Diversity & Inclusion

Antiracism Initiatives at University of Rochester Family Medicine Residency

In 2018, residency administration at URFMR began to explicitly combat implicit bias. Our approach draws on both a tradition of social justice initiatives at URFMR and our acknowledgment that a formalized approach to countering systemic bias in medicine is long overdue. We are focused specifically on anti-racism, though our efforts apply to other kinds of bias. Below is a brief summary of our multi-pronged, ongoing interventions. Please feel free to contact any of us on residency administration if you need more information on any or all of these domains!

1. Recruitment

If you are reading this during residency application season, this is probably the foremost item on your mind. In 2018, we learned that one of the key components of residency applications, the Medical Student Performance Evaluation, is measurably biased in the descriptors used for people of color and people who identify as female. (1) Since then, more information is available that implicates every step of the educational process as subject to implicit bias. (2) We performed a literature search, and realized that one of the most evidence-based ways to decrease implicit bias in our residency recruitment process was to implement structured interviews. Through a Delphi process, we identified the main values of our program and designed interview questions investigating each domain. Each proceeding year, we edited our question based on feedback, and are undertaking a formal evaluation of the interview questions.

2. Curriculum/Didactics

In the 2020-2021 academic year, we held a series of resident workshops facilitated by two community experts in the realm of anti-racism, Maisha Enaharo, MS, MPH, and Kit Miller, Director Emeritus of the M.K. Ghandi Institute for Nonviolence. In 2021-2022, we are integrating anti-racism into our weekly didactic sessions through the following:

• Lectures: focused on racism in particular area of medicine; develops antiracist approach to that area
• Skill-building workshop
• Bias checklist for all presenters to review all content
• Organically, through resident-led topics for their evidence-based medicine presentations

3. Resident-Led Initiatives

Despite the usual rigors of residency, several residents identified the need for additional opportunities to develop a personal approach to antiracism and founded the Antiracism Learning Group in 2020. Residents coordinate meetings every 1-2 months. These meetings are discussion groups for both faculty and residents, and focus on selected readings, films, and podcasts. Examples of topics include “Medical Apartheid” by Harriet Washington, and “July ’64.” 

4. Institution-Wide Initiatives

The Association of Minority Residents and Fellows is a community dedicated to the creation of safe spaces for University of Rochester Medical Center under-represented in medicine minorities. Our residency provides monthly protected time during all feasible rotations for our URiM residents to attend meetings (our only exceptions include inpatient “service requirements” where back-up is not available).

5. Department-Wide Initiative

Our department engaged the two community experts listed above for the 2020-2021 year to facilitate regular affinity groups for departmental leadership at various levels, as well as departmental wide trainings for staff, faculty, and residents alike. We currently have a “Change Team,” inclusive of resident and faculty representatives, who meet regularly to advance our anti-racism work.

• The HFM internal “Anti-Racism Change Team” is multi-disciplinary, comprised of medical assistants, front desk secretaries, nurses, social workers, behavior health specialists, residents, and faculty physicians

• The team meets every 2 weeks and reports to practice every 4 weeks
• Currently projects include: reviewing the process for dismissal letters and for prenatal drug screening, both of which are subject to potential implicit bias

6. Community Participation

Our residency has a long history of partnering with the community, and anti-racism is no exception. For many years pre-COVID, we hosted a chapter of Exploring.org, under the leadership of our program director Steven Schultz, MD. The purpose of our chapter was to introduce young teens from under-resourced backgrounds to professional careers in medicine. This initiative is still on hold due to COVID, as it relies upon in-person meetings.

We also have a partnership with University of Rochester Minority Association of Pre-Med Students (MAPS), and serve as a shadowing site. This, too, was on hold due to COVID, but is starting once more as of late 2021.

REFERENCES:

1. Ross DA, Boatright D, Nunez-Smith M, Jordan A, Chekroud A, Moore EZ. Differences in words used to describe racial and gender groups in Medical Student Performance Evaluations. PLoS One. 2017 Aug 9;12(8)
2. Spicer J. The Myth of Medical Meritocracy: How Our Selection Processes Perpetuate Inequity & Steps We Can Take to Rectify It. Lecture, presented at: Strong Memorial Hospital Diversity, Equity & Inclusion Grand Rounds, June 22, 2021. Rochester, NY.