Realizing Inclusion and Systemic Equity in Medicine: Upstanding in the Medical Workplace (RISE UP)—an Antibias Curriculum

Abstract

Introduction Racism is a public health threat, and racist behaviors adversely affect clinicians in addition to patients. Medical trainees commonly experience racism and bias. More than half of pediatric residents at a single institution reported experiencing or witnessing discriminatory behavior at work; only 50% reported receiving training on implicit bias, delivering difficult feedback, or peer support. Our multispecialty team created Realizing Inclusion and Systemic Equity in Medicine: Upstanding in the Medical Workplace (RISE UP), an antibias, anti-racism communication curriculum composed of three hybrid (virtual and in-person) workshops. Methods During the pediatric resident workshops, we introduced tools for addressing bias, presented video simulations, and led small-group debriefings with guided role-play. We also reviewed escalation pathways, reporting methods, and support systems. Residents completed an evaluation before and after each workshop to assess the curriculum's efficacy. Results Thirty-nine residents participated in RISE UP, with 20 attending all three workshops. Ninety-six percent of participants indicated they would recommend the workshops to colleagues. After the third workshop, 92% reported having tools to respond to bias, and 85% reported knowing how to escalate concerns regarding discriminatory behavior. Chief residents were most frequently identified as sources of resident support when encountering discriminatory behavior. Discussion This curriculum was successful in developing and strengthening residents’ responses to discrimination, including upstander support. The curriculum is adaptable for virtual, in-person, and hybrid settings, allowing for flexibility. Establishing institutional support, promoting faculty development, and creating and disseminating escalation pathways are critical to addressing racism in health care.

Recommendations for Faculty Development in Addressing Implicit Bias in Clinical Encounters and Clinical Learning Environments

“…[51][52][53] Moreover, such interventions only focus on one type of bias (e.g., race bias), yet individuals can be biased on any number of constructs. Interventions that moved beyond changing IAT scores have included participant reflection and discussion, and strategy identification, 29,30,36,[39][40][41][42][43][44]47,48 yet proved insufficient and impractical in the clinical environment. In our prior work, after instruction on implicit biases and their potential negative effects on clinical care, medical students were asked to write reflections on their biases and potential impact on future clinical care.…”

Seeking justice, equity, diversity and inclusion in pediatric nephrology

“…Formal training on recognizing and addressing microaggressions in the workplace is lacking. Calardo et al demonstrate the feasibility and effectiveness of deploying an anti-bias anti-racism curriculum for pediatric residents that is flexible and adaptable to virtual, in-person, and hybrid instruction to fill that need ( 63 ).…”

Racial Implicit Bias and Communication Among Physicians in a Simulated Environment

“…Given the negative influence of racial implicit bias on physician communication with Black patients 1 , 2 , 3 , 4 and the contributions of implicit bias in general to health care disparities, 8 addressing implicit bias has become a focus of medical education. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 Addressing implicit bias is mandated by accreditation bodies for undergraduate and graduate medical education. 23 , 24 Training in addressing implicit bias has been suggested for all practicing physicians.…”