Post by Admin on Apr 4, 2024 2:11:14 GMT
Exploring Racism and Health: An Intensive Interactive Session for Medical Students
Abstract
Introduction: Growing recognition of the deleterious effects of racism on health has led to calls for increased education on racism for health care professionals. As part of a larger curriculum on health equity and social justice, we developed a new educational session on racism for first-year medical students consisting of a lecture followed by a case-based small-group discussion. Methods: Over the academic years of 2016–2017, 2017–2018, and 2018–2019, a total of 536 first-year medical students participated in this mandatory session. The course materials were developed as a collaboration between faculty and students. The lecture was delivered in a large-group format; the small-group case-based discussion consisted of 10–12 students with one upper-level student facilitator. Results: The majority of respondents for the course evaluation felt that the course had met its stated objectives, and many commented that they had an increased awareness of the role of racism in shaping health. Students felt that the small-group activity was especially powerful for learning about racism. Discussion: Active student involvement in curriculum development and small-group facilitation was critical for successful buy-in from students. Additional content on bias, stereotyping, and health care disparities will be the focus of faculty development programs and will also be integrated into the clerkships to build on these important topics as students are immersed in clinical care.
Educational Objectives
By the end of this activity, learners will be able to:
1.
Define race and racism.
2.
Describe historical examples of institutional racism in science and medicine.
3.
Differentiate the levels of racism and how they can affect health.
4.
Utilize tools to address and cope with racial bias in the health care setting.
Introduction
Recent events in the United States have brought to light the continued struggles the nation faces with respect to racial bias and racism. It is increasingly clear that experienced racism has a profoundly deleterious effect on the health of minority populations—at both individual and institutional levels. Minority populations are exposed to greater amounts of stress and adverse social determinants that can lead to higher risk for poor mental and physical health.1–8 In the US health system, minority patients are less likely to receive high-quality health care services across multiple clinical settings,9 driven in large part by implicit bias on the part of physicians.10,11 Throughout medical training, students and trainees are exposed to multiple methods of instruction that enhance bias and misconceptions about race, genetics, culture, and disparities.12–16 In this context, teaching medical professionals about structural racism and how to recognize and address bias in clinical encounters has become increasingly imperative.11,17–20
Physicians, public health advocates, and medical educators have long recognized the impact that bias has on the well-being and care of patients. In acknowledging this, the Liaison Committee on Medical Education's Accreditation Standard 7.6: Cultural Competence and Health Care Disparities requires that “the faculty of a medical school ensure that the medical curriculum provides opportunities for medical students to learn to recognize and appropriately address gender and cultural biases in themselves, in others, and in the health care delivery process.”21
Likewise, medical students are increasingly requesting a focus on health equity and racism in medical education,22 including at our institution. In 2014–2015, Rutgers New Jersey Medical School (NJMS) students, in response to multiple killings of unarmed black men by the police, staged a die-in as part of the White Coats 4 Black Lives movement and advocated for increased teaching on issues of racism and its effect on health in the traditional NJMS curriculum.
In response, as a part of major curriculum revision, in academic year 2016–2017 (AY17), we created a new required course, Health Equity and Social Justice (HESJ), designed to be longitudinal over the preclerkship years, with the goal of making health equity content in the curriculum more accessible and explicit. The course included sessions on power and privilege in the physician-patient relationship, the role of unconscious bias in health care, trauma-informed care, spirituality, the social determinants of health, working with underserved populations, and exploring the patient's perspective, among others.
We offered the 3-hour, mandatory HESJ session on racism and health to all first-year medical students within the first month of the curriculum over AY17, 2017–2018 (AY18), and 2018–2019 (AY19). The session consisted of a didactic lecture and a small-group case-based discussion. Prior to the session, all students had attended an interactive lecture on unconscious bias, completed an Implicit Association Test (IAT),23 and submitted a personal reflection essay on the results of the IAT as part of HESJ.
Prior work with educational modules on racism for medical students,24,25 psychiatry residents,26 third-year clerkship students,27 and physicians28,29 has shown an increase in awareness of the importance of racism and bias, as well as an enhancement of a commitment to health equity. These interventions used one of multiple different modalities, including didactic lectures, small-group case-based discussions, online tutorials, and IATs. We found four such publications in MedEdPORTAL,25–27,29 one of which was designed for preclinical medical students25 but none of which included both didactic lecture and small-group case-based discussions.
Unlike other MedEdPORTAL publications, we incorporated both large-group didactic and case-based small-group activities to increase awareness of how racial historical insults shape society and consciousness, as well as to guide students in absorbing and processing the new information through debate and reflection. We engaged students in the curriculum design, a technique that has been successful in other efforts addressing cultural competency training.30 In addition, because we based the cases on student experiences, the discussions provided students opportunities to brainstorm about skills that they could use to navigate bias when they experience or witness it in the clinical setting.
