Address White Fragility In Order to Engage in Racial Caucusing

Tiffany Ho, MD, MPH | José Rodríguez, MD, FAAFP

Fam Med. 2022;54(4):318-318.

DOI: 10.22454/FamMed.2022.162964

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To the Editor:

Guh et al demonstrated how a 90-minute experiential workshop on racial affinity caucusing (RAC) enabled participants to feel comfortable implementing RAC at their own institutions.1 However, the authors acknowledge that their study’s success may be attributed to a self-selected group of faculty who knew the potential impact of caucusing as a tool to address racial health inequities, and who were familiar with White fragility. In places where faculty are unfamiliar with the power of RAC, gaining familiarity with the realities of White fragility may be a prerequisite for an RAC workshop, and can be further explored in that space.

Robin DiAngelo coined and defined the term “White fragility,” as “a state in which even a minimum amount of racial stress becomes intolerable, triggering a range of defensive moves.”2 Many White individuals admit that racism exists and needs to be addressed. But some, when you point out how they could be perpetuating racism, may become almost reflexively defensive. When White fragility is not acknowledged, racist behaviors and thinking can go unchallenged. This makes it difficult to implement systemic change and could cancel the gains from an RAC experience.

Many people of color (POC) are tired of having to educate leadership, colleagues, staff and friends on how racism manifests on numerous levels,3 a toll known as the minority tax.4 RAC shifts that responsibility by intentionally separating white individuals from POC. This allows the former group to explore White identity, privilege, and their role in racism, and the latter to focus on collective healing from negative racialized experiences. Ideally, RAC is initiated and supported by the highest levels of leadership—by leaders who are White and have confronted their own White fragility. Multilevel institutional awareness and acknowledgement of White fragility is pivotal to initiating the activation energy needed to implement RACs as well as sustaining the momentum needed to maintain these conversations in a safe space.

White faculty can prioritize time and resources to learn how to lead their respective RACs.5 As DiAngelo recommends, conversations about Whiteness should start at the micro individual level of analysis and move to the macro institutional/societal level.2 In addition, training materials and resources are available at crossroadsantiracism.org, raceandmedicine.com, racialequitytools.org, and at in the STFM Resource Library (https://resourcelibrary.stfm.org/viewdocument/toolkit-for-teaching-about-racism-i). We invite our White allies to use this knowledge to initiate RAC activities. As more of us implement, it will equip us with shared language to discuss racism, privilege, and other forms of oppression. In effect, we will be able to face them. In the immortal words of James Baldwin, “Not everything that is faced can be changed. But nothing can be changed until it is faced.” Perhaps then, we can make progress in rooting out racism in our field.


  1. Guh J, Krinsky L, White-Davis T, Sethi T, Hayon R, Edgoose J. Teaching racial affinity caucusing as a tool to learn about racial health inequity through an experiential workshop. Fam Med. 10 2020;52(9):656-660. doi:10.22454/FamMed.2020.596649
  2. DiAngelo RJ. White Fragility: Why It’s So Hard for White People to Talk About Racism. Beacon Press; 2018.
  3. Foster KE, Johnson CN, Carvajal DN, et al. Dear White People. Ann Fam Med. 2021 Jan-Feb 2021;19(1):66-69. doi:10.1370/afm.2634
  4. Rodríguez JE, Campbell KM, Pololi LH. Addressing disparities in academic medicine: what of the minority tax? BMC Med Educ. 2015;15(1):6. doi:10.1186/s12909-015-0290-9
  5. Michael A, Conger MC, Bickerstaff S, Crawford- Garrett K, Fulmer EF. Becoming an anti-racist White ally: how a White affinity group can  help. Perspectives on Urban Education. 2009;6(1):4.

Lead Author

Tiffany Ho, MD, MPH

Affiliations: University of Utah Department of Family and Preventive Medicine, Salt Lake City, UT


José Rodríguez, MD, FAAFP - Office of Health Equity, Diversity, and Inclusion, University of Utah Health, Salt Lake City, UT

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Guh J, Krinsky L, White-Davis T, Sethi T, Hayon R, Edgoose J. Teaching racial affinity caucusing as a tool to learn about racial health inequity through an experiential workshop. Fam Med. 10 2020;52(9):656-660. doi:10.22454/FamMed.2020.596649


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