Introduction
Race and Psychology
In October of 2021, the American Psychological Association (APA) issued a long-awaited “Apology to People of Color” for the harm the organization and the field of psychology have caused by promoting and perpetuating racism and racial discrimination. The apology listed specific oppressive actions against Black, Indigenous, and People of Color (BIPOC) by psychology as a field, both historically and on an ongoing basis. As a follow-up to the apology, APA conducted an internal strategic and collaborative process to understand the scope of the problem (APA 2022a) and put forward priorities towards advancing racial equity in both psychology and society (APA 2022b). For the first time in history, psychology’s primary governing organization has taken accountability for the impact of the racist foundations of psychology training, research, and practice, and put forward concrete action steps to ameliorate the harm and promote priority actions to transform the field of psychology (APA, 2021, 2022b).
One identified oppressive action entrenched in the field of psychology is the myriad barriers students of color face in their entry and completion of graduate-level psychology training programs (APA, 2021). The complementary ameliorative action step is to “promote racially conscious and equitable training in order to open pathways for students of color to successfully pursue careers in psychology” (APA 2022b, p. 14). To accomplish this, the recommendations include using psychological science to make training requirements racially equitable and to make efforts to reduce barriers to the completion of graduate training programs.
Professionalism in Health Service Psychology Training
Graduate-level training in health service psychology operates within a supervisory model in which trainees are supervised and taught clinical and professional skills by more experienced clinicians. Due to racist gatekeeping to training access, a vast majority of these more experienced clinicians are White and—consciously or unconsciously—espouse White supremacist cultural conceptualizations of professionalism, including perfectionism and paternalism (Okun & Jones, 2000). It is therefore unsurprising that professionalism is a concept that has long been weaponized against Black people, Indigenous people, and people of color (BIPOC) in medical and educational settings (Frye et al., 2020; Marom, 2019). Because the standards and definitions of professionalism in the fields of medicine and education are subject to racism at the individual and institutional levels, it is important to address the concept deliberately. One suggested approach has been to work towards a more detailed and intentional understanding of professionalism.
Although professionalism is identified as a foundational skill and core competency within the field of health service psychology, there is no consensus regarding the definition or essential elements of the competency (Elman et al., 2005; Grus et al., 2018). A variety of groups have worked to identify specific conceptualizations of professionalism in health psychology, pulling from the limited literature in the field of psychology as well as from values and associated indicators of professionalism in other fields of health professionals, including medicine, dentistry, and nursing (Ducheny et al., 1997; Elman et al., 2005). These conceptualizations have typically incorporated elements of “interpersonal functioning” such as collaboration, communication, and respect for others, and “thinking like a psychologist,” including critical thinking, logical analysis, and the ability to conceptualize problems of psychological concern from a variety of theoretical approaches (Ducheny et al., 1997). Grus et al. (2018) defined professionalism as a “value system” that guides psychology trainees and psychologists as they conduct their work and interact with individuals across systems and settings. They called for a system of ongoing, accurate assessments and evaluations of professionalism in training settings that focus on trainers and trainees. Their suggested process incorporates multiple reporters, opportunities for self-reflection and feedback, and includes opportunities for both growth and remediation.
Within the professionalism literature, there is scant reference to the impact of culture or diversity on the conceptualization or evaluation of professionalism. Elman et al. (2005) named “cultural diversity training” as a component of awareness of personal identity and Grus et al. (2018) included “cultural humility” as a key component of professionalism. Beyond this, the professionalism literature in health service psychology does not address the systems or the individuals who define standards of professionalism. Nor does the literature identify how those standards and standard bearers are influenced by the systems within which they exist and the identities they hold. This unstated standard of Whiteness doubtlessly leads to the enactment of harmful and racist standards of professionalism on trainees and trainers with identities that have been historically oppressed (Okun & Jones, 2000).
The literature reviewed here elucidates the entrenchment of professionalism in systems of White supremacist cultural and institutional power, leading us to the necessity of putting forward a teachable, measurable definition of professionalism that explicitly addresses racism. As graduate training environments respond to APA’s call for transformation, programs are tasked with the process of addressing potential programmatic and institutional harm while providing direction toward a more equitable and inclusive understanding of professionalism. Stakeholders within our school psychology doctoral program utilized participatory action research (PAR) methods to create an equitable, inclusive, experiential definition of professionalism to combat racism and, more broadly, support individuals with other diverse identities. Our goals were to improve programmatic understanding, teaching, and evaluation of professionalism; reduce opportunities for racist and discriminatory evaluation of students; and improve the climate of the program (Baum et al., 2006).
Current Study
The purpose of this paper is to detail the participatory action research methods used to co-create a broadly equitable definition of professionalism that intentionally values the lived experiences of both graduate students and faculty members. Specifically, we sought to form consensus around a diverse and equitable conceptualization of professionalism that could be used to develop an essence statement[1], cultivate a protective training context that fostered development of the competency, ensure accountability of trainees and faculty, and facilitate improvement across all domains of training and evaluation.
