In the wake of the racial injustice events and protests during summer 2020, the faculty and staff at the University of Houston-College of Pharmacy (UH-COP) felt a sense of helplessness and alarm. UH is generally proactive circulating and creating statements to show support for anti-racist education, changes in social justice, diversity, equity and inclusion. However, this time it was not enough. We wanted to have the courage to take a collective stand against racial prejudice, have the bravery not to remain silent.

Confronted with the question on why we have not solved this long history of racial tear in our country, we recognized we do not understand how we got to this situation in the first place. Our country’s present situation suffers from a lack of attention to the root causes. Thus, a better understanding of those root causes would help us discover how to move past where we are right now,  provide us with the tools to advance and to have open conversations about race and social injustices.

With that effort in mind, the Office for Faculty Development at UH-COP designed and implemented a challenging program for faculty and staff over a 9-week period during the summer of 2020. The program combined open free sources as well as loaned films, together with facilitated sessions by Pharmacy experts. Because it was important to participate in this significant moment, the program started less than three weeks after the death of George Floyd, while the protests and civil unrest, as well as the pandemic, were still present in the USA and around the world. 

Herein, we outline the approach taken to changing minds and behaviors in our academic unit, building understanding to racial disparities, diversity, equity and inclusion. As part of the program, we facilitated particularly emotional exchanges among faculty and staff, collecting both personal and professional experiences that shaped us around biases and racism. Additionally, feedback from participants regarding the effectiveness of the program was gathered. After this educational experience, it is our commitment to continue bringing awareness to this topic through inclusion of additional relevant topics and work with our students as elements of change. 

The Covid-19 pandemic has altered our personal and professional life as well as our society. Regrettably, many lives have been lost, and everyone knows somebody that passed away victim to the virus. In addition, we abruptly had to change our practices to continue being effective. In Higher Education, we had to move to online instruction and clinical practices, using new technology to continue training our scholars. A few months into this scenario, many inequities were uncovered, with certain minorities presenting cultural and socio-economic problems that Institutions did not anticipate. We realized that this global pandemic affects disproportionally our most vulnerable populations in the United States and around the world. 

While looking through that difficult lens, regrettably, we further witnessed an outpouring of systemic racism in its many forms, with the killing of blacks, increasing police brutality and confusing politics before, during and after 2020. Though institutions placed statements on websites supporting diversity, equity and inclusion, the breadth of racial disparities in our daily life, the educational and health system, as well as our society struck us hard, yet again. 

Racism is silently rooted in political and economic organizations within our social world. Examples in history showing how a past of repression, abandonment and violence (such as discrimination in housing, wealth, employment, and social services), intersect with politics, policies, law enforcement, and public health, are not familiar, even though they are intimately linked and demonstrated in the present society.  Many voices of the past have stated their views on racism worth noting. Systemic racism refers to the structures, organizations, beliefs, and practices acting together in a way that generate and maintain inequities among racial and ethnic groups (Powell, 2008). These systemic/structural instruments do not need the actions of people to survive (Bonilla-Silva 1997), as they are constantly altering the conditions necessary to ensure their dissemination (Link and Phelan, 1995). That means that even if individual discrimination were entirely eradicated, racial inequities would undoubtedly remain unchanged due to the persistence of structural racism (Jones 2000). 

The College of Pharmacy at the University of Houston was not an exception to this unfamiliar history. Thus, as part of the mission of the office for Faculty Development we decided that the best course of action during these tumultuous times was to embark on a review of our history, and educate our faculty and staff on the roots of the systemic racism that we suffer today. Hence, we designed and implemented a challenging program over a 9-week period. The program combined both, open free internet and paid resources, and finalized with a facilitated session in which faculty and staff talked about institutional racism, and exchanged personal and professional experiences around bias and bigotry. Additionally, a poll provided feedback from participants regarding the effectiveness of the program. 

We believe that this program helped us reach an understanding regarding the status of systemic racism in our society and community today. We were able to learn and confront our painful history, which will help us develop effective anti-racist personal reactions to entrenched inequalities. As health professionals, administrators and academics, this knowledge is important to confront also the disparities exposed during the COVID-19 pandemic and others perhaps to come. After this educational experience, it is our continued commitment to keep up the awareness through inclusion of additional relevant topics and work with our students as elements of change.

