meets the accreditation criteria of the CFPC and anyone can take it for a fee (free to Indigenous health workers in B.C.). Skilled facilitators guide and support each learner through interactive course materials. The course participants examine culture, stereotyping, and the consequences and legacies of colonization. Participants will learn about terminology; diversity; aspects of colonial history such as Indian residential schools and Indian hospitals and a timeline of historical events.

For Black populations, Dr. Nnorom recommends physicians and leaders read the document “Black Experiences in Health Care 2020,” which is an overview of the core themes, challenges and recommendations that emerged from a symposium of the same name. It highlights the importance of personal lived experience as Black people working in and/or engaging with the healthcare system, calls for a more equitable health system and outlines recommendations for healthcare providers. (It is available online, no charge.)

Dr. Nnorom also points to the Black Health Education Collaborative, a community of scholars and practitioners committed to improving Black health through education and research, which she co-led with Dr. OmiSoore Dryden. “We are in the process of creating resources and tools for healthcare providers and for understanding anti-Black racism and how to be able to treat Black patients with greater understanding, greater dignity and cultural dexterity,” she said.

“Call it Out” training is a free resource available from the Ontario Human Rights Commission, one that staff at Dr. Bloch’s clinic have taken. It’s a 30-minute interactive online program that offers a foundation for learning about race, racial discrimination and human rights protections. The course offers a historical overview of racism and racial discrimination, explains what different terms mean, and provides approaches to preventing and addressing racial discrimination.

HIRING A CONSULTANT

In all the larger centres across the country, there are individual consultants that specialize in training staff on antiracism, inclusion and diversity for a fee.

“We have used consultants on various diversity/anti-racist issues,” said Dr. Bloch. He recommends interested physicians and leaders carefully define particular organizational needs, then look for a consultant matched to those.

“There is no central repository of consultants, so this needs to happen through word of mouth, web searches, conversations, etc.,” he said. “It can be very helpful, if possible, for an organization to retain a consultant over months to years to support planning and implementation of a multi-faceted approach to these issues.”

The FHT at St. Mike’s has also facilitated healing circles for BIPOC (mainly Black) staff to create safe spaces to discuss and explore experiences of racism. “These have been very important and empowering, from what I hear,” said Dr. Bloch.

MORE RESOURCES In addition to the resources outlined above, and those from for-profit private consultants, here is a sampling of other resources physicians may want to check out and share with staff:

• The Canadian Centre for Diversity and Inclusion offers free toolkits on a range of BIPOC anti-racism/inclusion topics as well as paid workshops and courses.
• The Canadian Diversity Initiative has free resources and paid courses, including one on unconscious bias.
• Doctors of BC has a comprehensive list of linked resources for physicians and their staff to free and paid resources and courses.
• Cancer Care Ontario offers 13 free online Indigenous Relationship and Cultural Safety courses for individuals working with First Nations, Inuit and Métis people.
• Canadian universities, notably the University of Alberta (Native studies), the University of Toronto and the University of Waterloo have free resources and paid courses and certificate programs, some specifically for healthcare workers.
• The Society of Rural Physicians in Canada offers educational events to learn about Indigenous health and has a free extensive list of resources, including books and films, compiled by Dr. Darlene Kitty, that educate on Indigenous health and experiences.
• The Nova Scotia Human Rights Commission delivers free online training and workshops for organizations.
• CAMH’s Immigrant and Refugee Mental Health Project offers various resources, including a free online course for service providers responding to the needs of recent immigrants and refugees. 
• The Ontario Hospital Association has an anti-racism resource page for health workers that lists available courses and resources.
• The Public Service Alliance of Canada offers a list of free and paid anti-racism toolkits and resources.

No matter which programs, courses or resources are used, said Dr. Bloch, the bottom line is, “This is ongoing, longterm transformative work that requires deep commitment at all levels of an organization.”

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