Social and scientific motivations to move beyond groups in allele frequencies: The TOPMed experience.

For the genomics community, allele frequencies within defined groups (or "strata") are useful across multiple research and clinical contexts. Benefits include allowing researchers to identify populations for replication or "look up" studies, enabling researchers to compare population-specific frequencies to validate findings, and facilitating assessment of variant pathogenicity in clinical contexts. However, there are potential concerns with stratified allele frequencies. These include potential re-identification (determining whether or not an individual participated in a given research study based on allele frequencies and individual-level genetic data), harm from associating stigmatizing variants with specific groups, potential reification of race as a biological rather than a socio-political category, and whether presenting stratified frequencies-and the downstream applications that this presentation enables-is consistent with participants' informed consents. The NHLBI Trans-Omics for Precision Medicine (TOPMed) program considered the scientific and social implications of different approaches for adding stratified frequencies to the TOPMed BRAVO (Browse All Variants Online) variant server. We recommend a novel approach of presenting ancestry-specific allele frequencies using a statistical method based upon local genetic ancestry inference. Notably, this approach does not require grouping individuals by either predominant global ancestry or race/ethnicity and, therefore, mitigates re-identification and other concerns as the mixture distribution of ancestral allele frequencies varies across the genome. Here we describe our considerations and approach, which can assist other genomics research programs facing similar issues of how to define and present stratified frequencies in publicly available variant databases.

Towards anti-racist futures: a scoping review exploring educational interventions that address systemic racism in post graduate medical education.

Since 2020, brought to the forefront by movements such as Black Lives Matter and Idle No More, it has been widely acknowledged that systemic racism contributes to racially differentiated health outcomes. Health professional educators have been called to address such disparities within healthcare, policy, and practice. To tackle structural racism within healthcare, one avenue that has emerged is the creation of medical education interventions within postgraduate residency medical programming. The objective of this scoping review is to examine the current literature on anti-racist educational interventions, that integrate a systemic or structural view of racism, within postgraduate medical education. Through the identification and analysis of 23 papers, this review identified three major components of interest across medical interventions, including (a) conceptualization, (b) pedagogical issues, and (c) outcomes & evaluation. There were overlapping points of discussion and analysis within each of these components. Conceptualization addressed how researchers conceptualized racism in different ways, the range of curricular content educators chose to challenge racism, and the absence of community's role in curricular development. Pedagogical issues addressed knowledge vs. skills-based teaching, and tensions between one-time workshops and integrative curriculum. Outcomes and evaluation highlighted self-reported Likert scales as dominant types of evaluation, self-evaluation in educational interventions, and misalignments between intervention outcomes and learning objectives. The findings are unique in their in-depth exploration of anti-racist medical interventions within postgraduate medical education programming, specifically in relation to efforts to address systemic and structural racism. The findings contribute a meaningful review of the current state of the field of medical education and generate new conversations about future possibilities for a broader anti-racist health professions curriculum.

Dealing with callers' racialised talk in suicide preventive helplines: Accomplishing (anti)racism in the context of unconditional support.

This article investigates how mental health counsellors on helplines in Sweden deal with racism from callers who self-categorise as non-racialised. Previous studies have identified racism as a problem in health care interactions, but there is limited knowledge about the features of racialised talk and how staff respond. In this study, we use conversation analysis and membership categorisation analysis to examine racialised talk in 17 audiorecorded calls, a subset of 458 calls to suicide preventive helplines. The analysis shows that racialisation functions as a resource for callers to make sense of their mental health difficulties. This speaks to the complexity of responding to racism in a mental health setting, as counsellors must see to callers' needs, and calling out racialised talk may alienate callers. Call-takers manage this problem in three ways: (1) questioning racialised talk, (2) supporting the callers' stance in a way that makes it ambiguous if call-takers are coproducing racism or affiliating with callers' lives being difficult and (3) supporting callers' problems as mental health issues while resisting a potentially racist trajectory. The study offers direct insight into the workings of racism in health care and how practitioners can balance health care users' needs for support with an antiracist position.

Discrimination, critical consciousness, and mental health in American youth of color.