While 2020 has not been easy in many other fronts, the national climate regarding racism, (suffered by people of color in their everyday life) loudly exploded once again after more than 400 years of slavery, genocide, oppression and neglect, with the murder of George Floyd in May 25, 2020 at the hands of the police. Because it was important for us to participate in this significant moment, the office of Faculty development started researching for program options while the protests and civil unrest were still present in the USA and around the world.

1. Participants 

Our group of faculty (n=82) and staff (n=54) at the College of Pharmacy-UH included a diversity of race, rank, age, and sex (Figure 1 and 2).

Figure 1.- Faculty headcount (n=82) for 2020 at the College of Pharmacy-University of Houston. A) Faculty rank and race/ethnicity reported 
B) Faculty rank and gender reported.

Figure 2.- Staff headcount in % ( n=54) for 2020 at the College of Pharmacy-University of Houston. 
A) Staff race/ethnicity reported 
B) Staff gender reported.

The group of participants (averaging ~35-40% of faculty and staff, depending on the session) was composed of individuals with either prior training in diversity and health education (67%) or no prior training at all (33%), as depicted in Figure 4. Because we included all faculty and staff, the group was both intra-professional and interdisciplinary (faculty, basic scientists, clinical faculty, administrators and other staff), providing a broader lens on our collective view of diversity. The institutional review board (IRB) at the University of Houston determined that this study was exempt from review.

1.  Program Objectives 

To develop the program, the first impulse was to offer a workshop where we could have a conversation. However, there were two disadvantages to that selection: 1) the emotional labor for our people of color, which have been fighting racism for a long time, and they appear exhausted; 2) the disinformation and confusion over systemic racism, what is it, and its place in our modern society. Thus, our call to action prioritized education on the history of racial discrimination and disparities, followed by reflection and exchange. Our race and cultural diversity program pursued several objectives:

• Explore racism and inequality in the United States
• Discover the history of political and institutional interventions that favored racism
• Develop deeper understanding of how policies, practices, attitudes help racism 
• Reflect on our experiences, on higher education and institutional leadership 
• Learn individual and institutional interventions that might address racism
• Engage purposefully with a community of support 

The idea was to develop a program that will enable participants to confront issues of discrimination and xenophobia effectively and from the roots. By the end of the program, our vision was to change minds, grow a community of support, with a better sense of understanding that could translate in better practices for themselves, their departments and their communities. With this in mind, we created a nine-week virtual learning experience, in which participants met once a week to engage with practical tools and resources focusing on the science of race, the history of racism and learn about cultural diversity. The program structure included weekly live synchronous lectures, with embedded videos, documentaries, talks and movies, providing participants information, science and specially history that will give them the opportunity to reflect, make connections and participate in discussions. All materials from this program offered captioning services to accommodate all participants. 

1. Relevant resources for program development

All resources used in this program were obtained from legitimate free internet or subscription-based materials, unshared and used exclusively for educational purposes as described below:

