A qualitative study exploring experiences of racial minority stressors in pharmacy education and practice
Authors: Ahmed A , Hagos M , Bhatti I , Cartwright N , Chukwu-Etu O , Burini A , Dabiri L , Tolley C , Richardson C L , Doll A , Miah T , Rathbone A P 
Published: April 2024

Abstract

Introduction
Despite 49.1% of registered pharmacists in the UK identifying Black, Asian, or from a Minority Ethnic (BAME) background, senior management roles within pharmacy are dominated by white males.[1] People from BAME communities may experience racial minority stressors. Racial minority stressors are behaviours which range from unconscious bias, micro-aggression, and overt racism (macro-aggression). However, there is little evidence describing experiences of racial minority stressors in pharmacy practice and education.

Aim
To explore experiences of racial minority stressors in pharmacy education and practice.

Methods
A convenience sample of pharmacy students, trainees and pharmacists were recruited via email and social media posts to voluntarily take part in interviews and focus groups. Inclusion criteria were: be over 18 years old, conversant in English, capacity to give consent to take part in research and be either a pharmacy student, trainee or registered pharmacist. The only exclusion criterion was where the inclusion criteria were not met. Interviews and focus groups were held online using Microsoft Teams. A topic guide was generated from key themes in the literature and used during data collection to explore experiences of racial minority stressors in education and practice. Interviews and focus groups were transcribed verbatim and inductively analysed using thematic analysis underpinned by a phenomenological approach. Ethical approval was obtained from Newcastle University Ethics Committee.

Results
Forty-five participants were recruited. Six focus groups and sixteen one-to-one semi-structured interviews were conducted. The sample was varied, with 56% (n=25) students and 33% (n=15) registered pharmacists from community, hospital, primary care, academia and an additional 11% (n=5) still in foundation training in these sectors. The sample included a diversity of racial identities, including 40% (n=18) South Asian, 27% (n=12) White, 15% (n=7) Black, 7% (n=3) Chinese 7% (n=3) Arab, 2% (n=1) mixed, and 2% (n=1) not disclosed. Three themes were identified – Theme 1) Experiences of racial minority stress, Theme 2) Making sense of racial minority stress, and Theme 3) Responding to racial minority stress. Participants experiences of stressors were based on personal characteristics (for example skin colour, dialect, religious dress) which made them feel susceptible to judgement, racist comments and microaggressions in education and practice. Participants required time to make sense of, interpret, and understand experiences of racial minority stress. This was influenced by the sources of stressors, which included patients, the public, and colleagues as well as institutions and policies. Participants responded by ‘ignoring’ stressors from patients and the public which were thought to be due to ignorance or ill-health and ‘masking’ negative feelings if sources of stress were colleagues or institutions due to fear of negative impacts on training and career progression.

Conclusion
This study shows dealing with microaggressions, racial minority stress and judgement in pharmacy education and practice is a burden experienced by people from BAME backgrounds. This may contribute to the professional attainment gap in pharmacy, as these experiences are an additional burden that pharmacists, trainees, and students must bear compared to their non-BAME counterparts. Further research is needed to explore interventions to reduce minority stress.

References
1. General Pharmaceutical Council. The GPhC register as of 31 May 2022 - Diversity data tables. 2022.