To resist and cope with oppression, youth of color may use the process of critical consciousness which involves understanding racial injustices (critical reflection), developing motivation to fight these injustices (critical motivation), and taking action to enact sociopolitical change (critical action). However, little is known about how each dimension of critical consciousness affects mental health in adolescents of color. In a sample of 367 ethnically and racially diverse American adolescents of color (age range = 13-17; 68.9% girls, 28.6% boys, and 2.5% gender minority; 84.4% US-born), we conducted multivariate regressions in Mplus to examine the cross-sectional links between each critical consciousness dimension (reflection, motivation, and action) and mental health outcomes (anxiety, depression, and stress) over and above the impact of everyday discrimination. We also investigated the interaction between critical consciousness and discrimination in predicting mental health outcomes. Controlling for age, gender, nativity, and social class, we found that discrimination and critical action were both positively associated with anxiety, depression, and stress. For our covariates, girls and gender minority adolescents reported worse outcomes. No interactions were significant. Overall, critical action, while necessary to enact societal change, may have a complex relationship with youth's depression, anxiety, and psychological stress symptoms and warrants careful exploration. Future research should focus on understanding the longitudinal mechanisms of critical action and how we can maximize the benefits by protecting youth from those negative effects.

In Their Own Voices: A Critical Narrative Review of Black Women Faculty Members' First-Person Accounts of Racial Trauma Across Higher Education.

Phenomenon: Black women often face more challenges in academic medicine than others and are leaving the profession due to unsupportive work environments, systematic neglect, and experiences of invisibility. Research offers insight into Black women faculty experiences, but studies have largely been conducted on their experiences rather than written by them. We analyzed first-person narratives exploring Black women faculty members' experiences with racial trauma across the academy considering the intersectionality of racism and sexism to lay the foundation for understanding Black women physicians' faculty experiences in similar spaces. Approach: We gathered first-person narratives of Black women faculty members in the U.S. from ERIC, Web of Science, and Ovid Medline. We used a variety of terms to draw out potential experiences with trauma (e.g., microaggressions, stigma, prejudice). Articles were screened by two researchers, with a third resolving conflicts. Drawing on constructs from Black feminist theory, two researchers extracted from each article authors' claims about: (a) their institutions, (b) their experiences in those spaces, and (c) suggestions for change. We then analyzed these data through the lens of racial trauma while also noting the effects of gendered racism. Findings: We identified four key themes from the 46 first-person accounts of racial trauma of Black faculty members in higher education: pressures arising from being "the only" or "one of few"; elimination of value through the "cloak of invisibility" and "unconscious assumptions"; the psychological burden of "walking a tightrope"; and communal responsibility, asking "if not us, then who?" Insights: Black women's narratives are necessary to unearth their specific truths as individuals who experience intersectional oppression because of their marginalized racial and gender identities. This may also assist with better understanding opportunities to dismantle the oppressive structures and practices hindering more diverse, equitable, and inclusive institutional environments where their representation, voice, and experience gives space for them to thrive and not simply survive within the academy, including and not limited to medicine.

Anti-racism bystander training: A critical need in medical schools.

Despite increasing acknowledgment of racism in both the curricular and clinical spaces, it continues to pervade the medical field, with clear detrimental impacts to the health of our patients. The introduction of anti-racism bystander training (ARBT) may provide a unique opportunity to reduce inequitable care and health disparities that occur secondary to racism in healthcare. ARBT, in its various forms, has been shown to be an effective method to increase participants' confidence and efficacy in intervening on observed racist encounters. This training can take numerous forms, and the authors provide one successful template used with medical students at their own institution. If medical centers, educators, and leaders in the field of medicine truly hope to mitigate the individual racist behaviors that remain in healthcare, ARBT must be employed to a much wider degree in medical education.

Anti-racism curricula in undergraduate medical education: A scoping review.

