Electronic Spring 2021 | Issue 46

Two Psychiatry Residents to Create and Lead Class on Social Justice

By: Lala Park MD, Mind Matters Editor

I am proud to present two courageous, passionate resident physicians who led their peers in learning and talking about social justice and racism. These are essential yet often missing topics in our curriculum. Dr. Gabrielle Forestier and Dr. Amber Bard are third-year psychiatry residents at the University of Chicago. In August 2020, the pair started a 4-part series class called Social Justice in Medicine and Psychiatry (hereafter referred to as “Series”).

The goal of the class was to uncover structural and interpersonal racism and bias in medicine and psychiatry. This is important because racial discrimination and bias “inform our diagnosis, treatment process and therapeutic interactions with our patients,” says Dr. Forestier. The Series started with a presentation on the history of racism in psychiatry, which turned into a discussion of race in the South Side Chicago, where the University of Chicago Medical Center is located. The Series concluded in November 2020 with discussions in trans-racial therapy in different settings, including inpatient, ED, and outpatient.

The pair’s motivations to create the Series trace back to their intern year. “Being a white physician, the dynamic between myself and a Black patient is something I wanted to explore more deeply,” says Dr. Bard, “especially when we as psychiatrists have the power to commit our patients involuntarily.” Dr. Forestier states that, as a Black physician, she witnessed how Black culture was becoming pathologized. For example, non-Black physicians would interpret Black patients expressing cultural beliefs about God as impaired reality testing. However, sadly, as we all know, the power imbalance that exists between trainees and faculty physicians in residency did not allow Dr. Forestier to have these important conversations with her attendings in a safe environment.

Drs. Forestier and Bard used their challenging experiences as interns to stop the silence and expose the injustices that we resident physicians participate in, experience, and witness daily. Through the Series, the pair offered opportunities for their peers to be vulnerable and open with one another. Dr. Russell, a PGY-4, states that the Series allowed him to explore his white fragility in a safe environment.

Being the first of its kind during the pandemic, the Series was not without challenges. According to Dr. Bard, the Zoom environment at times prevented spontaneous, free-flowing conversations from taking place. The first class was conducted in a traditional lecture-style with the pair presenting PowerPoint slides; this was not what the Drs. Bard and Forestier had in mind. They desired more participation from their peers. Unafraid to start a conversation, they shared their concerns with the peers, who were receptive, and the class quickly adopted a group discussion style. Peers note the Series spotlighted racism, which has been neglected and ignored in medicine and psychiatry for too long. Dr. Lavie, a PGY-2, applauds that the Series opened up a disussion on racism within our nation and our institution. Another PGY-2, Dr. Eng, notes that the class allowed discussions about both explicit and implicit racism on multiple levels – individual, interpersonal, and structural.

Dr. Rosas, a PGY-2, appreciates her peers’ efforts to create a space and time to discuss racism, a topic that is difficult to discuss sometimes. Indeed, racism and social justice are essential yet marginalized topics in psychiatric training. Sadly, in regards to developing and providing training in such topics, there is a lack of guidance and resources. Both Dr. Bard and Dr. Forestier share that developing the Series took a significant amount of their time and work while also fulfilling their usual duties and obligations as residents. The Series had to be spearheaded by trainees, rather than being built into the residency didactics fully supported and protected by faculty. Unfortunately, the burden to educate people on marginalized topics often falls on the already marginalized persons, such as trainees and a small fraction of faculty, especially trainees and faculty of color. In order to change the status quo, faculty and upper management should treat social justice as a fundamental part of psychiatric residency curriculum as they think of the courses in psychopathology and psychopharmacology.

It was the pair’s experiences as interns at the University of Chicago that pushed Drs. Bard and Forestier to create this Social Justice Series. So, what did our current interns think of the Series? Dr. Bean says the Series gave him the space to examine how his own biases, atop societal influences, may disadvantage the patients he serves; the class also gave him the place to “begin the process of actively unlearning” those biases. Dr. Bertsch-Gout says an intersectional understanding of race and psychiatry was helpful to him and notes that psychiatry is not and may never be a perfect science and is influenced by social factors. Dr. Lacci states the class taught him a side of Chicago he never knew, from a lens of those different from himself. The Series had a positive role in shaping the interns’ outlook and attitude as new physicians in South Side Chicago.

Dr. Forestier has matched with the CAP program at Children’s Hospital in Philadelphia. She is looking forward to a career combining her interests in adolescent youth and the intersections between mental health and identity development as it relates to racial, gender, and sexual identities. Dr. Bard is currently researching opportunities to practice outpatient psychiatry in Illinois after graduation.