522 - From the Residents' Perspectives: Health Equity and Bias in the Clinical Learning Environment

Poster Number: 522
Publication Number: 522.116

Ariella T. Slovin, Children's National Medical Center, Washington DC, DC, United States; Jessica Hippolyte, Children's National Health System, Washington, DC, United States; Danoucheka Gelin, Children’s National, Washington, DC, United States; Aisha Barber, Children's National Hospital, Washington DC, DC, United States

Background: Racism and bias continue to be present in the clinical learning environment, impacting both patient care and the ability of physicians with diverse identities to thrive in medicine. These factors contribute to the 'silent curriculum’ that can undermine intentional efforts to debunk incorrect beliefs and disrupt microaggressions.

Objective: The objective of this study is to understand our trainees’ experiences and observations of health equity practices, health equity training, and bias in the clinical learning environment.

Design/Methods: The institution's Diversity, Equity, and Inclusion Subcommittee on Trainees developed and adapted questions to capture residents’ experiences of health equity and bias in clinical rotations. We obtained feedback from residents, faculty, and DEI consultants to assess the validity of constructs measured. The pediatric residency program incorporated these questions into existing anonymous resident-of-rotation evaluations required for all core rotations. After a pilot period in which questions were implemented into 6 rotation evaluations, questions were streamlined. 3 questions were then incorporated into all resident-of-rotation evaluations (Table 1). Data was analyzed using Welch’s t-test for evaluations from July 1, 2021, through June 30, 2022.

Results: 1495 evaluations were collected from 38 clinical rotations at a free-standing children’s hospital in an urban setting. 48% of evaluations were from ambulatory care rotations and 53% were from inpatient rotations. On a 5-point Likert scale where 1= strongly disagree and 5= strongly agree, overall residents’ aggregate responses were 3.48 for each of the three questions. Mean response scores for ambulatory rotations were significantly higher than inpatient rotations (Table 1).

Conclusion(s): Incorporating additional questions to existing resident clinical evaluations was an effective way of capturing resident perceptions of health equity clinical content and providing feedback to divisions. Overall, resident physicians indicate that clinical rotations do, to some degree, incorporate educational content related to systemic inequities and explicitly consider potential for biases when it comes to clinical decision-making and clinical teaching.  Residents perceived this as occurring more consistently in ambulatory rotations. This data will help inform targeted intervention and faculty development. Incorporating similar evaluation questions is a strategy other residency training programs can consider in order to help evaluate and improve health equity education.