How to open conversations about difficult topics with optimal effectiveness

Humanism in medicine often requires a period of flexing muscles we may not always have used in the past. Sometimes, just the act of bringing awareness to certain topics affecting both our professional and personal interactions may evoke strong reactions that can impede our ability to receive such insight and/or feedback. The Gold Humanism Honor Society recognizes both the necessity of addressing structural racism within our healthcare communities and work spaces in an open and nonjudgmental environment, and yet also appreciates the sensitive nature of having these discussions due to their potential to create defensiveness, divisiveness, or even greater power imbalances. The reasons for these sorts of difficulties may include any of the following:

  • Differences in upbringings
  • Differences of political opinions
  • Differences of religious or spiritual beliefs
  • Differences in cultural beliefs
  • Varied skill and experience levels
  • Varied comfort levels speaking truthfully in group or intimate settings
  • Varied levels of power among participants
  • Unrelated difficulties that arose elsewhere in one’s daily life prior to the interaction
  • Misunderstandings regarding group motives or intent

Therefore, we recommend the following methods of coordinating an open discussion about structural racism in healthcare among colleagues and trainees:

  1. The use of an outside third-party representative to act as a conversation guide. Ideally this would be a person separated from the group’s existing hierarchy, preferably trained or prepared with tools ahead of time, and with whom all group members can easily build rapport.
  2. Having a prop handy to be used as a “talking stick,” to help ensure each speaker is able to complete their thoughts with minimal interruption or immediate reaction.
  3. Recognize the enhanced effect of smaller groups as opposed to larger groups, which provides a less public and a potentially less threatening environment for any introverts in the group, as well as resists the temptation for certain personalities or people in power to dominate the interactions.
    1. Breakout groups who then reintegrate for discussion can have an added benefit of gathering as many perspectives and opinions as possible in a small amount of time.
    2. Often more than one session may be necessary in order to get critical and actionable information about how to improve the dynamic moving forward, both for our patients and for our colleagues.
  4. Resources about having conversations about race:


  1. Finding common ground early in the activity. The use of polling and icebreaker questions can be especially useful for group interactions, especially if being done remotely, as well as provide the added benefit of anonymity while also encouraging authentic and maximum participation.
    1. Here is a link with a tutorial on how to use the polling function during a Zoom meeting:
    2. Here are some ideas for easy icebreaker questions to aid in finding common ground. For example, you could ask each participant to introduce themselves and share something powerful, inspiring, or motivating that they’ve read in the past year.
    3. Here is a very short read with tips for knowing your audience: