Teaching About Racism in Medical Education: A Mixed-Method Analysis of a Train-the-Trainer Faculty Development Workshop.

BACKGROUND AND OBJECTIVES: Curriculum addressing racism as a driver of inequities is lacking at most health professional programs. We describe and evaluate a faculty development workshop on teaching about racism to facilitate curriculum development at home institutions. METHODS: Following development of a curricular toolkit, a train-the-trainer workshop was delivered at the 2017 Society of Teachers of Family Medicine Annual Spring Conference. Preconference evaluation and a needs assessment collected demographic data of participants, their learning communities, and experience in teaching about racism. Post-conference evaluations were completed at 2- and 6-month intervals querying participants' experiences with teaching about racism, including barriers; commitment to change expressed at the workshop; and development of the workshop-delivered curriculum. We analyzed quantitative data using Statistical Package for the Social Sciences (SPSS) software and qualitative data, through open thematic coding and content analysis. RESULTS: Forty-nine people consented to participate. The needs assessment revealed anxiety but also an interest in obtaining skills to teach about racism. The most reported barriers to developing curriculum were institutional and educator related. The majority of respondents at 2 months (61%, n=14/23) and 6 months (70%, n=14/20) had used the toolkit. Respondents ranked all 10 components as useful. The three highest-ranked components were (1) definitions and developing common language; (2) facilitation training, exploring implicit bias, privilege, intersectionality and microaggressions, and videos/podcasts; and (3) Theater of the Oppressed and articles/books. CONCLUSIONS: Faculty development training, such as this day-long workshop and accompanying toolkit, can advance skills and increase confidence in teaching about racism.

Teaching Racial Affinity Caucusing as a Tool to Learn About Racial Health Inequity Through an Experiential Workshop.

BACKGROUND AND OBJECTIVES: In its landmark report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, the Institute of Medicine concluded that unconscious or implicit negative racial attitudes and stereotypes contribute to poorer health outcomes for patients of color. We describe and report on the outcome of teaching a workshop on the tool of racial affinity caucusing to address these issues. METHODS: Applying the framework described by Crossroads Antiracism Organizing and Training, we developed a 90-minute workshop teaching racial affinity caucusing to family medicine educators interested in racial health disparities. The workshop included didactic and experiential components as well as a panel discussion. We administered pre- and posttests. RESULTS: Participants' (n=53) impression of and confidence in implementing racial affinity caucusing significantly increased following the workshop from a mean pretest score of 5.40 to a mean posttest score of 7.12 (P<.01) on a scale of 1 to 9. Ninety-two percent of participants indicated that the workshop made them more likely to think about implementing this tool at their home institutions (P<.01). CONCLUSIONS: This study demonstrated the first exploration in medical education of racial affinity caucusing and illustrated that it can be easily implemented in residency programs as an effort to address racial health inequities. Though the participating educators were mostly unfamiliar with it, the workshop was an effective introduction to this tool and by the end, educators reported increased comfort and enthusiasm for racial affinity caucusing, regardless of their preexisting levels of knowledge of or comfort with the tool. In addition, the overwhelming majority of the participants felt they could implement it at their respective institutions.

From Policy Statement to Practice: Integrating Social Needs Screening and Referral Assistance With Community Health Workers in an Urban Academic Health Center.

Purpose: Social and economic factors have been shown to affect health outcomes. In particular, social determinants of health (SDH) are linked to poor health outcomes in children. Research and some professional academies support routine social needs screening during primary care visits. Translating this recommendation into practice remains challenging due to the resources required and dearth of evidence-based research to guide health center level implementation. We describe our experience implementing a novel social needs screening program at an academic pediatric clinic. Methods: The Community Linkage to Care (CLC) pilot program integrates social needs screening and referral support using community health workers (CHWs) as part of routine primary care visits. Our multidisciplinary team performed process mapping, developed workflows, and led ongoing performance improvement activities. We established key elements of the CLC program through an iterative process We conducted social needs screens at 65% of eligible well-child visits from May 2017 to April 2018; 19.7% of screens had one or more positive responses. Childcare (48.8%), housing quality and/or availability (39.9%), and food insecurity (22.8%) were the most frequently reported needs. On average, 76% of providers had their patients screened on more than half of eligible well-child visits. Discussion: Our experience suggests that screening for social needs at well-child visits is feasible as part of routine primary care. We attribute progress to leveraging resources, obtaining provider buy-in, and defining program components to sustain activities.

Addressing Racism in Medical Education An Interactive Training Module.

