Responding to EDI Concerns Raised During Clinical Rotations

Even in the best work and learning environments, PA students can experience discrimination and bias. When bias or discrimination happens in a clinical setting by preceptors or patients, PA students are negatively impacted and may find difficulty completing their rotations. In addition, students may be struggling to meet professionalism standards that can lead to challenges completing their program on time.

Tiffany Maxwell, DHSc, MSA, PA-C, assistant dean and program director at Lincoln Memorial University, shared some thoughts recently that may help a program’s staff and leaders prepare future PAs for the clinical environment.

PA educators must help students address professionalism

Maxwell said she believes PA students are struggling with soft skills like professionalism and an acceptable bedside manner when they transition from the school setting into the health professionals setting.

Maxwell used examples like explaining to students they may be losing a patient’s trust if they are using their phones while in the patient room or the importance of calling someone at a clinical site if you must miss a shift rather than just sending an email or text message.

Maxwell said all students struggle in this way, but with students of color, “there is no grace in those areas.” This inequity can lead students of color to face a delay in graduation, a need to repeat a course, or even dismissal from the program.

Maxwell has responded by being very firm with students while she’s teaching them so they can understand the critical importance of professionalism before they begin their didactic year.

When a student encounters potential bias or discrimination, encourage them to address it where it happens

“Remember, although we describe our cohort as students, they’re adults. They’re college graduates. They’re wives, they’re husbands, they’re spouses, they’re mothers, they’re fathers. Now, the ‘how’ is always what I’m worried about but as far as the incident, I tell them, address it where it stands” Maxwell said.

Maxwell said she had a student who raised concerns because she felt she was dismissed before having a chance to see as many patients as she thought she should. Maxwell said she asked the student if she had asked why it happened. She pointed out the student was an adult and would soon be expected to address these issues on her own without an educator’s support.

“At that point, my belief, as a program director and as a person is to address it. Be transparent about it because if you don’t call it (out,) it’s not going to be fixed,” she said.

Encourage all staff to consider their words carefully

Maxwell noted she had a preceptor working with her students who had a habit of describing African American female students as “aggressive.” The preceptor didn’t understand why that was a trigger for some students.

Maxwell responded by reading aloud the definition of “aggressive” from a dictionary which cited “likely or imminent attack.” Maxwell asked the preceptor if she truly believed the student posed an actual risk of a likely attack at that moment.

“Once you bring it out, it sounds silly,” Maxwell said.

While Maxwell said the preceptor did not necessarily respond well and that she herself had some critique for the student; however, she believed the way she handled that incident was a learning experience for all involved and created room for growth.

Don’t be afraid to have uncomfortable conversations

Students, especially if they’re URiM (Underrepresented in Medicine), are going to experience bias and discrimination, intentional or not, and sometimes those experiences will be with mentors, teachers, or other healthcare professionals.

“Uncomfortable conversations are where progress happens and that’s where we see the most growth on both sides,” Maxwell said.

For more ideas to help address equity, diversity, and inclusion in your program, download PAEA’s DEI Toolkit and accompanying Best Practices Guide.