Health Equity Conference Series: An Educational Approach to Combat Implicit Bias and Structural Racism in Pediatric Hematology/Oncology

Background: Despite knowledge that racism exists in medicine and affects health outcomes, there is minimal training in medical education on how both structural and interpersonal racism play a central role in perpetuating health disparities. Specifically in hematology, oncology, and bone marrow transplant (PHOT we see this play out in the undertreatment of pain for our patient with sickle cell disease and the impact of socioeconomic status (SES) on the timing of relapse for patients with leukemia. Health Equity Rounds (HER) was created as a longitudinal case conference to address these gaps in knowledge. We used this model to create a subspecialty-specific health equity conference that aims to improve outcomes for our PHOT patients.

Purpose: Our aim was to apply an existing educational model within our field of PHOT to increase knowledge and awareness of the impact of implicit bias and structural racism on patient outcomes and propose evidence-based solutions on how providers and institutions can begin to combat this.

Methods: The Health Equity Conference Series was implemented over the 2023-2024 academic year at the University of California, San Francisco (UCSF). Using the HER model previously developed, the authors recruited faculty presenters to present on real-life cases that occurred at our institution. These presentations occurred on a quarterly basis. To assess the effectiveness of the conference series, we utilized the Kirkpatrick model and a quantitative approach with pre-/post-surveys to assess learners’ reaction, learning, and behavior after engaging with the material. Authors developed the surveys using the HER framework and piloted it at the ASH Medical Educators Institute (MEI) to obtain feedback. The final iterations of the pre-survey and post-survey were then administered to faculty prior to and upon completion of the health equity conference series. Faculty that participated in the series included: attending physicians, fellow physicians, social workers, advanced practice providers, and registered nurses. Authors utilized descriptive statistics to analyze pre- and post-survey data.

Results: In total, 4 presentations were given over the course of the academic year, with cases that focused on the following topics: interpreter-use and missed diagnoses, immigration status and historical context, pain management and sickle-cell disease, and delays in initial diagnosis for patients with non-English language preference (NELP). Attendance at each of these conferences was higher than the average attendance at weekly division conferences, with 37 people attending the first presentation, 31 people for the second, and 30 people for the third and fourth. Pre-survey results (41 participants), indicate that faculty were very uncomfortable, slightly uncomfortable, or neutral when asked to rate comfort level with the following learning objectives: “identifying the effects of implicit bias on clinical practice in PHOT” (39%), “analyzing the impact of structural racism on healthcare disparities seen in PHOT” (46%), “implementing evidence-based strategies to improve the quality of care offered to marginalized communities” (59%), “empowering PHOT providers to promote anti-racist efforts” (51%), and conceptualizing concrete health equity interventions to change practices within our division (63%). Post-survey results show that 92% of participants had a positive overall impression of the health equity conference series. At an individual level, providers mentioned that after the series, they felt “more mindful of sources of bias and empowered to point out biases that impact patient care.”

Discussion: Overall, implementing the health equity conference series was successful and well-received by faculty at UCSF. While the majority of faculty felt some comfort level with identifying the clinical effect of implicit bias and structural racism in PHOT, this study highlighted the discomfort and unfamiliarity with developing interventions at the patient and institution level to overcome these healthcare disparities. Education on how providers can play active role in disrupting interpersonal and structural patterns of racism is needed in medical education. Follow-up studies will be needed to analyze if participating in these health equity conferences leads to behavioral change at the individual level and improved patient outcomes.