1. Open Internet resources:
2. New York Times video-opinions.- New York Times’ award winning series of short documentaries documenting ‘Conversations on Race’ (2015) with Asian-Americans, Black Americans, LatinX, Native Americans, White Americans, Police, etc. These are interview-based films in which Americans share their experiences with race in this country. 
3. TEDTalks
   1. ‘Let’s get to the root of racial injustice’ by Dr. Megan Ming Francis, University of Washington in Seattle (2015), describing what is to be black in America.
   2. ‘Dark Room methodology: Bringing light to structural racism’ by  Dr. Vibhuti Arya, PharmD and MPH, and clinical Associate professor at St. John’s University College of Pharmacy and Health Sciences in New York (2020). 
4. Coursera ‘Race and Cultural Diversity in American Life and History’ (2018). Course developed by the University of Illinois at Urbana-Champaign, facilitated and narrated by Dr. James Anderson, Dean of the College of Education and Professor of Education and History. This course provides an understanding and appreciation on how race, ethnicity and cultural diversity molded our civilization, institutions, beliefs, laws and human interactions from the colonial times to the present.  The course has four modules:
   1. Module 1 – Introduction to the course, with discussion of concepts on race and identity
   2. Module 2 – Historical legacies of race in the United States of America, presenting a discussion about the 1600’s, origins of slavery, the role of race in the American civil war, and the translation of those times to the reality of today.
   3. Module 3 – A discussion on legacies of race and racism today. How race affects contemporary society, schools and our society.
   4. Module 4 –Discussion on the role of race and ethnicity in America social institutions. A conversation about institutional racism, and how concealing race has proven to increase opportunities.
5. Other resources:
6. Subscription to Vimeo and California News Reel ‘Race: The Power of an Illusion’ (April 2003). This documentary offers three episodes depicting the science of race, as well as very relevant historical events of paramount importance for the manner we see and treat race today.
   1. Episode 1: ‘The difference between us’ – This episode examines the contemporary science and genetics of race, and challenges our assumptions that human beings can be bundled into three or four different groups according to their physical traits.
   2. Episode 2: ‘The story we tell’ – Depicting the historical roots of the concept of race in North America, together with the believes and science of the 19th century, and how that science legitimized the concept of race, using it to rationalize and justify the social inequalities of Americans, calling them natural.
   3. Episode 3:  ‘The house we live in’ – Going deep into the realization that race actually resides not in nature but in politics, economics and culture. A description on how our social institutions make race by disproportionately channeling resources, power, status and wealth to white people.
7. Conversation and exchange with participants facilitated by a moderator with expertise in leading groups on this topic.
8. Program schedule/activities 

The program was delivered sequentially and as indicated in Figure 3. The resources used every week are described in Section 2.3. The director of Faculty development diversified and complemented materials from different sources, which were relevant in content, offering lectures, videos and articles together for every weekly session. 

Figure 3.- Program schedule and flow.

The first eight weeks were designed as scaffold educational modules on the science of race, history of social inequality, privilege and power. During the ninth week, reflection and exchange was encouraged by

randomly assigning participants to four different groups. The groups discussed various prompts, such as:

• What have you learned during the past eight weeks?
• Talk about things that provoked a strong reaction in you
• Share your personal or observed experiences on biases and racism
• How can we be racism ‘interrupters’?
• What is the level of optimism for change this time around?
• How do you see our Institution and how can we help to improve it?

This exchange was followed by a facilitated conversation about structural racism and the effects in Pharmacy education and the health system. 

1.  Learning

By implementing the program, we sought to educate better our academic unit in matters of race and cultural diversity. Additionally, we wanted to understand the experiences of discrimination that we are still suffering today trying to appreciate the interwoven mechanisms of social inequality, privilege and power. Participants learned how system of structures that had procedures rooted in law, and that handicapped African Americans and other minorities, even after being banned, have a strong impact in our lives today. Participants also learned how institutional racism has been obstructing people of color from gaining access to goods, services and opportunities to move ahead. This comprehensive educational program on racism taught us to account for key ways in which historical factors influence our present outcomes. Just to name a few:

1. Economic and social deprivation
2. Housing discrimination
3. Education disparities
4. Employment prejudice
5. Law and policies
6. Health disparities

Participants Reflections

The educational portion of the race and cultural diversity program for Pharmacy faculty and staff was extremely important and eye opening. To revisit the history of racism in the U.S.A so that there is a clear understanding of how the past still affects the present proved essential to engage all participants in reflection. The second portion on reflection and exchange was very honest, active, cooperative and engaging, working with colleagues and learning from each other so that we have the courage to speak about this difficult topic in a more personal manner.

Below is a summary of participant’s reflections, collected anonymously through the group engagement using Google Jamboard:

What have you learned during the past eight weeks?

• The history of racism in US. Especially as a naturalized immigrant perspective. Interesting to learn about Asian and Native American perspective and struggles, along with the African American perspective.
• Existence of so much research supporting the history and origin of racism.
• History of systemic racism, including legal denial of citizenship for ethnic groups that help build America (Asia, China and Africa).
• Access to education has not facilitated closing the gap.
• As a multiracial individual, this experience was eye opening because it made me more aware that racism was wider that my life experiences.
• The relationship between general biases and racism.
• Impactful laws that have perpetuated discrimination.
• Different perspectives of ethnic groups, their identities.
• Taking for granted opportunities, housing, and other privileges.
• Evidence to back up/confirm/illustrate racism, propagation of disparities.

