129 - Training an antiracist workforce: integrating an antiracist lens into clinical reasoning education

Poster Number: 129
Publication Number: 129.216

Elisabeth S. Young, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Laura Deering, UCSF, San Francisco, CA, United States; Bianca R. Argueza, University of California, San Francisco, School of Medicine, 2330 Post Street, Ste 320, CA, United States

Background: Racism is a known determinant of health, and health inequities disproportionately affecting racial/ethnic minorities are well documented. It is critical to normalize recognizing and naming structural and interpersonal racism in healthcare, and to train providers who actively engage in antiracism as a standard of care. An impactful opportunity to practice this is clinical reasoning conference (CRC), a common teaching venue at residency programs that typically involves a case presentation followed by discussion of case components. As medical training programs adopt antiracism curricula, applying an antiracist lens during CRC offers a path to translate concepts to clinical practice.

Objective: To integrate an antiracist lens into CRC and to evaluate feasibility, acceptability, and early lessons learned.

Design/Methods: The setting was an academic, quaternary care center where trainees participate in CRC twice weekly and are trained in structural racism. At four CRCs, attendees were randomly assigned to an antiracism pilot group vs standard groups discussing diagnosis, etc. Trainees identifying as Black, Indigenous, or People of Color (BIPOC) were invited to opt out. Facilitated by a faculty member with formalized training, pilot group discussion followed the prompt: “Understanding that structural and interpersonal racism affect the care of BIPOC communities, where are areas in this case where we can take an antiracist approach to prevent or mitigate inequity?”. We collected anonymous post-surveys and conducted focus groups by white and BIPOC affinity groups. Data analysis included descriptive statistics and thematic analysis.

Results: Of the 90 trainees invited, 39 submitted post-surveys and 12 participated in the focus groups. Of survey respondents, 54% self-identified as white. 56% of respondents participated in the pilot discussion. While nearly all respondents felt CRC was an appropriate place to discuss racism and should be continued, only 26% felt there was adequate time for discussion. Significant themes from focus groups included appreciation for applying structural racism training to clinical scenarios, difficulty moving from naming to addressing racism, and recognition of the disproportionate burden on BIPOC trainees to educate others.Conclusion(s): Results suggest it is feasible and acceptable to apply an antiracism lens to CRC, and BIPOC trainees must be allowed to opt out. Trainees struggled with how to address racism, and providing case specific learning points may harness greater impact to clinical practice in future iterations.
EY_PAS_CV_22.pdf
Table 2. Measures of Feasibility and Acceptability in Post-Survey Respondents