Introducing a Structural Racism Curriculum in a Pediatric Primary Care Clinic
Archit Sahai, MD; Alexandra Sims, MD, MPH; Lauren Lipps, BS; Rachel Lawton, PhD; Dominick DeBlasio, MD, MEd; Melissa Klein, MD, MEd
We created a structural racism curriculum in multidisciplinary primary care clinic which helped Fosterer increased awareness of local racism and improved resident willingness to discuss racism with coworkers, patients, and families.
Archit Sahai, MD
Abstract
Background: Black Americans are subject to structural racism which leads to Black children facing poorer health outcomes. Resident physicians currently receive limited training on structural racism and have limited knowledge of how racism impacts their patient population.
Objective: We sought to develop and evaluate a structural racism curriculum to increase awareness of local anti-Black racism among residents in a primary care clinic and create a more inclusive work environment between staff, patients, and families.
Methods: The curriculum consisted of four, thirty-minute sessions delivered quarterly over a one-year period. Sessions were presented within the resident pediatric primary care clinic to a multidisciplinary audience including resident physicians, attending physicians, medical assistants, and psychologists. Content covered (1) housing inequities, (2) infant mortality disparities, (3) medical abuse and mistrust, and (4) civic engagement. We linked these topics with local data and clinical examples. A post-curriculum survey was administered and we conducted a qualitative content analysis on de-identified data.
Results: Fifty participants completed a post-curriculum survey; most were resident physicians (72%). Residents identified specific social determinants of health, such as housing and transportation, as a consequence of structural racism when presented with a clinical vignette. They referred to clinic and community resources to help address the challenges presented. Residents also demonstrated increased local knowledge of structural racism. Infant mortality disparities and medical abuse were the most impactful as well as the most uncomfortable topics. After completion, residents were more willing to discuss racism and stated being more mindful of structural racism in interactions with staff and families. They sought to build stronger relationship with families. Lack of confidence and discomfort were the most common barriers to increasing communication with staff and patients.
Conclusions: Our structural racism curriculum implemented in a multidisciplinary primary care setting helped foster increased awareness of local anti-Black racism, and improved staff desire to discuss structural racism with coworkers, patients, and families. Future curricula can help provide further communication skills to prepare staff to have difficult conversations.