PC2001: Antiracist Curriculum Implementation for Pediatric Residents

Background: Racism negatively impacts child and adolescent health. While some residency curricula consider social determinants of health, implicit bias awareness, and training to address microaggressions, antiracist education in graduate medical training continues to evolve. We sought to implement and evaluate a longitudinal antiracist curriculum among pediatric residents to increase awareness of structural racism, knowledge of health inequity, antiracist clinical skills, and individual and institutional advocacy behaviors.

Methods: Our curriculum was administered over one year to pediatric residents at a large academic medical center. Seven hour-long sessions were offered using a hybrid in-person/virtual format during structured educational time. The first session introduced the curriculum. Subsequent sessions addressed key conceptual domains with relevance for adolescent health: schools, healthcare, justice system, employment, and housing/transportation. The final session reviewed key concepts and incorporated case-based discussions. We administered pre- and post- surveys to assess changes in awareness of structural racism, knowledge of health inequity, antiracist clinical skills, and individual and institutional advocacy behaviors. Awareness of structural racism was assessed with 27 Likert-type items spanning the five conceptual domains. We evaluated knowledge with 18 true/false or multiple choice questions about health inequity drawn from local and national data. Participants indicated comfort with antiracist clinical skills using 11 Likert-type items drawn from national toolkits and policy statements. Individual and institutional advocacy behaviors were measured with 14 Likert-type items derived from the Antiracism Behavioral Inventory. Participant demographics were summarized with descriptive statistics. McNemar or paired Wilcoxon signed-rank tests were used to compare measures before and after curriculum implementation.

Results: 79 individuals completed pre-surveys, 47 completed post-surveys, and 37 were eligible for matching across time points (Table 1). Mean age was 28.3 years (SD: 1.8). 78% were female, and most were earlier in training (PGY-1: 49%; PGY-2: 30%; PGY-3 or greater: 22%). The majority (68%) of residents identified as White. We found significant increases in awareness of structural racism across several conceptual domains (schools: p=0.027; healthcare: p=0.004; employment: p=0.003; housing/transportation: p=0.030) (Table 2). Mean knowledge score increased modestly after implementation (p=0.030). Antiracist clinical skills improved significantly (p < 0.001). Individual advocacy behaviors increased (p < 0.001), but there were no changes in institutional advocacy.

Conclusion: We demonstrate significant increases in awareness of various forms of structural racism, knowledge of health inequities, and antiracist clinical skills with a novel antiracist curriculum. Individual advocacy increased with the curriculum, but there were no changes in institutional advocacy, highlighting the importance of cultivating such behaviors during residency training. Ongoing initiatives related to this pilot include asynchronous online learning modules, case-based discussion guides, and dissemination across other departments and hospitals. Next steps include secondary forms of evaluation, such as standardized clinical scenarios and patient/peer feedback, as well as qualitative methods that further describe evaluated constructs.