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

BACKGROUND: A challenge facing many Academic Health Centers (AHCs) attempting to revise health professions education to include the impact of racism as a social and structural determinant of health (SSDoH) is a lack of broad faculty expertise to reinforce and avoid undermining learning modules addressing this topic. To encourage an institutional culture that is in line with new anti-racism instruction, we developed a six-part educational series on the history of racism in America and its impact on contemporary health inequities for teaching structural competency to health professions academicians. METHODS: We developed a six-hour elective continuing education (CE) series for faculty and staff with the following objectives: (1) describe and discuss race as a social construct; (2) describe and discuss the decolonization of the health sciences and health care; (3) describe and discuss the history of systemic racism and structural violence from a socio-ecological perspective; and (4) describe and discuss reconciliation and repair in biomedicine. The series was spread over a six-month period and each monthly lecture was followed one week later by an open discussion debriefing session. Attendees were assessed on their understanding of each objective before and after each series segment. RESULTS: We found significant increases in knowledge and understanding of each objective as the series progressed. Attendees reported that the series helped them grapple with their discomfort in a constructive manner. Self-selected attendees were overwhelmingly women (81.8%), indicating a greater willingness to engage with this material than men. CONCLUSIONS: The series provides a model for AHCs looking to promote anti-racism and structural competency among their faculty and staff.

Lessons Learned from Implementing Unconscious Bias Training at an Academic Medical Center.

Introduction: In 2018, our Midwestern university medical center began offering unconscious bias training. Each session concluded with a standard evaluation. We analyzed two years of data that focused on three areas: 1) whether demographic differences or amount of prior knowledge on the topic influenced the training experience; 2) what participants liked best about the training; and 3) whether participants' stated intentions to apply their learning at the end of the training aligned with institutional goals of the training. Methods: Participants attended sessions open to the campus community pre-scheduled by the Office for Diversity, Equity, and Inclusion and posted on its website. Chi-square tests were utilized to test associations between outcomes and questionnaire responses. Outcome measures included race/ethnicity, prior knowledge level, and overall rating of the training. Thematic analysis was used to code comments and establish themes from two open-ended survey questions. Results: Significant differences were found by race and ethnicity for all questionnaire responses; each were p < 0.001. Those who reported they had advanced/expert knowledge on the topic were less likely to report the training increased their knowledge, and those who reported their race as White/Caucasian tended to give the training the highest overall rating, as did heterosexuals. Through thematic analysis, participants valued the interactive nature of the training sessions, the use of storytelling, and the safety of the learning environment. Participants' intention to apply their learning indicated they had gained general awareness of bias and settings where it might influence their work. Conclusions: In an effort to foster a better working and learning environment for those who are underrepresented in the health professions, training was provide that may not have met the expectations of all participants. At the same time, participants who identified as White clearly increased their awareness of bias. Therefore, it is recommended to move away from one-size-fits-all unconscious bias training and develop a robust training continuum to provide ongoing advancement for diverse audiences.