'Better Than We Found It' - Addressing Unconscious Bias in Higher Education

“I remember being very aware of one of our classrooms - there were paintings of white men lining all four walls,” says Iris Burns, MPH. “It felt like an ironic suggestion of ‘We’re saying this space is for you, but really, it’s not.’”

Burns is pursuing a doctorate in occupational therapy (OT) and she is one of two Black students in the class of 2022. A 2019 national survey conducted by the American Occupational Therapy Association (AOTA) shows that nearly 84% of OT practitioners are white, and 74% of OT students are white, with Black, brown and indigenous communities being the least represented.

For Burns, being in the throes of a doctoral program just as the pandemic and racial injustice were sweeping across the nation and devastating her community was particularly challenging – especially separating the classroom from the outside world.

A little more than a year after George Floyd’s murder, we talk to Burns as she reflects on coping with racial bias while being a student, the added layers of stress that come with learning in a field where there is little representation of one’s identity, and the journey that led her to wanting be an occupational therapist. We also discuss a letter that she wrote to the president of Thomas Jefferson University, Dr. Stephen Klasko, with the support of her program director Dr. Tina DeAngelis and other faculty members. That letter led to an impactful and hopeful conversation.

“We had a brave and powerful discussion about ways we can work together to advance our diversity, equity and inclusion efforts and to improve as a university,” says President Klasko. “In so many ways, the past year has changed all of us profoundly. It demanded that each of us take a critical look at the shadow we cast – at how we affect others through our words, our actions and the exchanges we have both academically and as human beings. Jefferson is committed to building a diverse and inclusive environment for everyone. We continue to learn and will not shy away from these conversations.”

“I am repeatedly impressed by the bravery, tenacity and commitment of our students,” says Provost Dr. Mark Tykocinski. “What sets Jefferson students like Iris apart is their courage and willingness to speak up in constructive ways that help us continuously improve. Our mission statement, ‘We Improve Lives,’ is about enhancing the lives of everyone—our students, employees, patients and the communities we serve. To accomplish this mission, we have to be willing to see things through the lens of others. It is about understanding, embracing and respecting our differences and similarities. We have already accomplished much along these lines at Jefferson, but there is clearly more to do.”

Here is our conversation with Iris Burns.

How did you become interested in occupational therapy (OT)?

It’s funny, everyone in OT will tell you they want to help people – but it’s true! I didn’t learn about OT until my senior year of college. It was really intriguing, but it wasn’t a very familiar career path for me, so I first pursued my master’s in public health (MPH). I focused on diabetes research in Alabama, where I’m from. I enjoyed it and liked connecting with patients, but I felt like I needed to be more embedded in the community.

I found my way back to OT when I moved to Alaska, when my husband was stationed there as part of his active duty in the air force. I was taking some time to think about what I wanted to do, and decided to shadow an occupational therapist. One of the patients was an Alaskan Native who had just suffered a stroke. She was in charge of berry picking in her tribe. For a long time, the patient was making very little progress during in-patient rehabilitation, and you could see the toll that being isolated from her community was taking on her. The therapist changed her approach and designed interventions more tailored to the patient. She asked what berry picking involves and simulated a berry patch as a treatment. You could see the change in the patient almost immediately.  Over time, her fine motor control started to come back, her outcomes improved, and she was eventually able to go home. Watching this was a pivotal turning point for me, because it showed me not only how occupational therapy can be life-changing, but also when infused with cultural sensitivity, can really expand its impact. It was just amazing to me.

Did you see representation for yourself in OT? How did that impact your decision to pursue OT?

I knew entering the field of OT that there was little representation for the Black community. In fact, when I was applying to OT programs, a big factor for choosing Jefferson was because there was some diversity compared to other programs I applied to where I was the only person of color out of hundreds during the interview days. But even here, I am one of four Black students in our entering years’ combined cohort of 80.

During my MPH, I remember interacting with a lot of people belonging to marginalized communities, who are disproportionately affected by diabetes. There was so much distrust of researchers, doctors, and just the entire medical system. It’s very understandable, given the history of how Black and brown communities have been exploited and misled in the American medical system. I think, in order to address that distrust, we need more representation.

I think about my grandmother often. I imagine her in a medical situation, and the fear she might experience about not receiving culturally sensitive care, or feeling like she can’t be her authentic self. Then I imagine her seeing my face; that might help her feel more comfortable and overall improve her health outcomes, just by forging that trust.

Occupational therapists serve a unique role in a care team, and sometimes have the most interaction with the patient. I see that as a really big opportunity to make a patient feel safe and empower them to participate in medical decisions. There are so many people out there in marginalized communities who experience negative outcomes that can be avoided. Even if I can help one person out there, it helps to close that divide.

What were the first few months like as a student at Jefferson? What was it like being in a learning environment with little representation?