Talk about things that provoked a strong reaction in you

• Certain social experiments, such as the Doll experiment (black doll is bad, white doll is good) and negative stereotypes affecting children within the Black community (Dr. Kenneth and Mamie Clark, 1950, and Brown vs. Board of education, 1954).
• Shocking cases/stories, like the Japanese individual not allowed citizenship, reverting his rights.
• Learning that Black families need to have an extra conversation with their children regarding police harassment, etc.
• How many historical aspects are not taught in school.
• Overall systemic racism, engrained in policies as a country.
• All the interviews from the New York Times to different ethnic individuals and families.
• TED talk talking about how black people experience injustice.
• The differences in opportunities to grow wealth, housing. The example of Levittown.
• Truly learning about how much historical racism has affected entire group’s ability to access goods, services and health, and what it means for race relations and equity today.
• The fact that science does not support different races, as we know them.

Share your personal or observed experiences on biases and racism

• I only had white dolls to play with as my mom wanted her to fit into the culture I was in (assimilated) and now as a mom, I try to instill in my daughters that they are beautiful just as they are, embrace their own unique beauty.
• After getting a job in a store, I was being followed around. After a while, my boss shared that it was his way of making sure I was not stealing. He never did that to white employees. I have had similar experiences multiple times.
• As a woman, I went to buy car with my husband. Even though I was addressing the salesmen, he always addressed my husband back, never acknowledging me, because he said I probably did not know about cars. 
• Experienced the political theater surrounding CoVid-19, as Chinese Virus, together with stealing American jobs, stealing technology. I feel that politicians often tailor messages to pander certain demographics and gain political advantage.
• I suffered great disadvantage in the education system for not having English as the first language. Higher education was not easy either.
• Institutional racism at play when I was denied to travel to an African country to fulfill my Fulbright fellowship because the institution did not feel that the place was a worthwhile investment.
• Being stereotyped because of my ethnicity and name, offered cleaning jobs even though I am well educated. Not being given the appropriate credentials in front of white male peers at work. Being ridiculed because of having an accent.
• Not an easy journey as an Arab American and the prejudices and stereotypes. A lot of anxieties post-911, lost friends in high school because opting to wear a Muslim head covering (hijab). That feeling of having to work twice as hard, and be twice as careful in order to be recognized as an equal to white peers.
• Double problem tasting racism when you are a person of color and female. Racism and sexism combined.
• Attention must be paid to the many layers of racism. As a brown woman (of color), a person of South Asian descent and a Muslim, I feel I have four layers of biases. 
• Being called ‘African’ instead of my mane at school playground.
• Use of derogatory words on a drive-thru.

How can we be ‘interrupters’ of racism?

• When you see racism occurring call it out.
• Admit you place of privilege and use it in impactful ways.

What is the level of optimism for change this time around? 

• Not very optimistic. Seeing people teach their children makes it feel like we’re not going anywhere. Child’s friends were teaching him not to get along with Black children. It starts with parenting, teaching children to be racist or have hatred toward certain people.
• Tempered optimism: as we begin to see people engaging in discussions like this to make progress. I also feel like progress is not happening due to news/politics. It takes an active approach and discussion to make change.
• Disheartening to see the ugliness of past and current situations. This is deep seated and will take time to start unweaving it. However, this is a start, which is promising. Conversations happening at home and with coworkers – this is where we need to start to make change.
• Optimistic about the future because we are now having real discussions, even though they are uncomfortable for most. It is the hope that some action will occur and change will come, though not right away, but it will come.
• Change has to come now or there will be no hope for the future. We cannot risk the outrage to fade; we visibly see the next generation being better; but actual changes have to come to institutions.
• Optimistic, if we achieve diverse representation at the decision tables at all levels.
• How do you see our Institution and how can we help to improve it?
• Institution is trying and advancing, but more needs to be done.
• Representation within students/faculty – not just about financial support, also need other resources to support faculty of underrepresented minorities.
• Support, support, support!

1.  Participants’ Program Evaluation

After the program was delivered, a survey was sent to all participants to evaluate the series on Race and Cultural diversity anonymously. The survey was based on the Kirkpatrick model (Kirkpatrick, 

1993), the most popular and widely used training evaluation model.