The ultimate goal of this paper is to provide a model for psychology—and related disciplines—to co-construct actionable definitions of professionalism and other foundational skills that are explicit, based on universal and emic values, and are actionable and teachable. The outlined methods may serve as a guide for professionals across disciplines and systems to intentionally reduce inequities in settings that have historically excluded or oppressed individuals based on the processes or practices by which they are evaluated.
Furthermore, it is important to contextualize this paper within a broader framework, as several factors influenced the conception of this study. This study originates from Spring 2018, preceding APA’s 2021 apology. This study is situated between national movements in response to experiences of anti-Black racism before the project began (e.g., the murders of Michael Brown and Eric Garner in the summer of 2014) and those shortly after, in 2020 (e.g., the murders of George Floyd and Breonna Taylor). Additionally, this study was motivated by power dynamics within a graduate program, requiring an intentional and critical reflection process. Even today, with ongoing efforts to undermine Diversity, Equity, and Inclusion (DEI) initiatives, this study underscores the importance of participatory action methods in bringing about change within a program, with the aim of promoting equity.
Methods
This project was situated in the APA-accredited School Psychology doctoral program in the Department of Psychology at Tulane University in New Orleans, Louisiana. Tulane is a private doctoral university characterized by very high research activity (R1 in the Carnegie classification). The project was initiated by a subset of students in the program who sought clarity following evaluations of “unprofessional” conduct within informal feedback and end-of-year programmatic evaluations. A student survey conducted in the spring of 2018 sought to understand: 1) the program’s definition and operationalization of “professional” and “unprofessional”; and 2) students’ own definitions of “professional” and “unprofessional.” An initial thematic analysis of the responses suggested that students both understood and experienced Blackness and non-conformity to White norms as a liability for being labeled as unprofessional (e.g., volume of voice, facial expressions, specific hairstyles), which could consequently impact their academic and professional success (Alim, 2023; Anderson, 2020). Another finding of the survey was the request that students be provided with transparent guidelines for professional conduct and the opportunity to receive timely feedback about perceptions of their professionalism (see Appendix A). Following a presentation of these findings at the nexus of anti-Black racism and a broader confusion about the program’s definition of professionalism, faculty and students agreed that a broad, programmatic definition of professionalism should be co-created. A professionalism working group was formed in the fall of 2018, with one faculty member and three students volunteering to work towards this goal.
Participants
The participants of this PAR study were primarily the school psychology doctoral students and core program faculty; however, affiliated psychology department faculty were invited to participate in the process. One affiliated faculty who mentors school psychology students participated along with seven core program faculty (two associate professors, three professors, two professors of practice). Seventy-five percent of faculty (n=6) identified as White and 25% (n=2) as BIPOC. Seven faculty identified as female and one as male. Eighteen school psychology students participated in the process. At the time, the program was approximately 39% Black/African American; 55% White; <1% Latinx; 88% female; and 11% male. While these individuals also hold other identities, it is not currently possible to collect that information from all participants and therefore they are not listed.
To further contextualize the environment (and how it has shifted over time) in which this PAR work evolved, we offer a programmatic context statement to allow the reader to better understand the climate in which the researchers, students, and faculty implemented the described methods.
Programmatic Context
As with many predominantly White institutions (PWI), Tulane University’s foundation is built on the oppression of Black individuals. Its founder, Paul Tulane, forged his fortune on the labor of enslaved people. His endowment to start the university in 1881 explicitly stated it was for the education of “young White persons” (Tate, 2020). The board of trustees admitted the first Black students in 1963, following a lawsuit and the loss of funding from a coveted grant (Guillory v. Tulane, 1962). While Black undergraduate enrollment has increased to 6.63%, it remains significantly below national and local representation levels (12.1% and 59%, respectively) (Cowan Institute, 2022; Tulane University Fall 2021 Enrollment Profile; U.S. Department of Health and Human Services Office of Minority Health, 2021). Current Black undergraduate students report recurrent experiences of racism from faculty and students and feeling like they do not belong on campus due to the lack of representation of Black individuals at all levels of the university (Flanagan, 2022).
