Background: Anti-Black racism is embedded in American healthcare, (1) with roots in the structure and curriculum of medical education. (2) Dismantling racism in health care demands that medical education promote racial justice at all levels, from pre-clinical curriculum to clinical training and beyond. (3) However, there are significant barriers to teaching anti-racism content in the clinical learning environment, where the learning opportunities are immense but unpredictable. The purpose of this study is to understand the attitudes and behaviors of healthcare educators when discussing the topic of structural racism and implicit bias in medicine with learners.Aims: 1) Describe attitudes and behaviors clinician educators have when discussing structural racism and implicit bias with learners.2) Identify barriers facilitators and clinician educators face in discussing structural racism and implicit bias in routine clinical care with learners.
Methods: We conducted 30-minute semi-structured interviews with clinician educators across 2 academic institutions (Stanford Medicine and University of Alabama, Birmingham). Interviews were audio-recorded via a virtual videoconference platform (Zoom Video Communications Inc., San Jose, CA, USA), and subsequently manually transcribed and analyzed (Dedoose, 7.0.23) for common themes. Participants were also asked to complete a post-interview survey on their teaching practices around anti-racism (83.3% response rate).
Results: Ten healthcare professionals completed the interviews and post-interview survey. Most clinicians were within the first 5 years of graduating from residency or fellowship, (mean = 2.5 +/- 1.29;). The majority of educators (90%, n=9) reported frequently thinking about racism in their clinical decision. But only 60% (n=6) reported being moderately comfortable in discussing racial bias in clinical practice, and only 56% reporting teaching about racial bias several times a month. The most reported barriers for teaching anti-racism in healthcare included: lack of training, lack of time, and unfamiliarity with the topic. A thematic analyses of reviewed interview transcripts outlined some commonly shared experiences. These included concern about creating discomfort for learners and lack of faculty expertise on the subject. These prevented clinicians from teaching anti-racism.
Conclusions: Our findings indicate that healthcare professionals are frequently cognizant that racial bias affects clinical decision making, but are less likely to teach this content to learners. Identified barriers included both a lack of content knowledge and the lack of a structured framework to begin these conversations. Further initiatives to improve access to anti-racism training need integrate structured opportunities or platforms to teach this content in the clinical learning environment.