PURPOSE: Medical educators have increasingly focused on the systemic effects of racism on health inequities in the United States (U.S.) and globally. There is a call for educators to teach students how to actively promote an anti-racist culture in healthcare. This scoping review assesses the existing undergraduate medical education (UME) literature of anti-racism curricula, implementation, and assessment. METHODS: The Ovid, Embase, ERIC, Web of Science, and MedEdPORTAL databases were queried on 7 April 2023. Keywords included anti-racism, medical education, and assessment. Inclusion criteria consisted of any UME anti-racism publication. Non-English articles with no UME anti-racism curriculum were excluded. Two independent reviewers screened the abstracts, followed by full-text appraisal. Data was extracted using a predetermined framework based on Kirkpatrick's educational outcomes model, Miller's pyramid for assessing clinical competence, and Sotto-Santiago's theoretical framework for anti-racism curricula. Study characteristics and anti-racism curriculum components (instructional design, assessment, outcomes) were collected and synthesized. RESULTS: In total, 1064 articles were screened. Of these, 20 met the inclusion criteria, with 90% (n = 18) published in the past five years. Learners ranged from first-year to fourth-year medical students. Study designs included pre- and post-test evaluations (n = 10; 50%), post-test evaluations only (n = 7; 35%), and qualitative assessments (n = 3; 15%). Educational interventions included lectures (n = 10, 50%), multimedia (n = 6, 30%), small-group case discussions (n = 15, 75%), large-group discussions (n = 5, 25%), and reflections (n = 5, 25%). Evaluation tools for these curricula included surveys (n = 18; 90%), focus groups (n = 4; 20%), and direct observations (n = 1; 5%). CONCLUSIONS: Our scoping review highlights the growing attention to anti-racism in UME curricula. We identified a gap in published assessments of behavior change in applying knowledge and skills to anti-racist action in UME training. We also provide considerations for developing UME anti-racism curricula. These include explicitly naming and defining anti-racism as well as incorporating longitudinal learning opportunities and assessments.

Where are we now? Evaluating the one year impact of an anti-racism curriculum review.

PURPOSE: Undergraduate medical education has had a call to action to acknowledge racist practices that are impacting learners throughout their training. In 2020, our school performed a detailed curricular review and provided recommendations to address racism in the curriculum. Many schools have now undergone a similar curricular review process, but little is known about whether suggested antiracist curricular changes impact faculty teaching behavior or the overall curriculum. MATERIAL AND METHODS: In 2021, as part of the medical school's annual educational quality improvement process, course directors were required to answer a question about the changes they made to address racism in their courses based on recommendations provided the year prior from an antiracism curricular review. The documented changes were analyzed for themes and then organized by course and curricular year. These changes were compared with the suggested recommendations to analyze the number and types of changes implemented after one year. To evaluate student perceptions of change the general comments from academic years 2019-2021 were reviewed. RESULTS: After 1 year, approximately, 74% of our school's 328 anti-racism curricular review recommendations were implemented in courses. Over 80% were implemented in curricular year 1. The greatest number of recommendations implemented were related to the theme of critiquing the strength of evidence in race-based medical practices. The least amount change was made around the theme of challenging the biologic notion of race. CONCLUSIONS: An antiracism curricular review followed by an embedded continuous quality improvement process can be an effective approach to address racism in medical school curricula. Addressing racism in medical education requires medical schools to regularly identify curricular gaps, faculty needs and monitor their progress.

"We'd really love to but we're really busy": Silence, precarity and resistance as structural barriers to anti-racism in nursing education.

