619 - Residents’ Perspectives on Neonatal Health Inequities to Guide an Innovative Curriculum

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 619
Publication Number: 619.14

Keegan F. Bowers, Kaiser Permanente Pediatric Care Center, Berkeley, CA, United States; William T. Gravley, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States; Paulina Hume, Kaiser Permanente - Oakland Medical Center, Oakland, CA, United States; Alana Corre, Kaiser Permanente - Oakland Medical Center, Oakland, CA, United States; Christina M. Konecny, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, United States; Evangelina Molina, Stanford, Redwood City, CA, United States; Laura Robertson, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States; Rebecca Webb, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Sophia SY. Park, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States; Heather Briscoe, UCSF - San Francisco General Hospital, San Francisco, CA, United States; Genevieve Kinsey, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States; Stephanie Fong Gomez, Kaiser Permanente - Oakland Medical Center, Oakland, CA, United States; Nami Jhaveri, Kaiser Permanente - Oakland Medical Center, Oakland, CA, United States; Shamita Punjabi, Lucile Packard Children's Hospital Stanford, San Francisco, CA, United States; Becky Blankenburg, Stanford University School of Medicine, Palo Alto, CA, United States; Elizabeth Blecharczyk, Stanford University, San Francisco, CA, United States

Presenting Author(s)

KB

Keegan F. Bowers, MD (he/him/his)

Resident
Kaiser Permanente Pediatric Care Center
Berkeley, California, United States

Background: Racial and ethnic inequities exist in neonatal health care. Residents and practicing physicians need a framework or curriculum that increases understanding of bias and supports identifying and reducing inequities. Despite the importance of such a curriculum, resident experiences and perspectives regarding how to teach about neonatal health inequities are unknown.

Objective: To explore pediatric residents’ knowledge, perspectives, and experiences with neonatal health inequities, with the goal of developing a novel resident curriculum.

Design/Methods: In this exploratory, qualitative, IRB-approved study, we conducted 10 focus groups to explore pediatric residents’ perspectives on clinical experiences, prior education, preferred learning method, and curricular design related to neonatal health inequities. Using modified grounded theory, we developed codes, categories, and themes through constant comparison. We ensured trustworthiness through member checking.

Results:
10 focus groups were conducted with 45 total residents participating across 4 residency programs. One of the 10 focus groups specifically recruited residents who identified as underrepresented in medicine. 4 themes were identified (Table 1):

Residents highlight inequities (e.g., communication barriers and lack of optimized care) but find it difficult to address them in real time due to systems-level barriers, time constraints, and limited action-oriented knowledge.

Residents express a high level of moral distress and cognitive dissonance over the perceived inability to fully address inequities in the clinical setting and seek a safe space to communicate these emotions.

Residents desire protected time to engage in action-oriented education around inequities and to collaborate with team members and families with the shared goal of bringing about systemic changes.

Residents emphasize the importance of faculty knowledge, approach to, and role-modeling of addressing inequities, highlighting a need for ongoing faculty development.

Conclusion(s):
Residents’ perspectives are critically important as we design curricular and systems-level interventions to address neonatal health disparities. Residents are able to highlight inequities in their clinical rotations, but feel helpless to address them given a lack of action-based tools, insufficient time for learning and reflection, and absence of faculty role-modeling.