Tulane’s School Psychology Program is accredited by the American Psychological Association and is situated in the Department of Psychology in the School of Science and Engineering. BIPOC students are intentionally recruited to the program in support of APA’s goal to diversify the field. In 2017, 35% of school psychology students identified as Black and/or Latinx. The program identifies its training approach as an ecologically grounded scientist-practitioner model and several faculty conduct research within the Black communities of New Orleans (Tulane School Psychology Doctoral Program, n.d.). This deliberate cultivation of a diverse student body and a research focus on and within the Black community has drawn Black students to the program and sets the framework for a climate that is supportive of Black students. However, the impetus for this project was the report by graduate students that the program climate was unsupportive of Black students enrolled at the time of the study. Students reported that some faculty had made racist and/or unclear assessments of Black and other students’ professionalism, specifically related to natural Black hairstyles, non-verbal communication, and tone and volume of voice. In response, a professionalism survey was conducted in 2018, resulting in the assembly of the professionalism PAR team as a complement to the broader diversity, equity, and inclusion work simultaneously occurring at the departmental level. As the PAR work was taking place to address these specific instances of racism, White faculty continued to enact anti-Black racism at the program level that resulted in harm to both students and the community. The harm impacted Black students’ mental and physical health as well as their participation in research and service to the department.
The global context played a significant role in the university and city climate and, consequently, in the program’s professionalism and DEI work. The arrival of the COVID-19 pandemic in the United States in March 2020 revealed the devastating impacts of social determinants of health on BIPOC communities compared to broader society. Communities of color were overrepresented in COVID-19 cases and mortality rates due to a variety of factors, including pre-existing health comorbidities that can be traced back to social injustice, disproportionate representation in “essential industries” leading to increased exposure to COVID-19, justifiable mistrust in health institutions, and gaps in access to accurate health information (Tai et al., 2020). Within the program, all interactions were shifted to a virtual setting and students determined their own comfort level in continuing clinical work in person or shifting to virtual work.
The year also brought international mass protests in response to the murders of Ahmaud Arbery (May 8, 1994-February 23, 2020), Breonna Taylor (June 5, 1993-March 13, 2020), and George Floyd (October 14, 1973-May 5, 2020). In support of the inherent value of Black lives, the School Psychology program sent a statement of solidarity and support on June 5, 2020. In a program-wide meeting held on a video conferencing platform in September 2020, the program acknowledged and apologized for instances of interpersonal and programmatic racism. Program faculty stated a commitment to ameliorating racism present in the program and improving the program climate. To that end, the program participated in work led at the Departmental level by an external DEI consultant. Beloved Community led a DEI needs assessment to inform the development of an action plan to begin the process of eliminating all forms of discrimination in the program, with a particular focus on anti-Black racism.
Positionality Statement
The research team acknowledges team members who have historically and consistently contributed to and led initiatives to dismantle racism through advocacy, research, and clinical practice. To that end, we highlight the Black women on the team who have carried both the academic and emotional weight of both the events described in this paper and in the larger context. The project took place in a predominantly White learning environment and was initially co-led by both Black and White individuals; however, due to systemic challenges within the institution, and specifically within the program, one of the leaders of this work (a co-author and Black woman) affirmed that she could not willingly co-lead decolonized work within an unyielding, recapitulated system of racism due to misalignment with her own positionality and value system. She therefore stepped back from the project, but is supportive of its iterative growth and subsequent leadership. The authors of the paper who identify as Black women believe that people of color, especially Black people within the United States, must protect their souls, their wholeness, and their sanity in order to persevere against other obstacles. Research team members have asserted their commitment to creating safe places for Black and diverse scholars and clinicians, strengthening the sense of overall belonging for all members of our learning environments.
The membership of the research team varied across two phases of the project, including a total of six graduate students and one tenured core program faculty member. The first phase included the conceptualization of the project and the first round of data collection, analysis, and a member check. The second phase included the second and final rounds of analysis, a member check, and the creation of the professionalism essence statement and core beliefs. An additional graduate student author joined the team during the writing of this paper. Four graduate student members identified as cisgender Black women of different regional representations (two of Southern heritage, one from the Northeast, and one from the Midwest). Four of the authors identify as White, cisgender women (two from the Northeast and two from the Southeast) and one of the authors identifies as a White, cisgender male from the Northeast.
Procedures
A two-year, iterative process occurred in which program faculty and students worked together to define and identify specific competencies associated with professionalism. The explicit purpose of this process and the desired outcome were both to reduce instances of anti-Black racism while addressing broader diversity and possible concomitant discrimination and to provide the program with a values-based, teachable, learnable, and measurable conceptualization of the domain (see Figure 1). Following the preliminary data collection process in the spring of 2018, which revealed students’ (lack of) understanding of professionalism as defined by the program, a workgroup of diverse students and a faculty member was formed to define the topic to be studied and determine the data collection and analysis process. The group identified PAR as a guiding methodology for the process, leading to three rounds of iterative, participatory data collection and member checking, interspersed with analysis and continual refining of both the procedures and findings. Both deductive and inductive analysis strategies were utilized, starting with pre-existing domains of professionalism to elicit site-specific data and then developing new codes and themes through open coding (Vanover et al., 2021).