AIM: To identify structural barriers to the uptake and practice of anti-racism in nursing education, specifically in the Canadian context. DESIGN: A deconstructive, critical, qualitative inquiry informed by critical race theory, critical whiteness, feminism and post-colonialism. METHODS: This study employed an anonymous online open-ended questionnaire and online focus groups with Canadian nurse educators from April to June 2021. The data were analysed through a contextualist thematic analysis that accounts for data as essential experience and also a product of discourse. RESULTS: Structural barriers identified are organized into themes of: the academic environment; position and power; racism; program delivery; and Whiteness. Pervasive silence, especially white silence, can be interpreted in related contexts of precarity, self-interest and institutional violence. Overarching processes of precarity and resistance exert power over the environment of nursing education which act to destabilize, disrupt and discourage anti-racist efforts and education. CONCLUSION: The sustainability of anti-racism should be a primary focus. This entails attending to structures in nursing and higher education that make nursing education precarious work, especially for educators racialized as Other in the white supremacist racial binary of White: non-White. Explicit and ongoing attention to conditions that silence is necessary for any progress to be made. Strategies of applying anti-racism need to be as complex as the barriers. IMPLICATIONS: Many schools of nursing are engaged in attempts to include anti-racism as learning and environment. The structural barriers that interfere with effective integration of anti-racism as a lens for nursing education must be named and addressed so educators and schools can be successful. The implication of trying to incorporate anti-racism without addressing the barriers is a very superficial or pocketed application of anti-racism, and a continuation of the status quo that reproduces Whiteness and excludes and harms people racialized otherwise. IMPACT: The study addressed both strategies and barriers to anti-racism in nursing education. This article addressed structural barriers in anti-racism in Canadian nursing education. The main findings are that processes of precarity specific to nursing education in institutions of higher learning, and resistance through Whiteness, decision-making hierarchy and regulatory structures interfere with the application of anti-racism. This research impacts nurse educators in all nursing schools and leaders in higher education. It also impacts all current and future nursing students as the recipients of the education we provide. REPORTING METHOD: The paper adheres to COREQ checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

A qualitative study to explore experiences of anti-racism teaching in medical residency programs across the United States and subsequent creation of the SPOC (Support - Pipeline - Outcomes - Community) Model to guide future curricula design.

BACKGROUND: Racism contributes to health disparities and is a serious threat to public health. Teaching physicians about racism, how to address it in medical practice, and developing high quality and sustainable curricula are essential to combating racism. OBJECTIVE: This study aimed to (1) describe the experience of racism and anti-racism teaching in residency programs, and elicit recommendations from key informants, and (2) use these data and formative research to develop recommendations for other residencies creating, implementing, and evaluating anti-racism curricula in their own programs. METHODS: From May to July 2023, 20 faculty and residents were recruited via convenience sampling for key informant interviews conducted via Microsoft Teams. Interviews were audio recorded, transcribed, and coded. An initial list of themes was developed using theoretical frameworks, and then refined using a grounded-theory approach. A brief online optional anonymous demographic survey was sent to participants in August of 2023.  RESULTS: Eighty percent (20/25) of participants approached were interviewed. Seventy-five percent (15/20) answered a brief optional demographic survey. Seven themes emerged: (1) Racism in medicine is ubiquitous; (2) Anti-racism teaching in medicine varies widely; (3) Sustainability strategies should be multifaceted and include recruitment, resource allocation, and outcome measures; (4) Resources are widely available and accessible if one knows where to look; (5) Outcomes and metrics of success should include resident- faculty-, patient- community-, and system-focused outcomes; (6) Curricular strategies should be multilayered, longitudinal, and woven into the curriculum; and (7) Self-reflection and discomfort are necessary parts of the process.  CONCLUSIONS: This study is one of the first to qualitatively examine perspectives of key stakeholders invested in anti-racism teaching for residents. The Support - Pipeline - Outcomes - Community (SPOC) Model, that was developed using information collected during this study, can be used in the future as a guide for others working to design and implement sustainable and high quality anti-racism curricula for residents.

Equity and justice in medical education: mapping a longitudinal curriculum across 4 years.

BACKGROUND: In 2024 in the United States there is an attack on diversity, equity, and inclusion initiatives within education. Politics notwithstanding, medical school curricula that are current and structured to train the next generation of physicians to adhere to our profession's highest values of fairness, humanity, and scientific excellence are of utmost importance to health care quality and innovation worldwide. Whereas the number of anti-racism, diversity, equity, and inclusion (ARDEI) curricular innovations have increased, there is a dearth of published longitudinal health equity curriculum models. In this article, we describe our school's curricular mapping process toward the longitudinal integration of ARDEI learning objectives across 4 years and ultimately creation of an ARDEI medical education program objective (MEPO) domain. METHODS: Medical students and curricular faculty leaders developed 10 anti-racism learning objectives to create an ARDEI MEPO domain encompassing three ARDEI learning objectives. RESULTS: A pilot survey indicates that medical students who have experienced this curriculum are aware of the longitudinal nature of the ARDEI curriculum and endorse its effectiveness. CONCLUSIONS: A longitudinal health equity and justice curriculum with well-defined anti-racist objectives that is (a) based within a supportive learning environment, (b) bolstered by trusted, structured avenues for student feedback and (c) amended with iterative revisions is a promising model to ensure that medical students are equipped to effectively address health inequities and deliver the highest quality of care for all patients.

