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Bias and racism – unconscious or not – affect health care, so representatives from the University of Texas at El Paso and Texas Tech University Health Sciences Center El Paso have started to use theatrical role-playing to train health care providers on ways to deal with social discrimination.
Starting with the fall 2022 semester, a few faculty at both institutions infused training, workshops and curricula with elements learned at a weeklong training in August at UTEP that showed participants how they can confront biases, cultivate empathy and practice effective communication to enhance interactions with patients and colleagues.
Hideaki Tsutsui, chair and professor of theater at UTEP, was among those who participated in the Theatre for Healthcare Equity workshop that is based on facets of Theatre of the Oppressed – a method of critical thinking used as a tool for conflict resolution and community building. It focuses on acting as opposed to talking.
“This is a great outlet for theater to contribute to health care,” said Tsutsui, who presented the concept at a UTEP College of Health Sciences health disparities conference in September. “It serves as a bridge.”
Texas ranked in the bottom quarter in the health care treatment of Blacks and Hispanics nationally, but in the top 40% for its treatment of whites, according to a 2021 report by the Commonwealth Fund, a New York-based health policy foundation.
The report found that minorities were not offered the best available treatment and that they were denied or delayed access to services because of their race, ethnicity or the language they spoke.
Dr. Sadhana Chheda, associate professor of pediatrics at TTUHSC El Paso, participated in similar workshops in 2018 and 2019 as well as the August presentation. She liked how the program, which involves a lot of role-playing, provided medical personnel with a safe place to share situations, act out possible solutions, and encourage internal reflection and behavioral changes, if necessary.
“In the end, you’re really trying to make people aware of certain things,” said Chheda, who requested UTEP’s participation with the approval of TTUHSCEP leadership. “It has to come from within. In today’s environment being so polarizing, I thought this was a powerful way to teach.”
Adriana Dominguez, an assistant professor of theater at UTEP, said she incorporated games and activities inspired by Theatre for Healthcare Equity into her fall 2022 Latinx Theater course. She said it helped her students understand course material better. Dominguez said that her department has submitted proposals to present the material at two national health care conferences in 2023.
Carli Gaughf, founder and director of Theatre for Healthcare Equity, said the August workshop was the first time she offered a session to participants outside the medical field and the first time that she conducted the training outside the University of Rochester in New York where she is an educator in the Office of Equity and Inclusion.
Gaughf, who earned theater degrees from Florida State University and the City University of New York, based the theater program on her passion for social justice and familiarity with Forum Theatre and Theatre of the Oppressed, which give audience members the opportunity to join actors on stage to be part of the storyline. It uses theater to rehearse reality.
The first three five-hour sessions focused on instruction. The “trainees” used the last two days to demonstrate their competency as trainers.
Gaughf called the inclusion of theater faculty a smart collaboration because it generated new ideas and modified existing ones. She said the artist educators helped their medical peers to grasp abstract concepts, which allowed for deeper conversations about bias and racism. Gaughf said the main thing she learned from the experience was to use theater techniques to push the medical participants to be more playful as they venture out of their comfort zones.
“This is the process of discovery,” Gaughf said. “We’re leading people to discovery and not telling them how it should be. We’re discovering together because we don’t have all the answers.”
Rebecca Kenigsberg, director of the Restorative Theater Project and an educator who earned her theater degrees from UCLA and New York University, served as Gaughf’s assistant facilitator. Kenigsberg, an expert in the Theatre of the Oppressed, said she advised the future trainers to use non-threatening and non-judgmental questions to dig into the real issues of bias and racism because those answers would provoke the thoughts that would trigger the transformation.
“If this was easy to fix, we wouldn’t be doing this,” Kenigsberg said.
Chheda, the Texas Tech professor and a physician for more than 25 years, said she has faced discrimination based on race, gender and, when she was younger, age. The pediatrician said that her medical training did not include how to deal with bias and racism.
She said today’s medical students discuss social aspects of patient treatment, but the message gets lost in the lecture sometimes. That is why she wanted local people trained in this kind of instruction to help medical professionals in the region and beyond to understand the negative impact of health care inequities.
In 2021, there were more than 178,000 health care providers to include dentists, physicians and their support staff in the state, according to the Texas Department of State Health Services,
Of the community health workers, 61% were Hispanic, 22% were Black and 36% were female. Of the over 58,000 primary care physicians, 7.7% were Hispanic, 6.4% were Black, and 36% were female. Of the almost 15,000 dentists, 11.2% were Hispanic, 4.5% were Black and 37.7% were female.
Chheda and Tsutsui said they wanted to see both of their institutions continue to work together to create a regional hub for interdisciplinary research and instruction on this subject.
Tsutsui said he liked how the method focused on teamwork and could be customized to talk about other tough subjects in nurturing ways with participants from different backgrounds. He said he planned to use some of the workshop’s techniques to enhance student engagement.
The professor said UTEP leaders were supportive of the university’s participation, which included some faculty from the College of Health Sciences. His hope is that theater and dance instructors will continue to train with Gaughf and Kenigsberg to the point where his department could offer a certificate to students who want to conduct similar health care training for medical professionals.
“I think this would be popular with students,” Tsutsui said. “It’s a fresh kind of instruction.”