Upstander Training in Behavioral Health Settings

September 23, 2022

Target Audience

Psychologists, Western Psychiatric Hospital Staff and Faculty, and other Mental Health Professionals.

Learning Objectives

At the conclusion of this workshop participants will be able to:

1.    Define and understand the IQEE (Interrupt, Question, Educate, Echo) framework.
2.    Practice actionable tools to implement when witnessing or receiving bias, prejudice, or   microaggressions.
3.    Develop the skill of advocating for victims and learn how to become an ally.

Additional Information

Course summary
Available credit: 
  • 1.50 AMA PRA Category 1 Credit™
    The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
  • 1.50 Attendance
Course opens: 
Course expires: 
Event starts: 
09/23/2022 - 12:00pm EDT
Event ends: 
09/23/2022 - 1:30pm EDT


Introduction/Goals for Workshop: Rameshwari V. Tumuluru, MD


Overview of upstander training and the introduction to the IQEE (Interrupt, Question, Educate, Echo) framework. Five cases will then be presented: Rickquel P. Tripp, MD



Rickquel P. Tripp, MD will define and describe upstander training along with the IQEE framework (Interrupt, Question, Educate, Echo). Five (5) cases (upstander drills) with smaller breakout discussions to follow. These upstander cases are designed for the audience to think about what aspects within “your” particular health setting add a layer of complexity to these cases (scenarios) and how “they” may handle these aspects as an upstander.
The five case themes are as follows:

  • Case 1: You are attending a quarterly staff meeting where several psychiatrists and psychologists are providing updates related to their division. During a transition, your colleague Dr. Sharma (Indian American cis female) begins to approach the speaker Dr. Smith to ask a question. Your Department Chair Dr. Anderson (white cis male) interrupts her and states, "Dr. Smith doesn't have time to hear your catty comments. You should go sit down."
  • Case 2: Today is your first day working with Jason Lee, an Asian man, who just joined your research program. Unbeknownst to you, several subjects have cringed when Jason enters the room to administer the questionnaire and they don’t want to interact with him because he is “Chinese” and they are saying that he caused the COVID19 pandemic.  These comments and nonverbal behaviors have not been addressed by any member of the team prior to today.  It happens again when Jason and you walk into the room to interview Sue Smith, one of the study participants. Sue refers to Jason as “Mr. Chang” and states she doesn’t want to talk to him.
  • Case 3: You are in the nurses station on the inpatient floor. You overhear a staff member, Suzanne, state, ”I’m so upset they are getting rid of the Aunt Jemima name. I used to love that syrup, but now I’m not going to buy it since they ruined a perfectly great product.” You see your colleague Janet (a Black woman) look down at the floor and shake her head in disappointment.
  •  Case 4: You are in the nurse's station on the inpatient floor and overhear staff discussing an incident that just happened. As they are recounting the incident, which they acknowledge was totally inappropriate and one relates that a first-year resident was taking the history from a combative patient on the Tox service and yelled at her, “I don’t want a [N word] taking care of me”.  The trainee is nearby and you can see that she can hear the staff discussing the situation.  One staff member says she feels terrible that the trainee had to hear the N word but says the entire word multiple times in recounting the situation.  You see the trainee looking down and seeming upset.
  • Case 5: You are running a virtual Grand Rounds presentation. The speaker is presenting on health care disparities and inequities experienced by marginalized communities. About 15 minutes into the talk, a strange noise interrupts the presentation and a voice begins using hate speech and slurs related to the subject matter of the talk.

Participants will engage in small group discussions after reviewing the cases to address the IQEE framework:

  • Interrupt
  • Ask speaker to elaborate on what she/he means (calm, nonjudgmental tone)
  • Helps us clarify the exact meaning behind her/his statement (the What)
  • Question
  • Demonstrate attempt at understanding his/her perspective (the Why)
  • Reduces defensiveness in the conversation
  • Educate
  • Create a different way of looking at a situation
  • Use “I” to communicate the impact of the situation while avoiding blaming
  • May help speaker uncover their own unconscious biases
  • Echo
  • Two-part approach from both parties---
  • Apologize & Acknowledge VS Resistance & Re-educate or Report


Discussion and Question & Answer Session: Rickquel Tripp, MD

Each smaller Zoom breakout discussion group will be moderated by no more than two facilitators: Drs. Rickquel Tripp, Layla Banihashemi, Morgan Faeder, Ben Handen, Jody Glance, Cesar Escobar-Viera, Dan Buysse, Tushita Mayanil, Jill Glausier, Dana Rofey,Traci Kennedy and Mr. Reynold Joseph. The smaller groups will reconvene after discussing the cases with their respective groups and Dr. Rickquel Tripp will then gather feedback from each smaller group--within the larger group setting--on the reactions to the cases and discussion (links to behavioral health – “your” work and experiences.) This will also help create discussion and identify ideas and ways to help dismantle inequities, whether individually, in “your” unit or department or on a broader level.


Ending Comments: Dr. Rameshwari Tumuluru



Live Virtual Conference
Pittsburgh, PA
United States

Lead Presenter:
Rickquel P. Tripp, MD 
Clinical Assistant Professor of Emergency Medicine 
University of Pittsburgh School of Medicine

Rameshwari V. Tumuluru, MD
Associate Professor of Psychiatry
University of Pittsburgh School of Medicine 

Faculty Disclosure:
No members of the planning committee, speakers, presenters, authors, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships with any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients to disclose.

In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.

Physician (CME)
The University of Pittsburgh designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.

Available Credit

  • 1.50 AMA PRA Category 1 Credit™
    The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
  • 1.50 Attendance


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Please contact Harriet Wortzman ( for any additional information.