Critical consciousness and anti-racist action as rooted in family processes.

Racially ethnically marginalized communities in the United States are exposed to structural and interpersonal forms of racism that have harmful effects on their health, wealth, education, and employment (Centers for Disease Control and Prevention, Racism and Health. https://www.cdc.gov/minorityhealth/racism-disparities/index.html, 2021). Although a plethora of research exists outlining these harmful effects, research examining how youth from diverse backgrounds effectively combat racism is lacking. Emerging research demonstrates that families may play a key role in the development of critical consciousness and participation in anti-racist actions (Bañales et al., Journal of Social Issues, 2021, 77, 964; Blanco Martinez et al., American Journal of Community Psychology, 2022, 70, 278; Lozada et al., Journal of Black Psychology, 2017, 43, 493). Yet, many key family processes have not been examined in relation to youth development of anti-racist practices. The current study included a sample of 327 racially ethnically diverse emerging adults (Mage = 18.80, SD = 1.28, range = 18-25), and explored the association between ethnic-racial socialization (cultural socialization, preparation for bias) and youth critical consciousness (reflection, motivation, action) and anti-racist (interpersonal, communal, political change) actions, and how familism values impact these associations. Results found that ethnic-racial socialization was positively associated with all aspects of critical consciousness and anti-racist actions. Results also found that familism significantly interacted with ethnic-racial socialization to predict some aspects of critical consciousness and anti-racist actions, but not others. Implications of the findings and future research directions are discussed.

A special section: Contributions of family science to anti-racism efforts.

Concomitant with a growing recognition of demographic shifts toward greater racial/ethnic diversity in the United States and widespread depictions of racial injustice, desires for increased racial/ethnic tolerance and inclusivity have been expressed in various sectors of U.S. society, including education, healthcare, and business. However, the literature on effective strategies and interventions for advancing anti-racism, or efforts to reduce racial/ethnic injustice, is minimal and underdeveloped. The family science field, characterized by rich theories on human systems and interactions, strategies for changing interpersonal dynamics, and the recognition that perceived knowledge is dependent on sociopolitical location, has much to offer the study of strategies to actualize increased racial/ethnic equity. The articles in this special section demonstrate potential contributions family science can make to the endeavor for racial/ethnic equity, through presenting theoretical, empirical, and practice innovations and findings steeped in the family science orientation toward addressing systems, cycles, and change.

Parents' anti-Black messages, empathic reactions toward racism, fear of Black individuals, and perceived ability to engage in anti-racism advocacy among Asian American emerging adults.

Asian Americans, historically oppressed and influenced by White supremacist norms, may internalize anti-Blackness (beliefs of behaviors that minimize, marginalize, or devalue Black individuals) as they navigate White-dominated environments to survive and seek acceptance. However, there is limited research addressing the intergenerational socialization of anti-Blackness within Asian American communities and its impact as a barrier to cross-racial solidarity and involvement in anti-racism efforts. Thus, we tested whether parents' anti-Black messages were associated with fear of Black individuals and lack of empathic reactions to anti-Black racism, and in turn, related to hindrance in the perceived ability to engage in anti-racism advocacy among Asian American emerging adults. With data from 205 participants (Mage = 19.92, SD = 2.64, online convenience sample), we conducted a path analysis of parents' anti-Black messages indirectly associated with perceived ability in advocacy against anti-Black racism through fear of Black individuals and empathic reactions to anti-Black racism. Parents' anti-Black messages were associated with greater fear of Black individuals, which was associated with lower empathic reactions to racism, and in turn, ultimately associated with a lower perceived ability to engage in advocacy against anti-Black racism. This pathway was the best-fitting model compared with an alternative parallel model (fear and empathy as separate mediators) and a model with empathy as the first mediator. Our study suggests that clinicians, educators, and researchers should target parents' anti-Black messages and Asian American emerging adults' emotional responses (fear, empathy) to anti-Black racism in disrupting anti-Blackness at parental/family and individual levels.

