“I’m tired…”: The Impact of Racial Battle Fatigue in Health Professions Education

• In Event: Educator Trauma and Identity: Perspectives Across the Postsecondary Education Continuum

Abstract

“I’m tired…”. Two words that we’ve all spoken before. While a common phrase, the tone, context, and impact of these words may be different for individuals from racially minoritized (RM) groups – particularly, those working in historically white environments. In fact, such exhaustion may be a manifestation of racial battle fatigue (RBF), which includes the physiological, mental, emotional, and behavioral effects associated with navigating racial microaggressions (Pizarro and Kohli, 2020; Woods et al., 2021). Research from Quaye et al. (2020) explored these visceral effects of racism with individuals experiencing RBF. Participants noted that it felt like they were in an actual physical battle, reported feeling anxious and hyperalert, and mentioned suppressing anger amongst other tolls associated with RBF. Thus, when an RM individual expresses they are “tired,” the impact may extend beyond those mere words and may be deeply damaging (or even traumatizing).

Pizarro and Kohli (2020) conducted research whereby participants described the racism they experienced in a historically and predominantly white environment through the telling of counter-stories (Yosso, 2006). Ms. Shakur, a participant identifying as a Black woman, who was described as “upbeat” and “positive” and having a reputation for being “…engaging, caring, and critically conscious…” experienced microaggressions by white peers (Pizarro and Kohli, 2020). Ms. Shakur noted that she called out and challenged this hurtful behavior, but after experiencing it for more than five years, it took a toll. Ultimately, she decided to leave the “…school and the students she loved because she could not take the disrespect…” (Pizarro and Kohli, 2020, p. 969).

Such experiences are also rampant in health professions education, where systemic racism is simultaneously a threat to public health and a direct risk to the health of RM faculty. In particular, RM health professions faculty are overwhelmed with both experiencing trauma from racially charged events, both personally and professionally, while simultaneously being tasked with “fixing” this same system (Arya et al., 2020). Research from Alexis et al. (2020) found that RM individuals in academic medicine encounter more increased scrutiny than their counterparts. Bianchi et al.’s (2022) work acknowledges the structural racism in dentistry and the impacts on the profession and patients. Research in pharmacy education has explored microaggressions, the lack of RM faculty, and the burden RM students feel to succeed (Bush, 2020; Campbell et al., 2021; Woolen et al., 2024). However, there is limited research in health professions education regarding the experiences of racism in the context of RBF. Such research is needed to better understand the visceral experiences of racism, the impact on RM groups’ health, and the ways in which healing could occur (Okello et al, 2020). The purpose of this conceptual contribution is to (1) define RBF, (2) discuss the ways that RBF may impact health professions faculty, and (3) make the case for incorporating RBF into trauma-focused research on health professions faculty. In doing so, this contribution offers an important perspective on education justice and renewal by centering this important component of identity-based trauma for an under-researched population.

Author

• Antonio A. Bush, Association of American Medical Colleges