Feasibility of an Antiracism Curriculum in an Academic Pulmonary, Critical Care, and Sleep Medicine Division

Abstract

Background Structural health inequities and racism adversely affect patient health and the culture of academic medicine. Formal training to educate fellows and faculty on antiracism is lacking. Objective Our objective was to design, implement, and assess the feasibility and preliminary efficacy of a year-long antiracism curriculum within a pulmonary, critical care, and sleep medicine division. Methods This was a pre- and postintervention observational study conducted between July 2020 and June 2021. The curriculum was offered during an allotted educational meeting time slot at a single-center pulmonary, critical care, and sleep medicine division at a large academic institution to fellows and faculty. The curriculum consisted of 13 1-hour virtual interactive workshops delivered by local experts in diversity, equity, and inclusion topics. Surveys assessed knowledge on racism in medicine; opinions, understanding, and comfort surrounding race and racism in medicine; as well as additional questions to solicit feedback on the curriculum itself via visual analog scale and write-in comments. Results Before initiating the curriculum, 74% ( n = 28) of respondents reported interest in an antiracism curriculum, and the majority (95%, n = 36) believed that discrimination affects medical staff and patients. Respondents reported only moderate comfort in talking about race (median, 58; interquartile range 41–70 on visual analog scale 0–100, where 100 is strongly agree with “I feel comfortable talking about race”). The postintervention survey demonstrated stability of the belief of the presence of racial discrimination and a 15% increase in self-directed learning about related topics. Although knowledge related to the use of race in medical algorithms improved, 14% fewer participants reported interest in continuing to engage in a division-wide structured antiracism curriculum. Conclusion Implementation of a curriculum on justice, equity, diversity, and inclusion within a fellowship program is feasible and addresses an unmet need within graduate medical education.

Interventions to address unprofessional behaviours between staff in acute care: what works for whom and why? A realist review

“…We identified 42 evaluations or descriptions of 42 interventions, all of which sought to address UB in acute healthcare settings. Of the interventions; 30 were conducted in the USA [ 73 , 76 , 78 , 82 , 86 , 88 , 89 , 91 – 93 , 95 , 100 , 101 , 106 , 111 , 116 , 120 , 122 , 125 , 127 , 129 , 137 , 141 , 143 , 156 , 164 , 165 , 172 , 174 , 177 , 178 ]; five in Australia [ 74 , 108 , 126 , 160 , 162 ]; two each in Canada [ 132 , 169 ] and South Korea [ 83 , 94 ]; and one in Turkey [ 144 ], Ireland [ 100 ] and Iran [ 154 ]. Iran and Turkey were the only low- or middle-income countries to report an intervention.…”

“…If an intervention relies solely on single sessions (C), then while they may raise awareness and knowledge of skills to tackle UB in an organisation in the moment (O1), any planned behaviour change may not be sustained (O2), because they are intended as a one-time delivery of information or training and may be forgotten (M) CMOC 2. If an intervention relies solely on single sessions (C), then behaviour and sustained culture change may not happen (O), because it relies on individual behaviour change without any parallel organisation-wide approach (M) Multi-session interventions ( n = 11) [ 82 , 94 , 100 , 106 , 125 , 129 , 144 , 154 , 156 , 172 , 177 ] These are similar to single-session interventions but rely on use of multiple workshops or lecture-type sessions over time. Most still draw on education and role-playing type activities CMOC 3.…”

“…Interventions were evaluated with different study designs. Sixteen used a pre-post design [ 73 , 86 , 88 , 89 , 91 , 92 , 111 , 125 – 127 , 137 , 141 , 143 , 144 , 172 , 174 ], three used a pre-post design with a non-randomised control group [ 120 , 156 , 162 ], five other studies used a pre-post design with no control group, but with the addition of follow-up data collection [ 76 , 93 , 95 , 106 , 177 ], five used a randomised or quasi-randomised controlled trial design [ 83 , 94 , 132 , 154 , 169 ] and thirteen were descriptive case studies or feasibility studies which did not formally evaluate the effectiveness of the interventions they reported [ 74 , 78 , 82 , 100 , 101 , 108 , 116 , 122 , 129 , 160 , 164 , 165 , 178 ]. Only n = 18 (43%) of interventions reported using any theoretical framework, of which n = 13 (31%) drew on psychological theories, and n = 5 (12%) on organisational theories.…”

“…Yet, these groups are rarely considered in existing interventions to tackle UB. We only identified one published intervention seeking to address racism [ 82 ], and none that even mentioned women or minoritised groups. This imbalance reduces equity and fairness and causes members of these groups to feel left behind.…”

“…Key Dynamic 10 emphasises how existing research has been conducted with little regard to the additional burden of UB that women, staff from minority backgrounds, or with disabilities, experience. Only one intervention sought to address racist UB in acute care [ 82 ], and no others addressed this issue. Furthermore, sexual assault and sexism remain prevalent issues in the UK NHS and healthcare systems and societies worldwide, together with other known widespread issues such as racism, and disability and discrimination against LGBTQ + people.…”