Background: The Accreditation Council for Graduate Medical Education (ACGME) established a core competency that requires residents to demonstrate respect and responsiveness to diverse patient populations (1). While the importance of diversity, equity, and inclusion (DEI) in graduate medical education (GME) is recognized, establishing an effective curriculum to address these issues is challenging. In pre-survey data collected from internal medicine and pediatric residents at the University of North Carolina (UNC), 98% of respondents agreed that understanding the impact of racism in medicine was critical to deliver adequate healthcare, yet only half (52%) of respondents felt their institution was effectively addressing racism in medicine. 73% of respondents have directly witnessed racism affecting the care provided to a patient or colleague, yet of those, 60% did not take any action. These gaps highlighted the need for a formal DEI curriculum.
Purpose: The EMBRACE series was implemented to create a resident-driven, effective, and action-oriented curriculum to understand how implicit bias and structural racism impact patient care, while also creating concrete tools to be an effective anti-racist ally.
Description: EMBRACE was implemented in the fall of 2020 for the internal medicine and pediatric departments at UNC. The cornerstone of each session was the creation of a safe space for small group conversations around structural racism, implicit bias, and microaggressions in medicine. The first session focused on developing a shared vernacular to deliberately engage and support anti-racism efforts. Participants reflected on their own implicit bias and how that contributes to systemic racism. Session two analyzed a case of a patient whose care was impacted by structural racism, leaving participants with better insight into how implicit bias plays out in patient interactions. Session three utilized a flipped-journal club style to learn about the historical context that drives many of our current race-based metrics. Participants reflected on how racism, rather than race, drives health disparities. The fourth session provided concrete tools to empower and enable residents to better advocate for marginalized populations and to take action against witnessed acts of racism.
Conclusions: After the EMBRACE series, there was a 40% increase in respondent belief that UNC was effectively addressing racism in medicine (92% vs. 52%). Furthermore, the number of participants who responded to witnessed acts of racism increased by 13%, as did their confidence and comfort in doing so (60% vs. 40%). When asked what were the greatest takeaways, a majority of respondents mentioned simply having a space for open dialogue. One participant said “small group discussion was deep and honest.” Another shared that the most meaningful part was the “open discussions amongst colleagues from diverse backgrounds about their personal experiences.” There was a 25% increase in individuals’ awareness of their own implicit bias and how that impacts interactions with patients of different races (63% pre-survey agreed, vs. 88% post-survey). Since its inception, the EMBRACE curriculum has been shared with four additional departments within the UNC Healthcare system to implement similar anti-racism curriculums. While this marks only the beginning of an important journey, it highlights the critical work to be done. We must be proactive agents of the change we want to see within not only our own medical institutions, but also the greater society.