Racial Justice Curricula in Family Medicine Residency Programs: A CERA Survey of Program Directors

Abstract

Background and Objectives: Structural racism is a cause of health disparities. Graduate medical education is tasked with training physicians who understand and address disparities. Addressing health disparities includes education on racism, such as racial justice curricula (RJC). We surveyed program directors (PDs) about the prevalence and characteristics of RJC in family medicine residency programs (FMRPs). Methods: RJC questions were included in the 2020 Council of Academic Family Medicine Educational Research (CERA) survey of FMRP PDs. We calculated univariate and bivariate statistics to describe respondent characteristics and attitudes, program characteristics, curriculum characteristics, and barriers to implementation. Results: Of 624 PDs, 312 (50%) responded and 283/312 (90.7%) completed RJC questions. Less than one-third of FMRPs reported RJC, of which 98.9% focused on implicit/unconscious bias. Program characteristics associated with RJC included location, percent underrepresented minorities in medicine (URMM) residents and faculty, and percent patients identifying as Black, Latino/a, and Native American. FMRPs with RJC were more likely to have PDs who reported favorable attitudes toward including RJC and believed it is important for family physicians to understand structural racism. The greatest barrier to implementation of RJC was lack of faculty training. Conclusions: In this national survey, most FMRPs reported no RJC. Most respondent PDs endorsed that it is important for family physicians to understand structural racism and that RJC should be included in residency. Lack of faculty training was the greatest barrier to implementation. Research is needed to evaluate existing RJC and explore strategies for overcoming barriers to implemention.

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

“…Although health disparities teaching is now required in family medicine residency programs, it is unclear if and how anti-racism teaching, specifically, is taking place and whether it is effective [ 12 ]. Of the small number of social determinants of health post-graduate medical education curricula that exist and are described in the literature, the vast majority do not focus on sustainability or continuous quality improvement efforts [ 13 , 14 ].…”

“…Of the small number of social determinants of health post-graduate medical education curricula that exist and are described in the literature, the vast majority do not focus on sustainability or continuous quality improvement efforts [ 13 , 14 ]. Most reports focus on descriptions of the curricula, evaluation of the curricula and/or residents, and faculty perceptions of and experiences with the curriculum [ 12 ]. Similarly, there is a dearth of qualitative research exploring program directors’ and residents’ perspectives of racism and anti-racism teaching in various programs.…”

Evaluation of Family Medicine Residency Programs for Diversity, Equity, and Inclusion Milestones

“…In 2020, the Accreditation Council for Graduate Medical Education (ACGME) released Common Program Requirements for residency programs to address DEI 1 without providing strategies to measure programming or specific benchmarks. Additionally, while recent studies have documented underrepresented in medicine (URiM) resident and faculty recruitment efforts in various residency specialties [2][3][4][5][6][7][8][9][10] and offered racial justice and health equity curricula, [11][12][13] no large evaluations of DEI efforts in graduate medical education programs have been conducted. Smaller assessments have included the development of a climate assessment tool at a single program 14 or institution, 15 and the Racial Justice Report Cards developed by White Coats for Black Lives for medical schools and residencies, which were used to evaluate 26 medical institutions.…”

Meeting a need for anti-racism curricula in medical residency programs: A pilot study and results for implementation and future research

“…Although health disparities teaching is now required in family medicine residency programs, it is unclear if and how that teaching is taking place and whether it is effective (Wusu et al, 2022). Of the small number of social determinants of health post-graduate medical education curricula that exist and are described in the literature, the vast majority do not focus on patient-oriented outcomes, nor are they standardized, and none report any sustainability or continuous quality improvement efforts (Hunter & Thomson, 2019 (Gagliardi et al, 2022).…”

“…Of the small number of social determinants of health post-graduate medical education curricula that exist and are described in the literature, the vast majority do not focus on patient-oriented outcomes, nor are they standardized, and none report any sustainability or continuous quality improvement efforts (Hunter & Thomson, 2019 (Gagliardi et al, 2022). Most reports focus on descriptions of the curricula, evaluation of the curricula and/or residents, and faculty perceptions of and experiences with the curriculum (Wusu et al, 2022). Similarly, there is a dearth of qualitative research exploring program directors' and residents' perspectives of racism and anti-racism teaching in various programs.…”