First, data were collected from both faculty and students on their understanding of professionalism. Significant statements and quotes from the data were grouped into themes. Themes were divided by textural and structural (i.e., what and how) descriptions designed to empower students and faculty to embody professionalism (Creswell & Poth, 2016). Finally, we blended themes and descriptions to write a programmatic “essence statement” of professionalism in order to create clarity around expectations, thereby reducing or ameliorating harm as it pertained to students’ evaluative training experience. The final products of the PAR process were produced in the winter of 2021 and consisted of: 1) stated core beliefs about professionalism in the School Psychology Program; 2) an Essence Statement of professionalism in the program; and 3) operationalization of each theme of professionalism in the program by inclusion of a definition and behavioral exemplars of each theme (see Appendix B). The research process was iterative and brought themes, descriptions, and essence statements back to the larger group at every stage of the process to ensure involvement through critical reflection.
Theoretical Orientation
This project utilized PAR approaches with a psychological phenomenology view of creating an inclusive, living, site-specific definition of professionalism. Phenomenology describes the common meaning for a group of individuals of their lived experiences of a concept or a phenomenon, in this instance professionalism in a health service psychology training program (Creswell & Poth, 2016; Moustakas, 1994). Significant to the selection of the PAR process, Kidd and Kral (2005) identified participatory action research as a process in which goals and methods are developed in coalition, and then data are collected and analyzed, ideally resulting in the implementation of a shift in critical consciousness and change for the improvement in the experience of the participants (Reason, 1994). Within this process, there is an implicit or explicit focus on “emancipatory change at a larger sociocultural/structural level” (Fals-Borda, 1991; Kidd & Kral, 2005, p. 187; Reason & Bradbury, 2001).
Sources of Data & Analysis
Student Survey on Professionalism (Spring 2018)
After a number of verbal and written evaluations by faculty of primarily Black students as “unprofessional,” two students approached the acting program director to request permission to conduct a survey among the School Psychology students as to their understanding and experiences of: 1) the program’s definition and implementation of “professional” and “unprofessional”; and 2) their own definitions of “professional” and “unprofessional” in the context of the program. Through this process it was determined that no students were aware of how the program defined and assessed professionalism. It was further reported that 21% of respondents had been labeled “unprofessional” by the program and 64% had overheard or were told by a peer that a peer had been labeled by the program as “unprofessional.” Overall, students experienced an environment of anti-Blackness and one that elevated White norms over other ways of being (see Appendix A).
Professionalism Group Led Activities, Analyses, and Member Checking
Preliminary Group Activity (Winter 2019)
The first activity divided members of the program by role (i.e., faculty or student) with the hope of eliciting uninhibited responses. Student groups were diversified to contain varied developmental levels (i.e., number of years in the program). Starting from a deductive qualitative process, Grus et al.'s (2018) 10 core professionalism competencies (e.g., accountability, ethical engagement, self-reflection, excellence, humanism, civility, collaboration, cultural humility, psychology’s social contract with society, and social responsibility) and definitions of each competency were placed on large easel paper around a conference room and groups were asked to consider what this domain “looks like” and “does not look like” across the contexts of the training program. Groups rotated around the room to a playlist of songs that held cultural significance to the site and wrote their conceptualizations of behaviors that signify the domain. Faculty were assigned to write in black and students in another color in order to better identify between-group agreement or disagreement (see Appendix C).
First Round of Analysis (Spring/Summer 2019)
During the first round of analysis, the PAR team transcribed each quotation from the first group activity into a spreadsheet, printed the quotations, and grouped them by preliminary “short codes” (see Appendix D). At times this involved using the direct quotation (e.g., “taking responsibility”) from the group and at times distilling the quotation to an agreed-upon essence (e.g., “honesty about professional limitations” became “working within the boundaries of competence,” a current ethical standard of APA; “showing up on time,” “meeting deadlines,” and “following through on commitment” all became “meeting obligations”). We then grouped those shortcodes into preliminary themes (e.g., shortcodes “having difficult conversations,” “taking responsibility,” and “apologizing” became the preliminary theme of “self-accountability”). We included both positive and negative signifiers (e.g., “respect for differences” from looks like and “defensiveness” from does not look like were both coded under “openness”) within the preliminary themes.
First Member Check (Fall 2019)
Following the first round of analysis, the PAR team conducted a member check to update the program on our process and progress and get qualitative feedback on the preliminary themes as well as guidance on the desired next steps in the process. Small groups of three to four members were formed to include faculty members, students, and PAR team members. Small groups were provided with resources that included Grus et al.'s original professionalism categories, our preliminary themes, and examples from the original activity of what these preliminary themes look like and do not look like. The original data (i.e., easel papers) were posted around the room for reference. Groups were asked to provide feedback on preliminary themes in three ways: 1) Were the exemplary codes representative of the original data?; 2) Do the preliminary themes accurately represent the codes?; and 3) Overall, what resonates with you within this domain? The activity was followed by each small group sharing their experiences, thoughts, and suggestions with the larger group.
