Assessing the effectiveness of an antiracism clinical skills curriculum for medical students: a single institution mixed methods study

BACKGROUND: Despite knowledge that systemic racism exists in medicine and increased efforts within medical education to address this, educators continue to struggle with incorporating training for future healthcare providers on how to actively address implicit bias and structural patterns of racism into formalized curricula. This study sought to understand whether an antiracism clinical skills curriculum (ARC) for pre-clinical medical students (MS) at the UC Berkeley-UCSF Joint Medical Program (JMP) improved their ability to recognize how structural racism can influence clinical encounters and begin to identify tools to counteract this. METHODS: The ARC was developed by core faculty at the JMP using Kern’s six-step approach to curriculum development and then taught to a cohort of 32 pre-clinical MS over the 2022–2023 academic year. To evaluate the effectiveness of the ARC, we utilized the Kirkpatrick model and a mixed methods approach with pre-/post-surveys as well as semi-structured individual interviews to evaluate students’ reactions and learning. Instructional methods included standardized patients, journal article review, reflective exercises, small group case discussions, didactic lectures, and community member testimonies. RESULTS: Overall, 28/32 (87.5%) of students participated in the study, with 20/32 (62.5%) completing both the pre- and post-surveys. Of those participating, 13/28 (46.4%) agreed to complete an individual interview. After completing the ARC, students reported more familiarity with 13/14 (92.9%) learning objectives, including recognizing how patients experience racism in the medical setting. Prior to the ARC, students had a mean score of 2.9 on a 5-point Likert Scale (1 = not at all familiar and 5 = very familiar) related to their knowledge of race-based medicine and after the ARC, students had a mean score of 4.55 (p < 0.05). A major theme that emerged from the interviews was a desire for education in this area to shift from raising awareness to a more solution-oriented focus. CONCLUSIONS: These results demonstrate that while many MS are aware of health disparities, few can identify practical tools to help tackle these disparities. Even though most MS in this study believe antiracism training is important, many fear that this type of curriculum is deprioritized within an educational system that lacks institutional and structural support.