Abstract
Issues of race have traditionally been addressed in medical school curricula in a didactic manner. However, medical school curricula often lack adequate opportunity for the application of learning material relating to race and culture. When confronted with acts of racism in clinical settings, students are left unprepared to respond appropriately and effectively. Forum Theatre offers a dynamic platform by which participants are empowered to actively engage with and become part of the performance. When used in an educational context, Forum Theatre can be a powerful tool for students to interact with a wide variety of social issues. This paper describes the process by which one medical school designed a workshop in the Forum Theatre style to equip students to respond to racism observed in clinical settings. Based on real student experiences, the Responding to Racism in the Clinical Setting workshop was designed to give students an opportunity to combine cultural humility, communication theory and conflict resolution skills in order to prepare for interactions in clinical stages of medical education. As a result of workshop evaluations, surveys, and written reflections, the authors propose that Forum Theatre is a novel teaching modality for incorporating issues of race and culture into medical curriculum.
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References
Acosta, David, and Kupiri Ackerman-Barger. 2017. “Breaking the Silence: Time to Talk About Race and Racism.” Academic Medicine 92 (3): 285. https://doi.org/10.1097/ACM.0000000000001416.
Ahmad, N. Jia, and Marc Shi. 2017. “The Need for Anti-Racism Training in Medical School Curricula.” Academic Medicine 92 (8): 1073. https://doi.org/10.1097/ACM.0000000000001806.
Betancourt, Joseph R. 2006. “Cultural Competence and Medical Education: Many Names, Many Perspectives, One Goal.” Academic Medicine 81 (6): 499. https://doi.org/10.1097/01.ACM.0000225211.77088.cb.
Betancourt, Joseph R., and Marina C. Cervantes. 2009. “Cross-Cultural Medical Education in the United States: Key Principles and Experiences.” The Kaohsiung Journal of Medical Sciences 25 (9): 471–478. https://doi.org/10.1016/S1607-551X(09)70553-4.
Boal, Augusto. 2000. Theater of the Oppressed. 2nd ed. London: Pluto Press.
Clark, David C., and Peter B. Zeldow. 1988. “Vicissitudes of Depressed Mood during Four Years of Medical School.” JAMA 260 (17): 2521–2528. https://doi.org/10.1001/jama.1988.03410170069036.
Corsaro, Alice, Andrea Poscia, Chiara de Waure, Concetta De Meo, Walter Ricciardi, Gianfranco Damiani, Patrizia Laurenti, and Filippo Berloco. 2017. “Fostering Flu Vaccination in Healthcare Workers: Forum Theatre in a University Hospital.” Medical Science Monitor 23 (September): 4574–4578.
D’Ardis, Melanie. 2014. “Forum Theatre for Practice Simulation and Skills Development in Nurse Education: A Student’s Perspective.” Nurse Education Today 34 (8): 1136–1137. https://doi.org/10.1016/j.nedt.2013.12.002.
Dyrbye, Liselotte N., Matthew R. Thomas, Anne Eacker, William Harper, F. Stanford Massie, David V. Power, Mashele Huschka, Paul J. Novotny, Jeff A. Sloan, and Tait D. Shanafelt. 2007. “Race, Ethnicity, and Medical Student Well-Being in the United States.” Archives of Internal Medicine 167 (19): 2103–2109. https://doi.org/10.1001/archinte.167.19.2103.
Dyrbye, Liselotte N., Matthew R. Thomas, William Harper, F. Stanford Massie, David V. Power, Anne Eacker, Daniel W. Szydlo, Paul J. Novotny, Jeff A. Sloan, and Tait D. Shanafelt. 2009. “The Learning Environment and Medical Student Burnout: A Multicentre Study.” Medical Education 43 (3): 274–282. https://doi.org/10.1111/j.1365-2923.2008.03282.x.
Dyrbye, Liselotte N., Matthew R. Thomas, Jefrey L. Huntington, Karen L. Lawson, Paul J. Novotny, Jeff A. Sloan, and Tait D. Shanafelt. 2006. “Personal Life Events and Medical Student Burnout: A Multicenter Study.” Academic Medicine 81 (4): 374.
Fisher-Borne, Marcie, Jessie Montana Cain, and Suzanne L. Martin. 2015. “From Mastery to Accountability: Cultural Humility as an Alternative to Cultural Competence.” Social Work Education 34 (2): 165–181. https://doi.org/10.1080/02615479.2014.977244.