Second Round of Analysis (Fall 2019)
The PAR team transcribed the notes from the second member check into our coding spreadsheet. The team’s notes reflected three primary calls to action: the researchers should 1) make sense of smaller themes (e.g., accountability) that co-occurred across the preliminary larger themes; 2) edit existing themes to be more precise (e.g., changing “helping other students” to “empowering students”); and 3) move on to solidifying the final themes. Following the above feedback, we refined and finalized the wording of the preliminary themes and conducted a frequency analysis of preliminary themes across professionalism domains to see where there was overlap (e.g., “Self-Reflection” appeared under “Cultural Humility,” “Ethical Engagement,” and “Psychology’s Social Contract with Society”).
The PAR team first worked individually and then together to create themes and definitions relevant to our program and setting. This involved grouping sub-themes and then identifying a broader competency theme (e.g., “Receiving Feedback” and “Exploration of Identity” were broadly named “Self-Reflection”) and defining those themes based on the sub-themes (e.g., “Commitment to self-exploration, self-evaluation, and growth characterized by openness, self-awareness, and thoughtfulness”).
Final Member Check (Spring 2020)
The final round of member checking occurred during the COVID-19 pandemic. Because of the lockdown order, the meeting took place on a video conferencing platform. This round of member checking involved bringing the themes, definitions, and exemplars to the program and asking for feedback on these themes as well as suggestions for next steps for how both students and faculty would like to see the program teach, enable learning of, and evaluate the identified qualities of professionalism. Through this process it was suggested that the operationalization of each theme of professionalism be included in the final product (e.g., “Ideas such as operationalizing the codes would help us understand what next steps look like. For example, what does ‘staying abreast of cultural advances’ look like? Does the answer to that question have implications for research practices? ‘Research’ is not a category above; would that fall under ‘Learning?’”; “Under self, we saw ‘vulnerability.’ What is vulnerability’s relationship to professionalism? What does vulnerability look like within the context of professionalism?”).
Final Round of Analysis (Summer 2020)
The PAR team reconstituted with new members and came together for a final round of analysis to refine the themes and definitions of professionalism and operationalize the themes with Behavioral Exemplars.
Creation of Professionalism Essence Statement and Core Beliefs (Winter 2021)
The newly reconstituted PAR team was also responsible for the creation of the Professionalism Essence Statement as well as a list of Core Beliefs about the concept of Professionalism in the program. The fifth author was instrumental in the creation of the Professionalism Essence Statement and synthesized the final results into a concise and elegant statement with revisions offered by the rest of the team. The cumulative products of this process will be discussed in the Results section.
Results
As noted above, the PAR methods described resulted in a School Psychology Program Professionalism Essence Statement and a list of core beliefs (listed below) which were informed by a table of professionalism themes, definitions, and behavioral exemplars (see Appendix B). These elements were adopted by the School Psychology Program in Spring 2021, are now codified in the current School Psychology Program Handbook, and are publicly available for current and future students and faculty (School Psychology Program Handbook, 2022).
Professionalism Competencies, Definitions, and Behavioral Exemplars
A table of Professionalism Competencies with Definitions and Behavioral Exemplars (see Appendix B) was created from the cumulative, iterative data collections, analyses, and member checking processes outlined above. The site-specific competencies identified by the process are: 1) Self-Reflection; 2) Accountability; 3) Social Justice; 4) Diversity and Inclusion; 5) Commitment to Learn; 6) Kindness and Helping; 7) Components of Communication; and 8) Respect. Competency definitions included trainee-level indicators and broader, program-level indicators. This section includes all professionalism competencies and definitions as well as a sampling of behavioral exemplars.
Self-Reflection
Self-reflection was defined as a commitment to self-exploration, self-evaluation, and growth characterized by openness, self-awareness, and thoughtfulness. Highlights of behavioral exemplars that indicate the presence of self-reflection include: we are committed to self-exploration of our intersectional identities, biases, privileges, morals, and values; we remain curious and committed to personal and professional growth.
Accountability
Accountability was defined as a willingness to accept responsibility for and utilize proactive strategies to meet obligations. Seeking mutual understanding and common ground in the face of differences. Highlights of behavioral exemplars that indicate the presence of accountability include: we take responsibility for our actions, including being honest, not wasting time or complaining, and asking for help when we need it; we are proactive in using strategies to meet our obligations, including setting goals and appropriate boundaries, employing time management strategies, taking initiative (e.g., not procrastinating or avoiding), and engaging in self-care (including therapy).
Social Justice
Social justice was defined at the trainee level as advocating for clients and reducing barriers to service; elevating community voices and respecting the existing knowledge and expertise of schools. Social justice was defined at the program level as allocating time for students to engage in social justice practices. Highlights of behavioral exemplars that indicate the presence of social justice include: we share our research findings with participants; we leverage our privilege for the benefit of others; we actively recognize and reduce barriers to service.