BACKGROUND AND OBJECTIVES: Education of health care clinicians on racial and ethnic disparities has primarily focused on emphasizing statistics and cultural competency, with minimal attention to racism. Learning about racism and unconscious processes provides skills that reduce bias when interacting with minority patients. This paper describes the responses to a relationship-based workshop and toolkit highlighting issues that medical educators should address when teaching about racism in the context of pernicious health disparities. METHODS: A multiracial, interdisciplinary team identified essential elements of teaching about racism. A 1.5-hour faculty development workshop consisted of a didactic presentation, a 3-minute video vignette depicting racial and gender microaggression within a hospital setting, small group discussion, large group debrief, and presentation of a toolkit. RESULTS: One hundred twenty diverse participants attended the workshop at the 2016 Society of Teachers of Family Medicine Annual Spring Conference. Qualitative information from small group facilitators and large group discussions identified some participants' emotional reactions to the video including dismay, anger, fear, and shame. A pre/postsurvey (N=72) revealed significant changes in attitude and knowledge regarding issues of racism and in participants' personal commitment to address them. DISCUSSION: Results suggest that this workshop changed knowledge and attitudes about racism and health inequities. Findings also suggest this workshop improved confidence in teaching learners to reduce racism in patient care. The authors recommend that curricula continue to be developed and disseminated nationally to equip faculty with the skills and teaching resources to effectively incorporate the discussion of racism into the education of health professionals.

Raising voices: A commentary on "Say their names" by Sandhira Wijayaratne.

Comments on a poem by Sandhira Wijayaratne (see record 2018-12809-007). This poem uses the power of language to speak to the consequences of silence and complacency and points to the role of healers in the social narrative. In his work, Wijayaratne highlights the structural and systemic racism that plagues our nation today, and affects our work as healthcare providers. "Say Their Names" represents a timely contribution to this field and echoes much of the current national discourse around racial oppression. It highlights the role of systemic racism in setting the stage for health disparities, disease, and trauma. (PsycINFO Database Record

Resident Documentation of Social Determinants of Health: Effects of a Teaching Tool in the Outpatient Setting.

Social determinants of health (SDH) significantly affect the health of children and thus, screening is important in pediatric primary care. We assessed the use of a formal social history taking tool after a 2-phase intervention. The first phase (P1) was a teaching module describing SDH and community resources and the second phase (P2) consisted of visual reminders to use the tool. Patient charts (n = 322) were reviewed pre- and postintervention. Residents had higher documentation rates of Women, Infants, and Children (WIC) program use and housing subsidies at post-P1 and at post-P(1 + 2) (WIC, P = .01 and P = .03, respectively; housing, P = .02 and P = .04, respectively), and higher documentation rates of food stamp utilization at post-P(1 + 2) ( P = .04), as compared with baseline. Implementation of a simple teaching tool in the outpatient setting enabled residents to document income benefits and housing. Further studies should be done to evaluate effective teaching methods to elicit other important SDH.

The elephant in the room: Dialogues about race within cross-cultural supervisory relationships.

OBJECTIVES: For centuries, the concept of race, a uniquely pervasive social construct, has often complicated dialogue and interactions between groups of people. This study assessed perceptions and attitudes of faculty and trainees with varied racial backgrounds within graduate medical and psychology programs. Self-reported responses addressed potential barriers and facilitating factors required for meaningful conversations about race. METHODS: A brief 18-question survey was developed and administered electronically to three professional and academic Listservs within a large metropolitan city in northeast United States. Quantitative and qualitative analysis were conducted using SPSS Statistical Software and Text analyzer. RESULTS: Results revealed that among participants (N = 57) a majority experienced cross-racial supervision, and more than half indicated engaging in conversations about race within supervision. Respondents endorsed lack of comfort and lack of opportunity/time as significant barriers to discussing race within supervision. When race-related dialogues occurred, a majority of supervisees and supervisors found it beneficial. Most Supervisors of Color(a) actively initiated these conversations in supervision, while White supervisees endorsed the least benefit from these conversations. Contrary to our expectations, few respondents endorsed limited training as a barrier. DISCUSSION: The current study revealed cross-racial dialogues about race may be occurring frequently in supervisory relationships. Supervisees of Color reported benefiting from these dialogues, in contrast to their White counterparts, who endorsed the least benefit. Lack of comfort in supervisory relationships appears to be a significant barrier to having these conversations. Therefore, it is important for supervisors to create supervisory relationships emphasizing safety and comfort. Directions for future research are discussed.