Stacked Up Against Us: Using Photovoice and Participatory Methods to Explore Structural Racism's Impact on Adolescent Sexual and Reproductive Health Inequities.

While structural racism has profound impacts on adolescent health, little is known about how youth synthesize racialized experiences and work to dismantle systems of oppression. This article provides an overview of a Youth Participatory Action Research study that used Photovoice and community mapping to explore how structural violence, like racism, impacts the sexual and reproductive health of historically excluded youth as they navigate unjust socio-political landscapes. Youth participants used photography and community maps to identify how the experience of bias, profiling, and tokenism impacted their ability to navigate complex social systems. With youth voices prioritized, participants explored ways to address structural racism in their lives. The importance of co-creating opportunities with and for youth in critical reflection of their lived experience is emphasized. Through an Arts and Cultural in Public Health framework, we provide an analysis of the ways structural racism functions as a gendered racial project and fundamental cause of adolescent sexual and reproductive health inequities, while identifying pathways toward liberation in pursuit of health and well-being.

Social work's opportunity and obligation to achieve population health equity.

US healthcare remains a system in crisis, wherein spending outpaces other Western economies but health inequities match those of an emerging market economy. As a country founded in tenets of white supremacy, structural racism persists as evidenced by longstanding race-based disparities. Although the population health approach offers a potential framework for preventative and community-based health, without overt race-conscious design, race-based disparities will be replicated. This article outlines the current US context and healthcare policy changes that led to population health taking hold. It then articulates social work's pivotal role in population health by explicitly challenging colorblindness to reach race-based health equity. Opportunities for social work practice, leadership, and research are discussed.

Five ways 'health scholars' are complicit in upholding health inequities, and how to stop.

Health scholars have been enthusiastic in critique of health inequities, but comparatively silent on the ways in which our own institutions, and our actions within them, recreate and retrench systems of oppression. The behaviour of health scholars within academic institutions have far reaching influences on the health-related workforce, the nature of evidence, and the policy solutions within our collective imaginations. Progress on health equity requires moving beyond platitudes like 'equity, diversity and inclusion' statements and trainings towards actually being and doing differently within our day-to-day practices. Applying complex systems change theory to identify, examine and shift mental models, or habits of thought (and action), that are keeping us stuck in our efforts to advance health equity is a promising approach. This paper introduces five common mental models that are preventing meaningful equity-oriented systems transformation within academia and offers ideas for shifting them towards progressively more productive, and authentic, actions by health scholars to advance health equity across systems.

Addressing anti-black racism in an academic preterm birth initiative: perspectives from a mixed methods case study.

BACKGROUND: Growing recognition of racism perpetuated within academic institutions has given rise to anti-racism efforts in these settings. In June 2020, the university-based California Preterm Birth Initiative (PTBi) committed to an Anti-Racism Action Plan outlining an approach to address anti-Blackness. This case study assessed perspectives on PTBi's anti-racism efforts to support continued growth toward racial equity within the initiative. METHODS: This mixed methods case study included an online survey with multiple choice and open-ended survey items (n = 27) and key informant interviews (n = 8) of leadership, faculty, staff, and trainees working within the initiative. Survey and interview questions focused on perspectives about individual and organizational anti-racism competencies, perceived areas of initiative success, and opportunities for improvement. Qualitative interview and survey data were coded and organized into common themes within assessment domains. RESULTS: Most survey respondents reported they felt competent in all the assessed anti-racism skills, including foundational knowledge and responding to workplace racism. They also felt confident in PTBi's commitment to address anti-Blackness. Fewer respondents were clear on strategic plans, resources allocated, and how the anti-racism agenda was being implemented. Suggestions from both data sources included further operationalizing and communicating commitments, integrating an anti-racism lens across all activities, ensuring accountability including staffing and funding consistent with anti-racist approaches, persistence in hiring Black faculty, providing professional development and support for Black staff, and addressing unintentional interpersonal harms to Black individuals. CONCLUSIONS: This case study contributes key lessons which move beyond individual-level and theoretical approaches towards transparency and accountability in academic institutions aiming to address anti-Black racism. Even with PTBi's strong commitment and efforts towards racial equity, these case study findings illustrate that actions must have sustained support by the broader institution and include leadership commitment, capacity-building via ongoing coaching and training, broad incorporation of anti-racism practices and procedures, continuous learning, and ongoing accountability for both short- and longer-term sustainable impact.

