More Than Half of Family Medicine Clerkships Do Not Address Systemic Racism: A CERA Study

Abstract

Background and Objectives: The influence of racism in medicine is increasingly acknowledged, and the negative effect of systemic racism on individual and population health is well established. Yet, little is known about how or whether medical students are being educated on this topic. This study investigated the presence and features of curricula related to systemic racism in North American family medicine clerkships. Methods: We conducted a survey of North American family medicine clerkship directors as part of the 2021 Council of Academic Family Medicine’s Educational Research Alliance (CERA) survey. Results: The survey response rate was 49% (78/160). Almost all clerkship directors agreed (n=68; 97.1%) that teaching about racism at all levels of medical education was appropriate. Yet, 60% (n=42) of family medicine clerkship directors reported no formalized curriculum for teaching about racism or bias. Teaching about systemic racism was more likely to be present in the family medicine clerkship at institutions where clerkship directors reported that faculty receive 5 or more hours of training in racism and bias, as compared to institutions where faculty receive 4 or fewer hours of training in racism/bias (odds ratio 2.82, 95% CI 1.05-8.04, P=.045). Programs reported using racism in medicine curricula based in cultural competency (20%); structural competency (10%); both cultural and structural competency (31%); and neither or uncertain (40%). Clerkship directors reported high faculty, student, and institutional engagement in addressing systemic racism. We did not find an association between underrepresented in medicine director identity and racism curricula. Conclusions: In more than half of family medicine clerkships, systemic racism is not addressed, despite interest from students and institutional support. A higher number of hours of faculty training time on the topic of racism was associated with having a systemic racism module in the clerkship curriculum, but we lacked data to identify a causal relationship. Investments in faculty development to teach systemic racism, including discussion of structural competency, are needed.

Evaluating the impact of an educational intervention on the history of racism in America for teaching structural competency to medical academicians

“…It also demonstrates that there is an appetite for more of this type of learning on a medical campus. Unfortunately, it is also a commentary on how often teaching the history of medicine to students and faculty gets neglected in many AHCs [18].…”

Editorial: Mitigating implicit bias and promoting compassionate behavior in public health/healthcare professionals: implications for treatment outcomes

“…Efforts to educate healthcare professional students, and their clinical and basic science instructors, about the adverse effects of implicit bias on healthcare delivery also remain far too limited. For example, in North America, fewer than half of family medicine residencies consider systemic racism in their curricula ( Bridges et al, 2023 ). And such shortcomings are glaringly evident to many medical students.…”

Stages of Development

“…Perhaps this next part is a bit of wishful thinking, but it may be the case that not only is the potential to capture the impact of these changes immense, but so too is the potential to catalyze change based on what the research may show. Might the questions posed by Bridges et al 5 about the need to invest in education about systemic racism be addressed robustly now that the competency of medical knowledge includes the core requirement that "Residents must recognize the impact of the intersection of social and governmental contexts, including community resources, family structure, trauma, racial inequities, mental illness, and addiction on health and health care received?" Will these changes help more physicians like Drs Devlin 6 and Zhang 7 feel wholly accepted?…”