An Entrustable Professional Activity Addressing Racism and Pediatric Health Inequities

Abstract

Racism and discrimination are the root of many pediatric health inequities and are well described in the literature. Despite the pervasiveness of pediatric health inequities, we have failed to adequately educate and prepare general pediatricians and pediatric subspecialists to address them. Deficiencies within education across the entire continuum and in our health care systems as a whole contribute to health inequities in unacceptable ways. To address these deficiencies, the field of pediatrics, along with other specialties, has been on a journey toward a more competency-based approach to education and assessment, and the framework created for the future is built on entrustable professional activities (EPAs). Competency-based medical education is one approach to addressing the deficiencies within graduate medical education and across the continuum by allowing educators to focus on the desired equitable patient outcomes and then develop an approach to teaching and assessing the tasks, knowledge, skills, and attitudes needed to achieve the goal of optimal, equitable patient care. To that end, we describe the development and content of a revised EPA entitled: Use of Population Health Strategies and Quality Improvement Methods to Promote Health and Address Racism, Discrimination, and Other Contributors to Inequities Among Pediatric Populations. We also highlight the ways in which this EPA can be used to inform curricula, assessments, professional development, organizational systems, and culture change.

Teaching the Teachers: Development and Evaluation of a Racial Health Equity Curriculum for Faculty

“…The curriculum design is also supported by scholarship published after the curriculum's implementation, including the revised American Board of Pediatrics Entrustable Professional Activity 14, which defines activities that a general or subspecialty pediatrician should be able to perform routinely to address health disparities. 29 Sotto-Santiago and colleagues’ framework for creating an anti-racist educator also supports our aim to move participants from awareness to knowledge and further along to taking ownership of creating an anti-racist learning environment. 30 …”

Impact of Diversity in Training Resources on Self-Confidence in Diagnosing Skin Conditions Across a Range of Skin Tones: An International Survey

“…Nevertheless, despite these limitations, our findings are in line with recent positions from major societies, highlighting the urgent need of addressing equality and diversity in medical education. A recent viewpoint from US dermatologists called for a dermatologic curricula that incorporate concepts of antiracism, implicit bias, cultural humility, health disparities, and skin-ofcolor education into journal clubs, grand rounds presentations, resident lectures, and direct patient exposure (18)(19)(20) and similar devices have been raised by the American Academy of Pediatrics (21) and by European paediatricians (22).…”

Why Competency Frameworks Are Insufficiently Nuanced for Health Equity Teaching and Assessment

“…11 Although CBME is a dominant movement in medical education, CBME frameworks did not originally define outcomes related to health equity or assess content areas related to structural determinants of health. 12 Yet there is agreement in the academy and professional organizations that individual physicians should have knowledge of health equity and do have a professional responsibility to realize it in their practice in order to affect patient outcomes. 13,14 Beyond the few efforts made to amend competency-based frameworks, 12 health equity is typically an afterthought in curricula that were not designed to teach or assess the critical knowledge that is needed to understand and advance health equity.…”

“…12 Yet there is agreement in the academy and professional organizations that individual physicians should have knowledge of health equity and do have a professional responsibility to realize it in their practice in order to affect patient outcomes. 13,14 Beyond the few efforts made to amend competency-based frameworks, 12 health equity is typically an afterthought in curricula that were not designed to teach or assess the critical knowledge that is needed to understand and advance health equity. 12 In keeping with CBME frameworks' artificial distinctions between knowledge and action, the current approach is to teach about inequities rather than to expose why and how underlying structural mechanisms (eg, racism, sexism, ableism, violence, differential education and employment opportunities, health care access) contribute to such health inequities.…”