Combating Racism: Effects of a Longitudinal Community-Based Curriculum at the Graduate Medical Level

Racism is a public health crisis, and it is imperative that healthcare providers act to dismantle it. Although social determinants of health have been incorporated into graduate medical education, few longitudinal antiracism curricula exist. We evaluated a longitudinal antiracism curriculum for Internal Medicine (IM) residents, hypothesizing that participation would increase racism awareness and comfort with skills necessary to combat it.

We conducted four 1-hour antiracism educational didactic sessions and three 45-minute interactive small-group sessions for IM residents between 2021 and 2022. The curriculum was grounded in a governmentally commissioned regional racial inequality report. Curricular themes included structural racism, knowledge of health inequities, antiracist clinical skills, and individual/institutional advocacy behaviors. Participants completed pre-postsurveys with two validated measures: the Antiracism Behavioral Inventory scale and the Color-Blind Racial Attitudes scale. We used McNemar or Wilcoxon signed rank tests to compare participants' pre-posttest scores.

Eighty-three of 157 IM residents responded to the presurvey (response rate 53%) and 62 to the postsurvey (response rate 39%). Thirty-four residents representing postgraduate years 1-3 levels of training were eligible for response matching. We found statistically significant increases in awareness of racism/racial dynamics per overall Color-Blind Racial Attitudes scores (P < 0.001) and subcategories of racial privilege (P < 0.001) and blatant racial issues (P < 0.001). We also found an increase in individual advocacy (P = 0.008) per Anti-Racism Behavioral Inventory scores.

Our study indicates that this community-based longitudinal antiracism curriculum promotes increased racism awareness and antiracist behaviors across varying graduate medical education levels and may serve as a stepping stone for future antiracist curricula.