Alexander Andreia B, Palmer Megan, Palmer Dajanae, Pettit Katie
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Department of Educational Leadership and Policy Analysis, University of Missouri-Columbia, Columbia, Missouri, USA.
Acad Emerg Med. 2025 Feb;32(2):137-146. doi: 10.1111/acem.15034. Epub 2024 Oct 21.
Diversity, equity, and inclusion (DEI) in health care fosters many positive outcomes including improved patient care. DEI initiatives are often created by or require buy-in from departmental leaders with low DEI literacy. Book clubs are one way to develop DEI literacy. The purpose of this paper is to describe how leaders in the department of emergency medicine (DEM) process the information gained from reading a DEI book through discussion in a book club setting and explore how participation enhances their DEI literacy and fosters self-reflection.
This was a qualitative exploratory study based on a constructivist approach. Data were analyzed by four researchers using inductive thematic analysis techniques.
Sixty-eight leaders within the DEM participated in 11 book clubs. Nine themes were identified (examination of privilege, initial reaction to discussion about racism, discomfort, worry, self-reflection, release, role recognition, readiness, and education). After prompted examination of their own privilege participants moved through a model of perceived readiness to act. Participants started with feeling paralyzed by the work's enormity or becoming defensive. They then moved toward discomfort with discussions of racism and systemic racism and progressed to discussions around worrying that they were contributing to noninclusive environments. After a period of self-reflection, participants tended to release their paralysis, push aside their defensiveness, accept the role of discomfort, and express the importance of education on these issues. Participants then recognized their role in creating inclusive environments and started discussing what they can do about it, which, for many, was to show up to the conversation. An underlying driver of movement through this model was the education that was provided through the book.
By addressing privilege and systemic inequities through the reflective practice and dialogue of a book club, participants demonstrated a growing commitment and perceived readiness to advancing inclusive practices within medicine.
医疗保健领域的多样性、公平性和包容性（DEI）能带来诸多积极成果，包括改善患者护理。DEI倡议通常由DEI素养较低的部门领导发起或需要他们的支持。读书俱乐部是培养DEI素养的一种方式。本文旨在描述急诊医学部（DEM）的领导如何通过读书俱乐部的讨论来处理从阅读一本关于DEI的书中获得的信息，并探讨参与如何提高他们的DEI素养并促进自我反思。
这是一项基于建构主义方法的定性探索性研究。四名研究人员使用归纳主题分析技术对数据进行了分析。
DEM的68名领导参加了11个读书俱乐部。确定了九个主题（审视特权、对种族主义讨论的初步反应、不适、担忧、自我反思、释怀、角色认同、准备就绪和教育）。在促使参与者审视自己的特权后，他们经历了一个感知到的行动准备模型。参与者一开始因工作的艰巨性而感到瘫痪或变得防御性。然后，他们对种族主义和系统性种族主义的讨论感到不适，并进而讨论担心自己在营造不包容环境方面起到了作用。经过一段时间的自我反思，参与者倾向于解除瘫痪状态，抛开防御心理，接受不适的角色，并表达在这些问题上进行教育的重要性。参与者随后认识到自己在创造包容环境中的角色，并开始讨论他们能为此做些什么，对许多人来说，就是参与到对话中来。通过这个模型的潜在驱动因素是通过书籍提供的教育。
通过读书俱乐部的反思性实践和对话来解决特权和系统性不平等问题，参与者表现出越来越坚定的承诺，并感知到在医学领域推进包容实践的准备就绪。
