Preparing Medical Students for Anti-racism at the Bedside: Teaching Skills to Mitigate Racism and Bias in Clinical Encounters

Catherine Tarleton; Wendy Tong; Emily McNeill; Ahmed Owda; Beth Barron; Hetty Cunningham

doi:10.15766/mep_2374-8265.11333

Preparing Medical Students for Anti-racism at the Bedside: Teaching Skills to Mitigate Racism and Bias in Clinical Encounters

MedEdPORTAL. 2023 Aug 10:19:11333. doi: 10.15766/mep_2374-8265.11333. eCollection 2023.

Authors

Catherine Tarleton¹, Wendy Tong², Emily McNeill³, Ahmed Owda⁴, Beth Barron^{5

6}, Hetty Cunningham^{7

6}

Affiliations

¹ First-Year Resident, Department of Obstetrics, Gynecology and Women's Health, University of Hawai'i at Mānoa John A. Burns School of Medicine.
² First-Year Resident, Department of Medicine, McGaw Medical Center of Northwestern University.
³ First-Year Resident, Department of Neurology, University of California, San Francisco Weill Institute for Neurosciences.
⁴ First-Year Resident, Department of Ophthalmology, University of Michigan Medical School.
⁵ Associate Professor, Department of Medicine, Columbia University Irving Medical Center.
⁶ Co-last author.
⁷ Associate Professor, Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, and Morgan Stanley Children's Hospital at New York Presbyterian.

Abstract

Introduction: Systemic racism perpetuates health disparities and negatively impacts health care delivery and patient outcomes. Racism and bias can affect every aspect of clinical care, including history-taking, physical examination, laboratory interpretation, note-writing, oral presentation, and decision-making. Medical students must learn racism- and bias-mitigation skills early in their professional development to provide high-quality, equitable care.

Methods: In November 2021, senior medical students and faculty with expertise in promoting health equity and justice in medicine designed and cotaught a Zoom-based, 75-minute, interactive session for second-year medical students. Participants prepared by reading assigned articles. Breakout rooms were used to facilitate small-group discussions. Session topics included use of a structural vulnerability assessment tool, examples of how bias can impact the physical exam, demonstration of how language can transmit bias, and skill practice using neutral instead of stigmatizing language.

Results: Forty second-year medical students participated in the session. Thirty-one students (78%) completed Likert-type surveys evaluating reaction and learning. Results showed improvements in students' perceptions of their abilities to assess for structural factors that influence health, recognize ways bias can impact clinical encounters, and apply skills to minimize bias in clinical care and decision-making.

Discussion: Providing opportunities for health care learners to think critically about how bias impacts patients and communities and equipping them with tools to begin dismantling exclusionary, racist practices in medicine are achievable and crucial to actualizing a just and equitable health system. This educational session can be adapted for training across health care professions and the educational continuum.

Keywords: Anti-racism; Clinical Teaching/Bedside Teaching; Diversity; Equity; Health Equity; Inclusion; Racism in Medicine.

MeSH terms

Antiracism
Bias
Humans
Learning
Racism*
Students, Medical*