Diversity and Inclusion
Diversity and inclusion were defined at the trainee level as integrating culture into all aspects of work and staying current on cultural advances. Diversity and inclusion were defined at the program level as including a diversity of information, such as information from diverse authors and non-academic sources; increasing diversity within the Department and field; and commitment to nondiscrimination. Highlights of behavioral exemplars that indicate the presence of Diversity and Inclusion include: we call people by their preferred names, titles, and pronouns; we select readings and teaching materials from diverse authors; we do not take punitive actions towards cultural behavior (i.e., tone, dialect, hair, attire); we seek educational opportunities on the culture of clients, colleagues, or other stakeholders.
Commitment to Learn
Commitment to learn was defined as active pursuit of new knowledge and collaboration in research, academics, and practice; pursuit of consultation within and across disciplines; sharing of knowledge. Highlights of behavioral exemplars that indicate the presence of a commitment to learn include: we seek consultation when unsure or when facing ethical dilemmas; we collaborate with other programs, such as social work, sociology, and public health; we are always willing to learn new things; we push ourselves to take risks in conversations, classes, and supervision; we adapt syllabi to reflect new findings and emergent needs; we do not assume we have achieved expertise; we are open to different ways of knowing.
Kindness and Helping
Kindness and helping were defined at the trainee level as a focus on strengths, inclusion, understanding and elevating the voices of individuals, groups, and the Tulane and New Orleans community. Kindness and helping were defined at the program level as feedback is delivered in private and with the goal of supporting the growth of the individual. Highlights of behavioral exemplars that indicate the presence of kindness and helping include: we acknowledge the strength of others and give positive reinforcement, encouragement, and praise; we share and willingly provide help when [individuals] are experiencing difficult emotions; we express gratitude for others and treat them as we wish to be treated and we acknowledge their presence.
Components of Communication
Components of communication were defined at the trainee level as [participation] in genuine, gentle, non-judgmental communication, with a commitment to listen actively and engage in group activities and goal-setting with Tulane and the communities with whom we work. Components of communication were defined at the program level as leadership, credit, and resources are shared. Highlights of behavioral exemplars that indicate the presence of appropriate components of communication include: we give others the benefit of the doubt and withhold judgment. We assume that others are acting with good intent. We understand that we do not know what is going on in the private lives of others that might be impacting them; we are inclusive, loving, sincere, empathic, and gentle in communication. We refrain from hostile language, inappropriate jokes, and microaggressions; we are active listeners when others are speaking. We stay on topic, reflect, ask questions, present body languages that indicate we are listening and provide brief verbal responses (e.g., “I see”). If we disagree with the perspective of another, we do so respectfully.
Respect
Respect was defined at the program level as respect for individuals’ privacy, time, lived experience, and the shared spaces we inhabit. Highlights of behavioral exemplars which indicate the presence of respect include: we are respectful of individuals’ private lives and withhold comments and judgment (i.e., if you don’t have anything nice to say, don’t say anything at all). We are accepting of how people choose to spend their time outside of the university; we respect shared spaces (e.g., library and Clinic) and keep these spaces tidy and make space for others; we allow sufficient time for planning when making requests of people’s time. We respect when people take the time off that they need.
Professionalism Essence Statement and Core Beliefs
The professionalism essence statement and core beliefs are syntheses of the table of professionalism competencies, definitions, and behavioral exemplars and are listed here in their entirety.
Essence Statement
We are committed to fostering a training environment that promotes mutual respect, open communication, emotional safety, a sense of community, and a commitment to lifelong learning and excellence. We recognize that each person’s unique lived experiences influence how they interact with and navigate the world around them. We acknowledge the roles of historical systems of patriarchy, racism, and classism in excluding diverse voices and perspectives from our academic community and we commit to developing policies and practices that ensure equity and promote diversity and inclusion. We encourage ongoing self-reflection to identify personal biases and opportunities for personal and professional growth and development. We respect each other’s cultural differences and demonstrate cultural humility when engaging with each other, community partners, clients, and research participants. In addition to referencing scientific evidence-based literature, we intentionally immerse ourselves within the New Orleans community and the cultures and contexts of the youth and families we work with to increase the effectiveness and acceptability of our practice and research endeavors. We respect the autonomy of all trainees and develop trainee-centered training goals that integrate their unique personal values with the Program’s expected professional competencies. We demonstrate flexibility and compassion when faculty and trainee life circumstances arise that may potentially impact training goals and expectations.
Core Beliefs
1. We demonstrate respect for each other through our words, actions, and non-verbal communication to promote individual well-being.
2. We utilize effective communication characterized by openness, transparency, and humility.
3. We are committed to lifelong learning and continuously use self-reflection to acknowledge our own limitations and seek consultation and opportunities for personal/professional growth when needed.
