Practicing Strategies to Address Implicit Racial Bias in the Home Visit Setting: A Qualitative Study of Family Medicine Residents

06-14-2021 15:34


Abstract

Purpose: Implicit racial bias (IB) in physicians contributes to racial health inequities, yet few curricula addressing IB in graduate medical education have been evaluated, especially in the clinical setting. The purpose of this phenomenological study is to characterize Family Medicine (FM) residents’ experience of employing strategies to mitigate IB during primary care home visits (HVs) to urban, predominately African-American, homebound older adults. The outcomes of this qualitative study will inform future curriculum development.
Methods: FM residents in an urban, community-hospital based program completed pre-work, including taking the Implicit Association Test and evaluating strategies to address IB. Residents applied these strategies during HVs to homebound older adults. Residents completed written reflections about their experiences and commitments-to-change (CTC). A survey two months later assessed completion of targeted actions and barriers faced. Resident focus groups were utilized to enhance themes drawn from reflections. Researchers completed a thematic analysis of this data January-July 2020.
Results: Thematic analysis identified five themes: Response to IAT, barriers, strategies, value of HVs and mindfulness definition. In follow-up surveys, all residents’ stated level of CTC remained the same (9/9, 100%) and 8/9 residents (89%) had partially or fully implemented their intended change at 2 months.
Conclusions: This study found a lasting impact of IB training as residents continued to implement newly learned strategies in the clinical setting two months after training, applied skills to other bias types, and to settings outside of HVs. These findings can facilitate development of meaningful, clinically-based IB curricula with lasting impacts.

Author(s):Anna Goroncy, MD, MEd; Jamal Gurbis, BS; Keesha Goodnow, BAE
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Practicing Strategies to Address Implicit Racial Bias in the Home Visit Setting: A Qualitative Study of Family Medicine Residents

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