Questions in the survey targeted the four levels of the model: 

• Reaction
• Learning experiences
• Behavior
• Results

A summary of the participant’s evaluation is presented in Figure 4.

Figure 4.- Summary of participants’ program evaluation (~50% of participants attending the sessions participated in the program evaluation; n=29).

Figure 4.- Summary of participants’ program evaluation (~50% of participants attending the sessions participated in the program evaluation; n=29).

Briefly, participants had a beginner (41%) or intermediate (52%) knowledge in matters or diversity, equity and inclusion, with no (33%) or some (67%) prior training. Some participants came to the program with personal expectations (44%), and for the most part the modules meet those expectations (67%). A great majority (91%) found the content presented very relevant to the recent racial chaos and very/extremely useful for learning (69%). The delivery format was deemed to be appropriate and clearly presented (90%). Pre- and post-session materials were included in the form of news articles, publications and/or online resources, which were beneficial to 62-57% of participants respectively. This indicates that participants relied mostly on the synchronous sessions with peer. 

Most of the participants committed to attend other sessions following this program (95%). To follow up on this commitment, we tallied attendance to several other relevant sessions that followed the race and cultural diversity program during Fall 2020. Those sessions were (1) Checking in: initiating difficult dialogues to address underrepresented ethnic minorities (UREM) pharmacy student needs; (2) Inclusive teaching practices to build a learning community and a sense of belonging; and (3) Building on resilience: black male achievement in the postsecondary context. Attendance to those sessions was 56%, 78% and 33% respectively. Finally, and despite the program, 14% of participants still felt slightly uncomfortable talking about diversity, equity and inclusion topics.

Additionally, all participant’s feedback derived from the survey is also shown:

Reactions regarding the program:

• I learned about perceptions and problems in society associated with race.
• Make us more aware as a group of racial inequities, and challenges for minority students. 
• Learned more about the history of racism issues in the U.S., and explored challenges and success stories in the fight against racism.
• Program enlightened those that either had a shallow knowledge of the issues of race and racism and how cultural diversity and inclusion could impact equal opportunities, or to challenge those who were very knowledgeable and participants of institutional racism to accept the fact that the time has come for change.
• Expanded our collective knowledge of racial history in the USA, and we can use this knowledge to better understand our own inherent biases so that we can grow and learn how to better understand current events in that light.
• Great for all races to understand the intensity of racial injustice for Black people in America.
• Useful to revisit the history of race and cultural diversity within the US so that there is a clear understanding of how the past still affects the present. It was humbling to work with colleagues and learn from each other so that we can speak about this difficult topic together and work to be the most inclusive and diverse college that we can be.

How the program could be improved:

• It was great as is.
• I believe the series were well developed.
• Allow discussion time after each session.
• It was great. Everything was well structured and organized. Myself and others felt it was conducted very respectfully and accessible to all. I seem to remember one of the videos had audio that lagged but overall this is a minor issue.
• It should continue and further explore institutional racism and cultural sensitivity.
• Incorporate material from sociologists that explains where to go from here.
• Having a diversity team consisting of black faculty AND staff, men and women and hit the truly devastating truths that are hard to hear.
• Discussing perceptions and time for reflecting on something that triggered a deeper dive into how you experience the world.
• I do not think it could have been improved.
• More time and conversation.
• Sharing thoughts on each session immediately after the content.
• Limit the number of sessions.

Future plans for engagement:

• I want to be more involved in good change.
• This is an important and timely topic that I would like to continue.
• This should be an ongoing discussion and not just a one time discussion.
• I feel this is a topic that requires continuous learning.
• Continued discussions like this are important and hopefully will promote change.
• I think it is a topic we all need to be more educated, and engaged in.
• Continuity in this topic, to continue developing cultural humility and better serve patients and students.
• It is important to continue to develop better-informed understanding of these various subjects, and not live in a bubble.
• This is an important issue that we need to keep alive until it is not an issue any longer.