I’m from the South, then I moved to Alaska where there’s even less of a diverse population.  I know what it’s like to be in the minority, especially in academic and medical settings. But when I did a virtual interview with Jefferson, without even stepping foot on campus or in Philadelphia, I knew that I wanted to come here. I can’t explain it, but I felt like I belonged. My program director, Dr. Tina DeAngelis, was a big factor in my decision to choose Jefferson. I immediately felt that she cared so strongly about her students and their experiences. Once I got here, I was also encouraged to learn that there were a few faculty members of color; in fact, my advisor is a Black faculty member and that gave me a renewed feeling of ‘Okay, this is where I’m supposed to be.’ Seeing her in a faculty position also made me feel like I could see myself in roles outside of a traditional clinician.

In the first semester, I did notice little comments, little microaggressions that wouldn’t necessarily be addressed. And it wasn’t just about race, it was all sorts of identities that we as occupational therapists should be sensitive to. It felt like these were opportunities for teaching moments, but instead they kind of just got laughed away or swept under the rug.

When and how did things start to shift for you in the classroom?

By the time the third semester had started, the pandemic had hit and that was, of course, such a stressful time for everyone. Then a couple of months into the pandemic, George Floyd was murdered. Like so many Black people in this country, I was so traumatized, and feared for the safety of my loved ones. A few weeks after his death, in one of my research classes, we were assigned an article called “Black Man Hunting” and it was about police-induced trauma on the Black man’s psyche. I know that this was part of the curriculum that had been planned ahead of time and I appreciated that we were touching on this important issue, but it was incredibly triggering and difficult to read given the circumstances. Not just for me, but the entire class – we were all looking inwards to see what we could do to make a difference. But it definitely made it hard to focus on assignments or homework, and all I could do was put my thoughts down in a letter. It was cathartic to express what I was feeling.

After a really hard summer, the fall semester rolled around and one of my classes was on community-based OT and emphasized cultural sensitivity. Ironically, this ended up being one of the most challenging experiences. In the first or second week of this class, we discussed a scenario in which police were called to a classroom and arrested an eight-year-old Black child who was experiencing a crisis. We were asked if the situation was handled appropriately. I understand that there are differences in opinion. However, the rhetoric used to describe this Black child – scary, angry, aggressive and violent – was really harmful and disrespectful and should have been pushed back against. There were about 20 of us in the class, and although there was some apparent discomfort, no one said anything. I could not stay silent. I tried to say that it’s damaging to use language like that, especially with a child, and it can bias our behavior as healthcare professionals when we’re out in the community.

How did this impact your learning and experience in that class afterwards?

That was my first time in all my years of schooling that I have wanted to leave a classroom and never step foot back into it.

Going back to that class after that first incident was so re-traumatizing. At the same time, I wanted to excel at what I was doing and participate in meaningful discussions. But I felt like I couldn’t be myself, and it definitely impacted my learning. I didn’t participate in group discussions as much. I had trouble focusing. I’m supposed to come to class to learn, but how can anyone learn in an environment where they don’t feel empowered?  I felt I really had to endure and survive that classroom. Like everyone else, I deserve to thrive, not just survive. Unfortunately, there were similar incidents, and I continued to bring them to the attention of my program director, who was so supportive. Eventually, it escalated to the point where I was taken out of that class and put in a different classroom. That was even more disheartening because, in some ways, it felt like I was being punished for speaking out, rather than actual change being made or anyone being held accountable. In the new classroom, I did however experience the reality that differences of opinion can coexist to facilitate the learning process while maintaining cultural sensitivity. Because I saw that this was attainable, this is what fueled me to keep pushing for changes.

What is it like to navigate that decision of speaking out, or keeping your head down in the classroom, where discussion is so vital for active learning?

Being a student, you’re just trying to get through, learn, and make a good impression. That incident was definitely a turning point. There were so many times after that I wanted to speak up, whether it was to answer a question, to offer a different viewpoint or call out something harmful, but I didn’t want to be seen as that person who always has a problem. So, there was this constant internal dialogue – should I just try to learn, or should I try to make this a teaching moment? And that’s a battle that many students who come from underrepresented minorities face. But why should the burden fall on us to embrace those teaching moments? It’s just depleting, emotionally and mentally.

While I was trying to manage all of my classwork and my experiences in the classroom, I had written a letter that I shared with my program director and IDEA (Inclusion Diversity and Equity) committee liaison for our department, Dr. Lydia Navarro-Walker. The support I received from them was truly amazing and it encouraged me to share it with a larger group of faculty members, who were also supportive. I was having meetings, sometimes twice a week, trying to find answers as to how I can impart change and facilitate different classroom experiences for future students. And even if they do experience similar exchanges in the classroom, I wanted to make sure that they have a community behind them and a safe space to express their concerns. I wasn’t sure if I was doing enough to make a difference. One day, I was reading one of President Klasko’s Friday Letters to the Jefferson community, and he had quoted an Alicia Keys song called “You Matter.” Something about that resonated with me, and I decided to send the letter to him.