4. We utilize cultural humility when interacting with each other, community partners, and research participants. We do not endorse or practice tone-policing, body-shaming, gaslighting, anti-Blackness, anti-immigrant, anti-LGBTQIA++, or respectability politics within our research endeavors, practice, mentor-mentee relationships, or supervisor-supervisee relationships. We acknowledge the changing face of the profession of health service psychology and the communities we serve.
5. We strive for excellence in our practice, research, and academic endeavors. We utilize evidence-based techniques, seek consultation from community partners, and use our work to promote social justice rather than personal prestige.
Discussion
Following APA’s call to utilize psychological science methods to make psychology training environments more equitable, this study implemented participatory action research methods to achieve three main goals: 1) identify programmatic and individual level definitions of professionalism across training settings; 2) improve the ability to teach, learn, and assess professionalism with the express purpose of reducing anti-Black racism and other forms of bias and discrimination; and 3) detail ways of identifying what professionalism looks like and does not look like. In order to achieve these goals, a two-year, iterative PAR process was enacted to create a consensual, measurable, and actionable conceptualization of professionalism to hold both faculty and students accountable for professional behavior and reduce instances of racist and biased negative evaluation of professionalism.
This paper elucidates one program’s journey towards the co-creation of an equitable conceptualization of the competency of professionalism in health service psychology training. The context of the program is just as important as the process and, therefore, we encourage other programs and fields to use and revise these methods to both examine their contexts and undergo this process to create their own, site-specific definitions of professionalism. This project was only possible with the support of the faculty member on this project and the participation of the students in leading this considerable effort. Programs in which there is limited faculty support or a student body that does not have the mental, emotional, or reflective space to undertake such efforts will be unable to accomplish a similar outcome. It is also important to note that this project took place during a brief window of time in a program that has existed for decades before our time and continues to exist and evolve. Therefore, the context, process, and content detailed here have attempted to express those of the individuals involved in this paper.
Participatory Action Research Process
Sarason (2003) noted the primary focus of successful participatory action research should be on the process rather than the outcome, providing sufficient details for others to replicate the procedures. This paper sought to provide the contextual setting as well as a detailed outline of the process undertaken by one health service psychology training program to reduce racism and White supremacy in the program through the creation of a shared meaning of professionalism. We hope the methods and data analysis process shown above will provide a blueprint for other psychology and graduate training programs and organizations across disciplines to utilize and further develop and adapt for their own purposes (Kral et al., 2002).
Notable outcomes from the process included the creation of local, program-specific definitions and behavioral indicators of professionalism competencies. Furthermore, concepts such as cultural humility, celebration of diversity, and social justice are included throughout the program-specific domains, definitions, and behavioral indicators. This process and the outcomes achieved moved our program closer to Grus et al.'s (2018) stated goal of a teachable, learnable, and measurable understanding of professionalism and extended beyond their recommendations by directly addressing race, culture, and diversity across domains. The inclusion of behavioral identifiers requires all program members to be held to a higher level of accountability in their use and evaluation of the term “professionalism” across learning settings and makes it more difficult to enact covert and overt racist evaluations of cultural behavior.
The program’s Essence Statement acknowledges its positionality within historical systems of patriarchy, racism, and classism and announces a commitment to the development of policies and practices to dismantle these systems in order to ensure equity and promote diversity, demonstrating an important step towards this reimagination. Components of the creation of an environment supportive of broadly diverse graduate students are woven throughout the eight professionalism competencies. The competencies include directives to being open to different ways of knowing, a recognition that we have much to learn, and a commitment to an openness to learn by listening to all voices. Furthermore, there is an expressed prohibition of taking punitive action towards cultural behavior. The agreed upon programmatic concept of equitable accountability in professionalism is salient in light of the former unidirectional evaluation of professionalism by faculty of students. Students now have a way of holding faculty accountable to upholding professionalism as defined and codified by the program. These outcomes are in alignment with APA’s stated goal of “cultivating psychological safety and accountability in training programs” (APA 2022a, p. 14).
Professionalism Competencies & Broader Equity
The impetus for and context of this project and the professionalism competencies identified by this process are specific to our program; however, they also speak to the broader goals of APA in addressing and repairing the harm caused to BIPOC psychology trainees and detoxifying the environments in which trainees are situated. To further these goals, APA’s Racial Equity Action Plan includes the domains of training of psychologists and knowledge production. Within the psychological training domain, APA calls for a revolutionary reimagination of graduate training to center diverse perspectives and support the inclusion of diverse graduate students at every step of the training process, from recruitment through entry into the profession and beyond (APA, 2022). While APA has directed the field of psychology to work towards embodying anti-racism, the program and field still have significant progress to make before becoming truly anti-racist training environments. Both APA and our program exist within White supremacist systems that make commitment to anti-racism complex and White supremacy difficult to dismantle (Ladson-Billings & Tate, 1995). Frye et al. (2020) posit that racist incidents—such as the evaluation of Black individuals as unprofessional—are endemic of White supremacy, which is entrenched in every aspect of society, including psychological training and research settings. It follows that utilizing PAR to define professionalism is not a panacea for all institutional racism. Statements of anti-racism and a focus on reducing racism at the individual and program level will not alone result in equity. Efforts to equitably define professionalism must be part of broader work to address racism at systemic levels or risk being used as a “tool of social control” to maintain the dominance of those already in power (Frye et al., 2020, p. 861).
