To Dodge or Disclose: a Faculty Development Workshop to Promote Discussion of Racial/Ethnic Minority Trainee Cultural Identity

Appendix. Sample Scenarios

Scenario 1

The second-year resident is a 30-year-old African-American female. She has been working with a patient named Chris in psychotherapy for management of anxiety symptoms.

Case

Chris is a 28-year-old African-American male who reports increased anxiety and urges to urinate when riding the subway. Because of this, he leaves home an hour early to accommodate the frequent bathroom breaks along the subway route.

One month into therapy, there is a lot of media coverage of the recent deaths of two African-American males by police. Chris reports that he went to work that week feeling down and also feels isolated because he is one of only two African-Americans who works in his office. He reports that no one at work seemed to care until multiple police officers were killed at a Black Lives Matter protest. In previous sessions, he has expressed frustration with his coworkers, who have commented on how articulate he is, as though it is unusual for someone of his race to be intelligent. He also expresses increased fear when he encounters police.

At the end of the work week, his company announced that the flag would be at half-staff in honor of the fallen police officers. Though he understands the reason for this, he also is frustrated that there is no acknowledgment of the young African-American men killed by police. He knows that sharing this view with his colleagues will not be accepted.

Supervision Discussion

The resident shares that she understands how the patient feels being a minority in the workplace and feeling at times that she has beliefs that do not align with her colleagues. She tells the supervisor that she did not disclose this to the patient. She has experienced a number of patients talking about race, and she wonders if this patient shared this because they are of the same ethnicity. She wants to address his anxiety symptoms and wants to be careful not to invalidate his experiences.

Scenario 2

The third-year adult psychiatry resident is an Indian-American female, late 20s/early 30s, who is interested in community psychiatry, cultural psychiatry, and forensics.

Case

Ms. Z is in her late 40s, born and raised in Cambodia, moved to the USA in her 20s, with a diagnostic history of schizophrenia. She identifies as Catholic. Her primary symptoms are active auditory hallucinations. She spends most of her day reading books and walking.

During the patient’s initial appointment, she asks the resident where she is from. The resident answers “here.” The patient is dissatisfied with this answer and asks, “No, where is your family from?” The resident tells her she is from India, and asks the patient why this is important to her. She responds by telling the resident that in her experience, Indians struggle to connect with others.

At her third appointment, the patient wants to talk to the resident about the Vedas. She says that her boyfriend Joe likes them the best. The resident asks her why she chose to read them, and the patient responds, “God told me to study Hinduism.”

Supervision Discussion

The resident is a couple of months into her clinic year of residency. This patient encounter left her with a vague sense of discomfort because of some of the questions the patient asked of her, and because several patients had been asking about her ethnicity, so she decided to bring the case up in supervision with her supervisor. She is not entirely sure what her question is, but she knows that she left the room uncomfortable and confused about the exchange, and somehow it has gotten under her skin. She is also acutely aware of the looming boundary issues that may arise, and is not sure how to manage them.