# Attitudes of Family Medicine Program Directors on Including Race in Clinical Presentations: A Cross-Sectional Survey Study

## TL;DR

This study explores how U.S. Family Medicine residency program directors feel about including race in clinical presentations and finds mixed attitudes, with some opposition linked to gender and race identity.

## Contribution

The study provides new insights into attitudes among Family Medicine program directors regarding the inclusion of race in clinical presentations and identifies demographic correlations with opposition.

## Key findings

- 35.8% of program directors opposed including race in clinical presentation opening lines.
- Opposition was more common among female directors and those identifying as American Indian/Alaska Native, Black, or other race.
- Recent implicit bias training was associated with greater opposition, though not statistically significant.

## Abstract

Background and objectives

Clinicians’ implicit biases contribute to persistent healthcare disparities in the United States. Including patient race or ethnicity in the opening line of a clinical presentation (e.g., “A 40-year-old Black woman presents with…”) reinforces the false notion of race as a biological construct and can trigger unconscious biases. This study surveyed U.S. Family Medicine Residency program directors (PDs) to assess attitudes toward this practice and to identify factors associated with support or opposition.

Methods

Study questions were included in the 2021 Council of Academic Family Medicine Educational Research Alliance (CERA) omnibus survey of all ACGME-accredited Family Medicine residency PDs, approved by the American Academy of Family Physicians Institutional Review Board in Leawood, Kansas, USA. The primary outcome was the PD's attitude toward including race or ethnicity in the opening line. Data analysis was performed at Rutgers New Jersey Medical School in Newark, New Jersey, USA. Analyses examined associations with PD demographics, program characteristics, and participation in implicit bias training.

Results

Of 631 eligible PDs, 275 responded (response rate: 43.6%). Among the 260 respondents who answered the primary question, 35.8% opposed including race in the opening line, 45.8% supported its use in select circumstances, and 18.5% supported using it in all circumstances. Opposition was more common among PDs identifying as female and among those identifying as American Indian/Alaska Native, Black, or other race. Recent implicit bias training was associated with greater opposition, although not statistically significant.

Conclusions

Many PDs continue to support including race in opening clinical statements despite increased awareness of how such practices may contribute to bias. These findings highlight the need for clear guidance, faculty development, and equity-focused curricular strategies that promote thoughtful and evidence-based approaches to discussing patient identity in clinical education.