Within these contexts and the broader social climate following the protests of Summer 2020, Tulane’s School Psychology program has worked to improve its diversity and inclusive climate through action, including the undertaking of this professionalism work. Beyond this project the program has dedicated time in monthly, program-wide meetings to addressing topics of equity and diversity, program faculty have demonstrated commitment to their own shared learning about equity and diversity in their monthly faculty meetings, a new course has been developed by the faculty co-author on anti-racist research methods, and program faculty and students are represented on the Psychology Department’s EDI committee.
Tulane’s School Psychology Program plays an important role in diversifying the field of psychology through its commitment to recruiting, training, and graduating Black psychologists, which allows for culturally concordant care in Black communities and the uplifting of Black populations through research. It is important to note that there is only one Black faculty member in Tulane’s School Psychology program and they—along with White faculty members—have mentored a significant number of Black graduate students who have successfully completed the program. However, we must hold the duality that the program can both produce well-trained Black clinicians and still cause harm to Black graduate students in the process. A substantial literature base exists detailing Black doctoral students’ experiences of racism at the institutional, department, programmatic, and individual levels and the concomitant detriment to both their mental and physical health (Gildersleeve et al., 2011; McGee et al., 2016, 2019). Black students report significant anxiety, feeling dehumanized and marginalized, significant weight gain, and feeling like they had to “push through” even when experiencing significant health problems (Gildersleeve et al., 2011; McGee et al., 2016, 2019). Therefore, part of the broader work must include taking accountability for, reflecting on, and ameliorating our and other programs’ past and present harm enacted on Black students.
Challenges
Unsurprisingly, because the authors hold different racial identities and roles and this paper addresses racism that has been both experienced and affected by the authors of this paper, strong differences emerged across racial lines and within individuals’ perspectives and emotions on how best to frame this study. The level of detail to include about instances of racism in the program was hotly debated with some authors wanting to elaborate on specific, traumatic instances of anti-Black racism in order to hold the program accountable, while others voiced concerns that this level of detail would be harmful to and misrepresent the program. This negotiation ultimately resulted in all authors agreeing to remain on this paper; however, the debate and resulting compromise illuminate the remaining deep constraints of the power dynamics of White supremacist systems within which we conducted and produced this work. Addressing racism brings up many feelings, including anxiety, fear, and shame for both the people who are oppressed and those who oppress, intentionally or unintentionally. It is an unusual undertaking to write about experiences so central to our lives, training, and identities and we hope the reader holds our vulnerability with grace.
Conclusion
Despite historic and current barriers, many individual psychologists and psychiatrists, including Isaac Prilleltensky and Frantz Fanon, and some professional organizations, such as the Association of Black Psychologists, have long focused their attention on influencing and affecting social change to ameliorate the impacts of racism on the foundations of psychological training, research, and practice, and creating a supportive space for Black psychologists. APA has now joined in explicitly acknowledging their own role in the enactment and perpetuation of racism and expressed a commitment to deconstructing racism at every level of psychology. While there is a stated desire by many organizations and institutions to move from perpetrating racism to a stance of being anti-racist, this co-option of the stance of anti-racism complicates efforts to dismantle systems of racism (Frye et al., 2020). In order to avoid the trap of perpetuating structural and systemic racism, the problem of Whiteness must be addressed head-on in psychological training environments and the institutions in which they exist (Hanna et al., 2021). If we hope to achieve anti-racism and true liberation, university leadership and the student body must consist of people who hold a variety of racial identities and the research base must be expanded to include diverse leadership, authors, and participants as well as embrace non-dominant research methods (e.g., critical race theory).
The implementation of anti-racist systemic and structural change is often a laborious and daunting task, especially given how deeply anti-Blackness is intertwined within mainstream culture and academic institutions in the United States. Despite the harmful missteps that contributed to the inception of this iterative process aimed at advocating for social justice and equity for BIPOC students, our program’s faculty and students have demonstrated strength, perseverance, and a commitment to increasing diversity in the field of health service psychology and subsequently improving the quality of care for the communities we serve. Moreover, our collaborative approach (e.g., humanization of aspects of graduate training, humility, facilitation of difficult conversations, and demonstration of mutual respect) and the genuine efforts by faculty to share power are truly ground-breaking and forward-thinking actions within the larger context of health service psychology. The program remains committed to continuing the journey towards equity and justice, and we hope the efforts can provide courage and solidarity to other health service psychology training programs that are on their own journeys.