We chose to expose students to these topics very early in their clinical training (the first month of the first year) to set the stage for subsequent clinical experiences and for future health equity curricular elements. The topics included the power and privilege dynamic in the clinical encounter, cultural humility, social determinants of health, working with underserved populations, and adverse childhood experiences/trauma-informed care—all areas where race and racism play important roles influencing health and access to high-quality health care.
www.mededportal.org/doi/10.15766/mep_2374-8265.10783
Abstract
Introduction: Growing recognition of the deleterious effects of racism on health has led to calls for increased education on racism for health care professionals. As part of a larger curriculum on health equity and social justice, we developed a new educational session on racism for first-year medical students consisting of a lecture followed by a case-based small-group discussion. Methods: Over the academic years of 2016–2017, 2017–2018, and 2018–2019, a total of 536 first-year medical students participated in this mandatory session. The course materials were developed as a collaboration between faculty and students. The lecture was delivered in a large-group format; the small-group case-based discussion consisted of 10–12 students with one upper-level student facilitator. Results: The majority of respondents for the course evaluation felt that the course had met its stated objectives, and many commented that they had an increased awareness of the role of racism in shaping health. Students felt that the small-group activity was especially powerful for learning about racism. Discussion: Active student involvement in curriculum development and small-group facilitation was critical for successful buy-in from students. Additional content on bias, stereotyping, and health care disparities will be the focus of faculty development programs and will also be integrated into the clerkships to build on these important topics as students are immersed in clinical care.
Educational Objectives
By the end of this activity, learners will be able to:
1.
Define race and racism.
2.
Describe historical examples of institutional racism in science and medicine.
3.
Differentiate the levels of racism and how they can affect health.
4.
Utilize tools to address and cope with racial bias in the health care setting.
Introduction
Recent events in the United States have brought to light the continued struggles the nation faces with respect to racial bias and racism. It is increasingly clear that experienced racism has a profoundly deleterious effect on the health of minority populations—at both individual and institutional levels. Minority populations are exposed to greater amounts of stress and adverse social determinants that can lead to higher risk for poor mental and physical health.1–8 In the US health system, minority patients are less likely to receive high-quality health care services across multiple clinical settings,9 driven in large part by implicit bias on the part of physicians.10,11 Throughout medical training, students and trainees are exposed to multiple methods of instruction that enhance bias and misconceptions about race, genetics, culture, and disparities.12–16 In this context, teaching medical professionals about structural racism and how to recognize and address bias in clinical encounters has become increasingly imperative.11,17–20
Physicians, public health advocates, and medical educators have long recognized the impact that bias has on the well-being and care of patients. In acknowledging this, the Liaison Committee on Medical Education's Accreditation Standard 7.6: Cultural Competence and Health Care Disparities requires that “the faculty of a medical school ensure that the medical curriculum provides opportunities for medical students to learn to recognize and appropriately address gender and cultural biases in themselves, in others, and in the health care delivery process.”21
Likewise, medical students are increasingly requesting a focus on health equity and racism in medical education,22 including at our institution. In 2014–2015, Rutgers New Jersey Medical School (NJMS) students, in response to multiple killings of unarmed black men by the police, staged a die-in as part of the White Coats 4 Black Lives movement and advocated for increased teaching on issues of racism and its effect on health in the traditional NJMS curriculum.
In response, as a part of major curriculum revision, in academic year 2016–2017 (AY17), we created a new required course, Health Equity and Social Justice (HESJ), designed to be longitudinal over the preclerkship years, with the goal of making health equity content in the curriculum more accessible and explicit. The course included sessions on power and privilege in the physician-patient relationship, the role of unconscious bias in health care, trauma-informed care, spirituality, the social determinants of health, working with underserved populations, and exploring the patient's perspective, among others.
We offered the 3-hour, mandatory HESJ session on racism and health to all first-year medical students within the first month of the curriculum over AY17, 2017–2018 (AY18), and 2018–2019 (AY19). The session consisted of a didactic lecture and a small-group case-based discussion. Prior to the session, all students had attended an interactive lecture on unconscious bias, completed an Implicit Association Test (IAT),23 and submitted a personal reflection essay on the results of the IAT as part of HESJ.
Prior work with educational modules on racism for medical students,24,25 psychiatry residents,26 third-year clerkship students,27 and physicians28,29 has shown an increase in awareness of the importance of racism and bias, as well as an enhancement of a commitment to health equity. These interventions used one of multiple different modalities, including didactic lectures, small-group case-based discussions, online tutorials, and IATs. We found four such publications in MedEdPORTAL,25–27,29 one of which was designed for preclinical medical students25 but none of which included both didactic lecture and small-group case-based discussions.
Unlike other MedEdPORTAL publications, we incorporated both large-group didactic and case-based small-group activities to increase awareness of how racial historical insults shape society and consciousness, as well as to guide students in absorbing and processing the new information through debate and reflection. We engaged students in the curriculum design, a technique that has been successful in other efforts addressing cultural competency training.30 In addition, because we based the cases on student experiences, the discussions provided students opportunities to brainstorm about skills that they could use to navigate bias when they experience or witness it in the clinical setting.
We chose to expose students to these topics very early in their clinical training (the first month of the first year) to set the stage for subsequent clinical experiences and for future health equity curricular elements. The topics included the power and privilege dynamic in the clinical encounter, cultural humility, social determinants of health, working with underserved populations, and adverse childhood experiences/trauma-informed care—all areas where race and racism play important roles influencing health and access to high-quality health care.
www.mededportal.org/doi/10.15766/mep_2374-8265.10783