Green, Adrienne. 2016. “The Cost of Balancing Academia and Racism.” The Atlantic, January 21. Accessed November 24, 2018. https://www.theatlantic.com/education/archive/2016/01/balancing-academia-racism/424887/.
Guthrie, E. A., D. Black, C. M. Shaw, J. Hamilton, F. H. Creed, and B. Tomenson. 1995. “Embarking upon a Medical Career: Psychological Morbidity in First Year Medical Students.” Medical Education 29 (5): 337–341. https://doi.org/10.1111/j.1365-2923.1995.tb00022.x.
Guthrie, E, D Black, H Bagalkote, C Shaw, M Campbell, and F Creed. 1998. “Psychological Stress and Burnout in Medical Students: A Five-Year Prospective Longitudinal Study.” Journal of the Royal Society of Medicine 91 (5): 237–243. https://doi.org/10.1177/014107689809100502.
Hardeman, Rachel R., Julia M. Przedworski, Sara Burke, Diana J. Burgess, Sylvia Perry, Sean Phelan, John F. Dovidio, and Michelle van Ryn. 2016. “Association between Perceived Medical School Diversity Climate and Change in Depressive Symptoms among Medical Students: A Report from the Medical Student CHANGE Study.” Journal of the National Medical Association 108 (4): 225–235. https://doi.org/10.1016/j.jnma.2016.08.005.
Hunt, Linda M., and Katherine B. de Voogd. 2005. “Clinical Myths of the Cultural ‘Other’: Implications for Latino Patient Care.” Academic Medicine 80 (10): 918.
Kirmayer, Laurence J. 2012. “Rethinking Cultural Competence.” Transcultural Psychiatry 49 (2): 149–164. https://doi.org/10.1177/1363461512444673.
Kolb, Alice Y., and David A. Kolb. 2005. “Learning Styles and Learning Spaces: Enhancing Experiential Learning in Higher Education.” Academy of Management Learning & Education 4 (2): 193–212. https://doi.org/10.5465/amle.2005.17268566.
Kolb, David A. 2014. Experiential Learning: Experience as the Source of Learning and Development. FT Press.
Kumagai, Arno K., and Monica L. Lypson. 2009. “Beyond Cultural Competence: Critical Consciousness, Social Justice, and Multicultural Education.” Academic Medicine 84 (6): 782. https://doi.org/10.1097/ACM.0b013e3181a42398.
McGee, Ebony O., and David Stovall. 2015. “Reimagining Critical Race Theory in Education: Mental Health, Healing, and the Pathway to Liberatory Praxis.” Educational Theory 65 (5): 491–511. https://doi.org/10.1111/edth.12129.
Metzl, Jonathan M., and Helena Hansen. 2014. “Structural Competency: Theorizing a New Medical Engagement with Stigma and Inequality.” Social Science & Medicine 103:126–133. https://doi.org/10.1016/j.socscimed.2013.06.032.
Metzl, Jonathan M, JuLeigh Petty, and Oluwatunmise Olowojoba. 2018. “Using a Structural Competency Framework to Teach Structural Racism in Pre-Health Education.” Social Science and Medicine 199:189–201. https://doi.org/10.1016/j.socscimed.2017.06.029.
Metzl, Jonathan M., and Dorothy E. Roberts. 2014. “Structural Competency Meets Structural Racism: Race, Politics, and the Structure of Medical Knowledge.” AMA Journal of Ethics 16 (9): 674–690. https://doi.org/10.1001/virtualmentor.2014.16.9.spec1-1409.
Middlewick, Yvonne, Trevor J. Kettle, and James J. Wilson. 2012. “Curtains up! Using Forum Theatre to Rehearse the Art of Communication in Healthcare Education.” Nurse Education in Practice 12:139–142. https://doi.org/10.1016/j.nepr.2011.10.010.
Mitchell, Karen S., and Jennifer L. Freitag. 2011. “Forum Theatre for Bystanders: A New Model for Gender Violence Prevention.” Violence Against Women 17 (8): 990–1013.
Murray-García, Jann L., Steven Harrell, Jorge A. García, Elio Gizzi, and Pamela Simms-Mackey. 2014. “Dialogue as Skill: Training a Health Professions Workforce That Can Talk About Race and Racism.” American Journal of Orthopsychiatry 84 (5): 590–596. https://doi.org/10.1037/ort0000026.
