Attitudes and behaviors of medical providers have been identified as one of the many factors that can contribute to health disparities. Implicit bias describes thoughts and feelings that people unknowingly hold and express automatically, without conscious awareness. Project EMBRACE, the acronym for “Ending Medical Bias and Racism by Advocating for Change and Equity” was a collaboration between several residents from the UNC Departments of Internal Medicine and Pediatrics. Developed and presented in four noon conference sessions, the concept started with Melissa Wooten, MD, MPH.
“The idea was born out of frustration with the social injustices we’re continually witnessing in our country, highlighted this past summer by the deaths of George Floyd, Breonna Taylor and Ahmaud Arbery,” Wooten said. “With the ‘Black Lives Matter’ movement growing, it felt like we didn’t have a formal curriculum to bring this movement into our work and specifically discuss racism in medicine. With the help of countless other individuals, we created this series to bring together the medicine and pediatric departments and build a space for encouraging reflection, education, and most importantly, action around the racism (both in the form of subtle implicit bias or decades old institutional racism) we witness every day in the healthcare field.”
Terminology and Implicit Bias
Keisha Gibson, MD, MPH, vice chair for diversity in the department of medicine, introduced the first session focused on defining implicit bias and identifying vocabulary to help trainees deliberately engage and support anti-racism efforts. Trainees were encouraged to recognize their own implicit bias and understand how it contributes to structural racism, and they were given concrete action steps for becoming effective allies.
Health Disparities: A Case for Structural Racism
The next session focused on helping trainees gain insight into how implicit bias plays out in patient interactions and contributes to health disparities. Students reflected on Dr. Jennifer Tsai’s “It’s Time to Talk About Racism in Medical Education” in small group breakouts, virtually and in person, exploring how they could become better patient advocates for vulnerable populations.
Race Metrics and Health Disparities
The third session looked at race-based metrics and health disparities, and offered historical context for how many current medical metrics, tests, and diagnoses are based. Learners reviewed data showing how race as a social construct impacts the health and wellness of patients, and they considered latest evidence that algorithms used by hospitals and providers to guide healthcare demonstrates implicit racism that many are often unaware of, and which often result in black people receiving inferior care. Breakout groups explored how incorporating social determinants of health into the equations could remove bias and how making social determinants of health more visible in EPIC could lead to change.
Taking Action, Responding to Racism
The concluding session welcomed Nate Thomas, PhD, UNC School of Medicine Vice Dean for Diversity, Equity, and Inclusion, and Stephanie Brown, PhD, Strategic Manager from the Office of Inclusive Excellence.
“What we wanted to introduce today is a framework for you to work with, to help you understand what areas you feel comfortable addressing,” Thomas said. “Where you feel uneasiness, continue to develop the skills to navigate the uneasy situations, but realize that you can’t always change how people think. What you can change is the environment so that it is one that doesn’t tolerate racist behavior.”
Brown explained the bystander effect and introduced bystander training with action steps. Then in breakout groups, trainees discussed two patient-provider scenarios that demonstrated racism.
Carlos Rubiano, MD, reported ‘follow-up’ was most important to his group, both with the person who made the comment, and the person who received the comment. Sydney Greenberg, MD, summarized her group’s conversation and recognized the inherent challenge in what can realistically be done versus what “we can hopefully do.”
Dr. Thomas expressed his hope that everyone will continue to learn about racism and the viewpoints of different generations keeping the focus on what a person does and not who they are, citing an example from Jay Smooth.
“What you don’t want to do is get into a conversation about whether or not a person is a racist—you just want them held accountable for what they’ve done. If you set that precedence, you can lean in with your values and do the follow-up that confirms to the other person you are an ally.”
The conference was led by internal medicine residents, pediatric residents and advisors who included: Christel Wekon-Kemeni, MD, Alessandra Angelino, MD, MPH, Melissa Wooten, MD, Carlos Rubiano, MD, Jennifer McEntee, MD, MPH, Mike Contarino, MD, Asantewaa Boateng, MD, Erin Finn, MD, Sydney Greenberg, MD, Joelle Kane, MD, Xavier Williams, MD, MPH, and Rob Short, (fourth year medical student).