VCH medical staff had the opportunity to explore the differences between gender, sex and sexuality and their implications for our work in a recent Out Loud and Proud workshop. Anti-Racism Advisor Neila Miled with the UBC Faculty of Medicine’s Respectful Environments, Equity, Diversity & Inclusion Office, and Equity Education Strategist Rachael  E. Sullivan from UBC’s Equity and Inclusion Office facilitated the session that was presented by the VCH Medical Staff Diversity, Equity and Inclusion Committee, the Vancouver Physician Staff Association, and the Richmond Hospital Physician Society.

The session opened with the opportunity to suggest “burning questions”—items medical staff wanted addressed over the two hours spent together. These included how to translate what was learned to make a difference, how this type of material can be integrated into curriculum for early professional program, ideas for letting patients know when an office is a safe space to share gender identity, how to respond to colleagues who don’t understand the importance of respecting pronouns, and how to move beyond creating awareness and provide tools to reduce discrimination.

The facilitators played the first few minutes of a Ted Talk by Valerie Alexander that highlights unconscious bias.

“Most of us are not even aware of our biases; this workshop is an opportunity share your vulnerabilities and to become aware of some of your unconscious biases,” said Neila. “It’s a chance to have a sense of safety even in discomfort.”

She and Rachael reviewed three normative frameworks that make it possible to have unconscious biases:

• Cisnormativity, which assumes that cisgender is the norm and privileges this over any other form of gender identity.
• Heteronormativity, which is based on the attitude that heterosexuality is the only normal and natural expression of sexuality.
• Amatonormativity, a word coined by Elizabeth Brake to describe the widespread assumption that everyone is better off in an exclusive, romantic, long-term coupled relationship, and that everyone is seeking such a relationship.

“Holding these beliefs can lead to common microaggressions,” said Rachael. “These can include the use of heterosexist or transphobic terminology, endorsing heteronormative culture and behaviours, not recognizing diverse relationships and chosen families, assuming a universal LGBTQ experience, assuming sexual pathology or abnormality, and denying bodily privacy. These beliefs can make a clinical space unsafe and may lead patients to not disclose their gender identity.”

The workshop included an overview of sexual orientation and gender identity beginning with a conversation about the 2SLGBTQIA+ acronym:

• 2S = Two Spirit
• L = Lesbian
• G = Gay
• B = Bisexual
• T = Trans
• Q = Queer
• I = Intersex
• A = Asexual
• + = The ever-expanding identities

“Knowledge,” Neila reminded participants, “is the first strategy for respectful and inclusive practices.”

Participants learned the importance of respecting a person’s chosen pronouns and that sharing these helps to raise awareness of how important pronouns are in our everyday interactions.

“Gender inclusive language is important when building relationships with new clients,” said Neila, who referenced UBC’s Inclusive Language Guide.

“It’s about thinking through your assumptions,” added Rachael. “Rather than asking a patient about their husband or wife, use the word partner. Instead of referring to a patient’s son or daughter, mention their child. The same goes for gender-affirming care. Use words like upper body rather than breast or chest.”

One of the most important things to remember as we educate ourselves about the differences between people is that we will make mistakes. And the best way to learn from our mistakes is to acknowledge them, use the correct word, term, or pronoun, and move forward.

“Don’t make a big deal out of your apology, as that puts pressure on the other person to make the person who made the mistake feel better,” said Rachael.

She and Neila suggested ways for medical staff to become upstanders. Strategies for action when you encounter microaggressions include the five Ds: direct; delegate; distract; delay; and document. Which ever way you choose to act, they emphasized, be respectful and avoid shaming.

“You can be an active witness to a microaggression by interrupting, expressing hurt feelings, disagreeing, questioning the validity of a statement, pointing out how something is offensive, and by supporting the receiver of the microaggression.”

The presentation concluded with the P.A.U.S.E. framework designed to interrupt everyday bias:

• P = Pay attention
• A = Acknowledge your assumptions
• U = Understand your perspective
• S = Seek different perspectives
• E = Examine your options and make a decision

Participants provided positive feedback to the workshop and spoke of how the session had empowered them.

Wrote one: “This has been a remarkable presentation. Thank you both. So much to reflect on. We need to have this be incorporated in undergrad medical curriculum.”