Table 2 Constructs of the logic framework for address racism in medicine with an explanation of their logic and the accompanying facilitators of racism based on participant responses
Construct | Explanation | Facilitators of Racism |
|---|---|---|
Understanding racism | The participant expresses an understanding of racism* (or lack of racism) that is incomplete or incorrect. | • Conflating the presence of BIPOC physicians with a lack of racism • Attributing a perceived lack of malicious intent by the perpetrator as an absence of racism • Lack of understanding of how systems of power are required to convert racial bias to racism |
Recognizing racism | A participant who understands racism is unable to attribute racism as a factor in an episode or interaction that they experienced or witnessed. | • The invisibility of privilege† for white physicians who benefit from racism • Subtlety of structural and implicit bias [33] • Lack of validation for BIPOC physicians that their experiences differ from white colleagues due to racism |
Naming racism | A participant who recognizes that they have experienced racism is unable to use the term “racism” to describe the experience. | • Sociocultural expectations and norms: • Maintenance of the physician-patient relationship • Colourblindness‡ • Cultural gratefulness • Coping strategies among BIPOC physicians that focus on denial or ignoring discomfort |
Confronting racism | A participant who names that they experienced racism is prevented from confronting the process or person that was racist. | • The burden of proof on the targets of racism to prove ‘beyond a reasonable doubt’ that racism contributed to their experience • The criminalization of racism such that racism is seen as such a strong or offensive accusation that it is rude or mean to use this term [38] • Social risk of those who ‘play the race card’ |