Pilot Assessment of “discrimination and Its Impact on Our Black and Brown Patients": A Brief Curriculum for Maternal Child Health Professionals

Background: Like many organizations, University Hospitals (UH) was compelled by the events of 2020 to examine current policies, declare an anti-racist stance, and take actions to advance social justice and racial equity. Purposely located in one of Cleveland, Ohio’s most underserved communities, the UH Rainbow Ahuja Center for Women & Children (“the Center”) was designed to improve access to high quality, equitable health care. As part of a state-funded grant to enhance group care at the Center, a bias and competency training curriculum was developed for clinicians and staff.

Methods: Twenty-two clinicians, staff, and researchers participated in a pilot two-session (1 hour each) virtual training intended to enhance staff capacity to deliver respectful, culturally sensitive and competent care. Titled “Discrimination and its Impact on Our Black and Brown Patients”, training objectives included: understanding how identities shape biases, developing tools to recognize biases, identify impact of biases on patient care, and ensure that participants are well prepared to address their biases in clinical interactions. Part one explored historical implications contributing to health disparities and inequities, both in general and specific to local context. Part two focused on application of this knowledge through a series of case studies. Participants completed a 51-item post-training questionnaire after the final session, regarding familiarity and comfort with best practices caring for underserved populations, ongoing training needs, and course feedback.

Results: Twelve participants completed the evaluation (ages 24-66 years). Most identified as White (n=5), female (n=11), and held a graduate degree or higher (n=11). “Time” was consistently identified by participants as a barrier to speaking about the impact of bias in healthcare, regardless of audience (colleagues, patients, or in general). Greater “experience” was identified as needed to increase comfort speaking with patients, while greater “knowledge and understanding” was endorsed as needed for communication with both patient and general audiences. Future training options most often requested were: “understanding privilege and oppression in the healthcare setting” (n=9), “structural competence (beyond cultural)” (n=8), and “bias in the healthcare setting” (n=6). Most (n=9) felt prepared to apply what they learned on the job. Several felt that the training was not long enough (n=5), indicating that more time was needed to engage with the material.

Conclusion: There is a need for training and knowledge development in bias and health equity work, and the desire for more time to apply these learnings is an important insight for system leadership. Future efforts will continue to refine and enhance this training, with the goal of its incorporation as a permanent component of system initiatives to promote social justice and health equity.