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It is an unfortunate reality that systemic racism exists in the Canadian healthcare system. It is present in many forms – from microaggressions and perceived biases towards others of different ethnicity, to blatant acts of hatred.
However, steps are being taken to address and overcome some of the practices and approaches that perpetuate institutional racism – a common experience for individuals who are Black, Indigenous or people of colour (BIPOC) when accessing healthcare and who have been shown to have poorer health access and outcomes than others in Canada.
One such step is moving to align UHN Emergency Department (ED) practices with the 16 recommendations agreed upon at the 2021 Canadian Association of Emergency Physicians (CAEP) Academic Symposium on Equity, Diversity, and Inclusion.
"Emergency Departments (EDs) are sometimes the only point of healthcare experience for some populations," says Dr. Jennifer Bryan, an Emergency physician at UHN and CAEP2021 Anti-racism and Anti-colonialism Panel Lead. "Given the diversity of patients seen in EDs across the country, Emergency physicians are uniquely positioned to promote equity in our encounters with patients, peers, and learners.
"I'm pleased to see UHN start looking at how to best align with these recommendations to encourage non-discriminatory practices in hiring, retention and education in our field."
With support from a 40-member working group, 16 recommendations were drafted based on a literature search (including "grey" literature: studies produced outside of traditional publication channels), a national survey of Emergency physicians, and input obtained through community consultation and solicited from expert medical, academic and community advisors before being presented at the CAEP2021 Academic Symposium.
Published in the Canadian Journal of Emergency Medicine, the 16 recommendations seek to address racism and colonialism among key areas such as patient care; hospital and departmental commitment to equity, diversity and inclusion; physician advancement; and professional development and medical education.
As a member of UHN's Anti-racism & Anti-Black Racism Committee, Dr. Bryan benefited from the expert advice of Jacqueline Silvera's, Director, Diversity and Mediation, People & Culture at UHN. Dr. Bryan in turn applied these learnings during the process of developing the recommendations as part of her participation in the working group.
The recommendations provide several concrete actions that both Emergency physicians and the institutions where they work can take to deconstruct institutional racism.
At UHN, examples of how the department is beginning to align with the actions include anti-racism education through ED grand rounds, co-creation of an ED sickle cell working group with patients and community advocates, providing support for physician-staff participation as mentors in the University of Toronto Diversity Mentorship Program (DMP), and working with the leadership of the Emergency Medicine Residency Program to revise current education strategies to more accurately reflect race as a social entity and the impacts of racism and colonialism in healthcare.
"Racism – implicit and structural – is a major problem across all healthcare settings and the negative implications of it are amplified in high stakes, high acuity and high-volume areas like EDs," says Dr. Sam Sabbah, Chief of Emergency Medicine at UHN.
"UHN Emergency Medicine, through Dr. Bryan's invaluable work, is taking a major leadership role nationally and globally, by providing actionable recommendations on combating racism in EDs and ensuring that these spaces are positive healing environments for all."