Facilitating difficult conversations through art: creating an anti-racism digital image library for health professions education.

Racism has been recognised as a threat to patient outcomes, public health, and the healthcare workforce, and health professions (HP) educators and learners alike are seeking effective ways to teach anti-racism in HP education. However, facilitating conversations on race and racism in healthcare contexts can be challenging. Integrative arts and humanities approaches can engage learners in the critical dialogue necessary to educational interventions focused on anti-racism. Discussions of works of visual art, for instance, can leverage visual art as an avenue for indirection to balance introspection and revelation with psychological safety. Structured pedagogical frameworks that emphasise the perspectives and experiences of participants, such as the Visual Thinking Strategies approach, can lead to open-ended and collaborative discussions where participants can safely explore their assumptions in a space that encourages productive discomfort. Visual arts-based programs on anti-racism in HP are limited, though, in part because no collection of images exists to support HP educators in this endeavour. This paper describes the process of developing a digital image library to support HP educators seeking to generate discussions on race and racism as part of anti-racism curricula. We also highlight common themes, best practices, and potential pitfalls associated with use of the image library.

A Novel Narrative Medicine Approach to DEI Training for Medical School Faculty.

Problem:Diversity, Equity, and Inclusion (DEI) trainings for medical school faculty often lack self-reflective and pedagogically focused components that may promote incorporation of anti-racism and social justice into medical school curricula. Intervention: A four-session Narrative Medicine (NM) anti-racism program was designed for medical school faculty using critical race theory, phenomenology, and NM methods. Each workshop consisted of a lecture on key NM concepts and a small-group breakout session incorporating group discussion, close reading, and reflective writing. Context: This NM anti-racism program was developed and implemented in April 2021 by two medical students for faculty at an institution in the southeastern U.S. The program was supported by the Office of Inclusive Excellence at the institution and held in collaboration with the institution's medical education teaching academy. Program evaluation consisted of pre- and post-program surveys, which queried participants' previous experiences with DEI and medical humanities programs, perceptions of self-identity and privilege, and confidence in teaching concepts of anti-racism. Of the total program participants (n = 32), 19 completed both surveys (54.3%). Survey data were analyzed using bivariate testing methods and qualitative thematic analysis. Impact: Post-program surveys showed 13 (68.4%) participants felt "somewhat more" or "more" comfortable engaging in concepts of race, and 12 (63.2%) participants felt "somewhat more" or "more" comfortable including topics of race into their teaching compared to before the program. Five themes were generated following qualitative analysis: (1) the value of longitudinal narrative reflection in a small-group setting for DEI work; (2) desire to commit more time to DEI, anti-racist, and social justice work while balancing busy teaching and clinical schedules; (3) the value of storytelling in DEI and anti-racism programming; (4) an understanding of deconstructive and reconstructive work of anti-racism in medicine; and (5) an increased ability to educate and enact change through teaching, activism, and institutional cultural and policy changes. Lessons Learned: This novel NM DEI training for medical school faculty was successful in increasing comfort discussing and teaching concepts of race in the medical school classroom, while providing a uniquely reflective space for personal growth. Participation in this longitudinal reflective experience was limited by physician schedules, therefore efforts to make time to participate in similar longitudinal interventions must be undertaken.