Family physicians across the United States (U.S.) comprise the frontline of medical care for large portions of the population including many underserved and underinsured patients (Bazemore et al., 2019). Providing family medicine physicians with the tools they need to combat racism can play an important role in decreasing disparities (Enhance Racial Disparities Training, Say Primary Care Residents, n.d., White Docs Can -- and Should -- Address Racism in Health Care, n.d.). The skills of primary care educators to effectively teach about anti-racism have also been called into question (Vass & Adams, 2020). Both the American Academy of Family Physicians (AAFP) and the Society for General Internal Medicine (SGIM) have developed tools to help educators design curricula to accomplish this (AAFP Promotes Health Equity Curricular Toolkit, n.d., SGIM Forum - SGIM Forum Newsletter, n.d.). Despite these calls to action, only a small number of graduate medical education programs report implementing curricula to help learners improve awareness about racial and ethnic disparities (Hasnain et al., 2014).
Strategies for teaching residents to combat racism include knowledge improvement techniques, competency-based curricula, and increasing underrepresented minorities in medicine (Stowers et al., 2020). Studies show that residents believe that the implementation of such a curriculum would be useful for their development as effective physicians (Taylor et al., 2019). This study aimed to design, implement, and evaluate an anti-racism curriculum for a community-based family medicine residency program in the Southeastern United States.
Evidence base
Components of the curricula described in the literature include lectures, direct patient experiences, longitudinal experiences, and increased diversity of the residents and faculty (Eddy & Labuguen, 2002; SCL Health, n.d.; Zweifler & Gonzalez, 1998). Some of these curricula also include descriptions of curricular evaluations (Guh et al., 2019). These studies rarely assess patient-oriented outcomes. Implementation of knowledge- and competency-based anti-racism curricula in family medicine residency programs increases knowledge and confidence in addressing the problem of systemic racism in medicine and racial disparities in health. Wolff et al. (2007) demonstrated that a competency-based curriculum improved resident capabilities (Wolff et al.2007); while Dennis et al (2019) showed that lecture curriculums and workshops changed knowledge and attitudes, increased awareness and understanding of racism in medicine (Dennis et al., 2019)
A randomized trial evaluating virtual skills-based courses to improve cultural competence showed improved scores on the Cultural Competence Assessment Tool. Implicit bias training for faculty and residents led to a feeling of empowerment among participants to address racism and racial disparities in health. Future family medicine residency anti-racism curricula should include this as part of their measured outcomes.
Problem statement and objectives
Although process outcomes have been examined and documented for multiple anti-racism curricula, the question remains: Do patient-oriented outcomes demonstrate that these curricula benefit the populations served and for whom they aim to ultimately improve health?
The main objectives of this project were to design, implement, and evaluate an anti-racism curriculum for family medicine residents. The hypothesis was that implementation of the curriculum would decrease disparities among clinic patients and provide a learning experience for residents.