Overall comments about the program:

• I liked that we all started learning and listening rather than talking. The sharing session was eye opening. We need to continue talking when we can come back together.
• I feel that focus and content in this area is critical to our faculty growth in this important area--both in how we relate to each other and how we relate to our students.
• The series came in a timely manner. I think there should not be too much in the summer to capture more people. Also spacing it out throughout the year would be good to continue the discourse.
• I liked the history of race and racism.  The connection between the history of racism and today's society. We need to continue open discussions on how we reflect racist thoughts and deeds in our daily interactions with each other to encourage change, and if we are lucky, this will help positively affect institutional racism and encourage cultural diversity and inclusion. 
• I am glad that programs such as this are provided to the faculty and staff. They allow for open conversations and sharing of ideas. This was excellent. 
• Fewer sessions will increase engagement. Too much. Moderation is the key.
• I liked the use of multimedia and how the series progressed.
• I think having the students be involved along with faculty and staff may be a good exercise. 
• I liked the mix of different ways we looked at it: history, medical, etc. 
• I like the sessions seem specific to certain areas so you can choose which sessions are relevant to you.
• It has all been a great learning experience for me. At this point I feel like I am a sponge just soaking everything up.

1.  Study Limitations

We acknowledge that this study has limitations. Participants were only composed of a small sample size from a single College, not representing the entire Institution. It would be interesting to try this program in other Colleges, especially in the humanities area, and including a more diverse sample. Additionally, a bigger sample size would allow performing comparative studies by age, ethnicity, and gender.

The goal of the program described herein was to encourage learning on how individual and structural racism, society and policies contributed to our present racial turmoil. Understanding first the many faces of social segregation, immigration policies as well as intergenerational effects provides an understanding to the multiple dimensions of structural racism (Chandra et al., 2011). 

The implementation of the program had several aims, such as presenting evidence, demonstrate influence, call to action and encourage discussion. This was a community engagement at the College level, in which participants not only acquired knowledge, but contributed with ideas and feedback, expressing a commitment for continuation as well as perhaps proper implementation into the College’ strategic plan. We believe that this could represent an initial metrics towards implementing initiatives concerning inclusion, equity, climate indicators, diversity education and training in the near future. 

It is our hope that with this program we have formed a community of support, and had a greater sense of empathy towards matters of race and diversity. The majority of us understood and reflected on the concept of bias and felt confident to manage our individual biases; we committed to create an inclusive environment, and shared or recommended this very same program to our families, friends and colleagues (personal communications, not shared in data presentation).

How can we translate and apply our knowledge to our Institution? Decades ago, higher education committed to foster cultural diversity, increase faculty and staff representation as well as learner diversity by stablishing specific programs, especially in the health professions (Yanchick et al., 2014; Chisholm 2004; Chisholm-Burns 2008; Hayes 2008). While the University of Houston has gained momentum in this area, achieving this goal is not an easy task, and many institutions have not followed up with the effort. We are certain that it will remain difficult to progress without support. We need to back up faculty and staff of color when assigning them to more committees, but penalizing them for a reduced productivity. Moreover, when assigning them to mentoring and educational programs for minority students, without acknowledging these efforts in annual reviews and promotion process; or evading offering internal diversity grants, to rely solely on extramural funding. All this creates a culture of exclusion, which we must be devoted to change in higher education. 

It is our hope that programs like this one help explain race-associated differences in this country. By acknowledging the etiologic clues embedded in policies, laws, culture, and science, we can start dismantling the perpetuated ideas of differences among the races and ethnicities. We trust these series have prepared us to fight racism at three different levels (Jones, 2000):

1. institutional (disparity access to goods, services, and opportunities)
2. personal (expectations about aptitudes, reasons, intentions of others due to race)
3. internalized (stigmatized races accepting negative messages about their own abilities and intrinsic worth). 

We believe the program to be effective and of worth when participants invited family members, neighbors, colleagues and their communities, to engage with the material available, raising questions and having discussions beyond the walls or our College and Institution. The readers are invited to inquire further, if they feel this program could, in any way, be useful for their setting.

The author confirms being the sole contributor of this work and has approved it for publication.

The author would like to thank Dr. Louis Williams for his constant encouragement during the creation and implementation of the program as well as for his critical review on this manuscript. 

This article was funded by a publication grant from the Underrepresented Women of Color Coalition (UR-WoCC) at the University of Houston.

The author declares no conflict of interest.