Paradies, Yin, Jehonathan Ben, Nida Denson, Amanuel Elias, Naomi Priest, Alex Pieterse, Arpana Gupta, Margaret Kelaher, and Gilbert Gee. 2015. “Racism as a Determinant of Health: A Systematic Review and Meta-Analysis.” PLoS ONE 10 (9). https://doi.org/10.1371/journal.pone.0138511.
Rosal, M. C., I. S. Ockene, J. K. Ockene, S. V. Barrett, Y. Ma, and J. R. Hebert. 1997. “A Longitudinal Study of Students’ Depression at One Medical School.” Academic Medicine: Journal of the Association of American Medical Colleges 72 (6): 542–546. https://doi.org/10.1097/00001888-199706000-00022.
Ryan, C Anthony, Nuala Walshe, Robert Gaffney, Andrew Shanks, Louise Burgoyne, and Connie M Wiskin. 2010. “Using Standardized Patients to Assess Communication Skills in Medical and Nursing Students.” BMC Medical Education 10 (1). https://doi.org/10.1186/1472-6920-10-24.
Santen, S. A., D. B. Holt, J. D. Kemp, and R. R. Hemphill. 2010. “Burnout in Medical Students: Examining the Prevalence and Associated Factors.” Southern Medical Journal 103 (8): 758–763. https://doi.org/10.1097/SMJ.0b013e3181e6d6d4.
Seguin, A., and C. Rancourt. 1996. “The Theatre: An Effective Tool for Health Promotion.” World Health Forum 17 (1): 64–69.
Shapiro, Johanna. 2008. “Walking a Mile in Their Patients’ Shoes: Empathy and Othering in Medical Students’ Education.” Philosophy, Ethics, and Humanities in Medicine 3 (1): 10. https://doi.org/10.1186/1747-5341-3-10.
Sharma, Malika, and Ayelet Kuper. 2017. “The Elephant in the Room: Talking Race in Medical Education.” Advances in Health Sciences Education: Theory and Practice 22 (3): 761–764. https://doi.org/10.1007/s10459-016-9732-3.
Sharma, Malika, Andrew D. Pinto, and Arno K. Kumagai. 2018. “Teaching the Social Determinants of Health: A Path to Equity or a Road to Nowhere?” Academic Medicine 93 (1): 25. https://doi.org/10.1097/ACM.0000000000001689.
Singleton, Glenn E. 2014. Courageous Conversations about Race: A Field Guide for Achieving Equity in Schools. 2nd ed. Los Angeles, California, USA: Corwin Press.
Stillman, P. L. 1987. “Ensuring the Clinical Competence of Medical School Graduates through Standardized Patients.” Archives of Internal Medicine 147 (6): 1049–1052. https://doi.org/10.1001/archinte.147.6.1049.
Tervalon, Melanie, and Jann Murray-García. 1998. “Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education.” Journal of Health Care for the Poor and Underserved 9 (2): 117–125. https://doi.org/10.1353/hpu.2010.0233.
Tsai, Jennifer, and Ann Crawford-Roberts. 2017. “A Call for Critical Race Theory in Medical Education.” Academic Medicine 92 (8): 1072–1073.
Tuxbury, Janis S., and Patricia M. (Wall) McCauley. 2012. “Nursing and Theatre Collaborate: An End-of-Life Simulation Using Forum Theatre.” Journal of Nursing Education 51 (8): 462–465.
White-Davis, Tanya, Jennifer Edgoose, Joedrecka Brown Speights, Kathryn Fraser, Jeffrey Ring, Jessica Guh, and George Saba. 2018. “Addressing Racism in Medical Education An Interactive Training Module.” Family Medicine 50 (5): 364-368. https://doi.org/10.22454/FamMed.2018.875510.
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This article does not contain any studies with animals performed by any of the authors. This article contains de-identified survey data collected from human participants. Informed consent was obtained from all individual participants included in the study. This study received exemption status approval from the Ohio University Institutional Review Board, case number 18-E-223
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Manzi, J., Casapulla, S., Kropf, K. et al. Responding to Racism in the Clinical Setting: A Novel Use of Forum Theatre in Social Medicine Education. J Med Humanit 41, 489–500 (2020). https://doi.org/10.1007/s10912-020-09608-8
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DOI: https://doi.org/10.1007/s10912-020-09608-8