Moving Beyond “Check A Box”: Shifting Physician Perceptions and Culture with an Antiracism and Equity Curriculum

TL;DR

This study shows that the DARE curriculum improved physicians' antiracism knowledge and shifted departmental culture toward greater equity.

Contribution

The study introduces a comprehensive antiracism curriculum and demonstrates its impact on both individual and group-level cultural shifts in medicine.

Findings

Participants showed significant improvement in antiracism medical practice knowledge after the DARE curriculum.

The curriculum was perceived to shift departmental culture toward antiracism.

Trainees reported increased exposure to antiracism education in medical school.

Abstract

The purpose of this study was to evaluate the impact of the Discussing Anti-Racism and Equity (DARE) curriculum on individual physician knowledge and practice, as well as on perceptions of group culture.

DARE was a longitudinal multimodal curriculum targeted at pediatric and adult emergency medicine (EM) trainees and faculty, made up of 12 lectures/workshops, three simulations, five book clubs, and two movie screenings. We used a multiphase, parallel convergent mixed-methods approach. Focus groups before and after DARE explored prior education, antiracism attitudes and behaviors, perceived impact of intervention curriculum, and perceptions of departmental medical culture. We elucidated themes using thematic analysis. Surveys of trainees and attendings evaluated individual attitudes and practices related to equity and antiracism.

We held nine focus groups with a total of 52 participants. Half of participants were EM residents (26), and half were faculty (12 pediatric EM and 14 general EM). Four major themes emerged around antiracism education and DARE. Both trainees and faculty reported a lack of standardized or effective prior education, although trainees are beginning to report increased exposure in medical school. Participants reported an overall positive impact of DARE on individual knowledge and practice, with continued room for improvement. Focus groups particularly highlighted a perceived shift in departmental antiracist culture post-DARE. Finally, future curricular aims were elucidated. A total of 56 surveys showed significant improvement in all realms of antiracism medical- practice questions when posed as retrospective pre-post questions (P < 0.01).

The DARE curriculum increased individual antiracism awareness and cultivated culture shift among the targeted clinician group. Focus groups provided clear next steps for ongoing and expanded education.