Health Equity Rounds: An Interdisciplinary Case Conference to Address Implicit Bias and Structural Racism for Faculty and Trainees

Abstract

Introduction: The medical community recognizes the importance of confronting structural racism and implicit bias to address health inequities. Several curricula aimed at teaching trainees about these issues are described in the literature. However, few curricula exist that engage faculty members as learners rather than teachers of these topics or target interdisciplinary audiences. Methods: We developed a longitudinal case conference curriculum called Health Equity Rounds (HER) to discuss and address the impact of structural racism and implicit bias on patient care. The curriculum engaged participants across training levels and disciplines on these topics utilizing case-based discussion, evidence-based exercises, and two relevant conceptual frameworks. It was delivered quarterly as part of a departmental case conference series. We evaluated HER's feasibility and acceptability by tracking conference attendance and administering postconference surveys. We analyzed quantitative survey data using descriptive statistics and qualitatively reviewed free-text comments. Results: We delivered seven 1-hour HER conferences at our institution from June 2016 to June 2018. A mean of 66 participants attended each HER. Most survey respondents (88% or more) indicated that HER promoted personal reflection on implicit bias, and 75% or more indicated that HER would impact their clinical practice. Discussion: HER provided a unique forum for practitioners across training levels to address structural racism and implicit bias. Our aim in dissemination is to provide meaningful tools for others to adapt at their own institutions, recognizing that HER should serve as a component of larger, multifaceted efforts to decrease structural racism and implicit bias in health care.

Implicit bias in healthcare: clinical practice, research and decision making

“…65 Unconventional methods of teaching bias may include a teaching bias to medical students in a non-clinical setting (such as a museum, a weekly series of case conferences examining health equity and implicit bias, and transformative learning theory). [100][101][102] Transformative learning theory resembles what many consider to be key components of Balint groups and combines multiple single interventions (such as experience, reflection, discussion and simulation). 102,103 Hagiwara and colleagues outlined three translational gaps from social psychology to medical training which may hinder the effectiveness of bias training to improve health outcomes.…”

Interrupting Microaggressions in Health Care Settings: A Guide for Teaching Medical Students

“…Although students and facilitators could be left to come up with possible ways to address microaggressions when they occur, outside resources could also be used to help guide the discussion, such as the previously published Interrupting Microaggressions tool (Appendix B, pp. [17][18]. 21 In addition, using previously learned materials from a preclerkship doctoring course could provide a bridge between the curricula learned in various courses.…”

“…Similar to other published work, it uses cases gleaned from experiences of trainees, which provide for robust discussion. 18 Yet it offers a distinct approach to focus on microaggressions in small-and large-group formats.…”

“I Didn't Know What to Say”: Responding to Racism, Discrimination, and Microaggressions With the OWTFD Approach

“…Finally, our program extends an emerging approach of reenacting real case examples from one's own institution to replicate the realistic conditions under which such incidents occur. 20 …”