What was this letter about? What was Dr. Klasko’s response?

It was called “Visible for Jefferson, Invisible to Jefferson.” A little before the first incident in the classroom happened, there was a photoshoot for the OT department page, and they were looking to showcase the diversity of the program.  I had my doubts about it due to the lack of diversity in the OT student cohort, but I thought about if I had seen a Black student and other people of color on a program page, maybe it would have given me a sense of belonging. There was another time that pictures were being taken at an event on campus, and there’s a shot of me that ended up on the third floor of the library. It felt so incongruous to see that, and then have that experience in the classroom where it felt like my Blackness was not being protected in any way. It was genuinely difficult to know if my presence on this campus was valued or not.

After sending the letter, my program director and I set up a meeting with President Klasko and Provost Tykocinski. When we met, it wasn’t just about sharing my experience. I wanted to be able to present ideas for change. I presented data on the lack of representation in OT, and a proposal for how we could change that, especially since Jefferson’s OT program ranks  #6 in the nation. We have opportunity and responsibility to lead in the nation for increasing diversity efforts in OT. I wanted to leave Jefferson in a better place than when I arrived. That proposal actually formed the basis of what I plan to focus on in my third year.

Tell me more about that!

The main idea is to create a physical space – a multicultural student center - where all students, but especially those who come from marginalized communities, whether it is race, ethnicity, gender and sexual identities, can come together and express themselves authentically. I’d really like for it to be a haven of sorts and conversation starter for people from different identities to learn from each other. I think having this intentional space to build relationships, trust and talk out any differences we may have, can have a cascading effect in terms of improving diversity. I believe it could help make not only recruitment of more diverse students more top of mind, but retention efforts as well.

How do you think you’ll look back on this experience?

I can’t find the words to describe it. On the one hand, I would not be the person that I am right now without this experience, but on the other hand, I’m disheartened by it. I'm thankful that I had the opportunity to fight for what I believe inclusive spaces should look like in the classroom. But I also know that these experiences were depleting. I will say, however, that I don’t think I would have been able to speak out like this at other schools I considered. It was because of the support of my program director, my advisor, certain faculty members, interdepartmental members and President Klasko, that I felt safe and supported enough to try to enact change and to speak my voice here at Jefferson. I could have just kept my head down and stayed silent until I graduated. But this is bigger than me. I’m speaking out for all the students that will come after me.

What do you think you’ll tell other young Black students who are interested in this space of OT?

That's a really hard question because I don't want to influence their experience before they’ve even started. But I do want to be honest about the fact that it will be challenging. Our whole country is coming to terms with the conversation around racism and racial justice, and I know it’s going to take time and intentional efforts for change to occur. So, I would say be patient, believe in yourself and your abilities and that you deserve to be in this space to learn and thrive.

**************

Editor’s note: These difficult, but necessary, conversations have sparked a larger discussion about how to build a more inclusive OT curriculum, as well as improve representation. In her role as chair of the Commission of Education of AOTA, Dr. DeAngelis says bearing witness to Burns’ experience and others that have come before her, here and at other OT/OTA programs across the country, has served as an impetus for the commission to enact change at the national level and to strive to develop supportive content for both students and faculty.

“It is time for the field of OT to change and more accurately reflect the communities they serve, and Iris has been a vital agent for that change,” says Dr. DeAngelis. “She is the voice in the back of my head when I’m having discussions about how to ensure that students and faculty of all backgrounds feel supported and are given equal opportunity. Iris doesn’t realize it, but she’s made a huge impact not just at Jefferson, but at the national level as well.”

In addition to Burn’s push for change, the department chair, Catherine Piersol, PhD, dedicated faculty and in particular, faculty of color - Lydia Navarro-Walker, OTD and Tracey Vause-Earland, PhD – have facilitated important changes. There is a planned partnership with health science high schools in Philadelphia, whereby faculty of color visit to raise awareness about OT and provide exposure to underrepresented communities; a revised approach to admissions interviews to address implicit bias; and a more structured and intentional training around diversity, equity and inclusion.

Burns proposed awarding a yearly scholarship to an OT student who demonstrates advocacy and leadership related to diversity, equity and inclusion. Dr. DeAngelis hopes it will be called the “Burns Scholarship.”

There has been a broader push for change at the University. With the resoluteness of the Board of Trustees, President Klasko and Provost Tykocinski, and under the leadership of Chief Diversity Officer, Lisette Martinez, a Blueprint for Action has been created to: institute anti-racism and anti-bias training across Jefferson; address underrepresentation among leadership, faculty, staff and students; create diversity councils; and facilitate open and safe dialogue across the community.

*Note: This article reflects the expressed views and opinions of those interviewed.