Teaching U.S. Pediatric Trainees to Discuss Race and Racism in the Primary Care Setting: Implications of Learners' and Families' Differing Perspectives.

Abstract

Background. Despite their impact on children's health and well-being in the U.S., race and racism are not routinely discussed during pediatric outpatient visits. It is unclear whether families want to discuss race and racism with their pediatrician and - if so - how pediatric residents should be trained to facilitate these conversations effectively. Objective. We explored the perspectives of physician parents, community members, and pediatric residents on discussing race and racism during outpatient pediatric visits as part of a needs assessment to inform the development of a curriculum to teach pediatric residents how to discuss race and racism with families in the primary care setting. Methods. We recruited pediatric residents (n = 6), physician parents (n = 6), and community members (n = 2) to participate in focus groups. Participants were divided into focus groups based on their stakeholder role and self-identified race. We recorded and transcribed focus group dialogue and used thematic analysis to examine the data. Results: Participants expressed hesitancy regarding discussions about racism between families and their pediatrician, given possible unintended consequences. Participants felt that shared experiences amongst patients and providers could help improve provider and patient comfort during these conversations. Black physician parents and community members highlighted the importance of celebrating children's racial identities and avoiding preemptively broaching conversations about racism. White physician parents and residents, in contrast, expressed desire for standardized guidance and suggested phrasing to improve their comfort. To effectively train pediatricians to have conversations about racism, all participants expressed the importance of pediatricians learning about racism's effects on children's health, both broadly and locally. To learn this information, community members felt community involvement would be most beneficial, whereas pediatric trainees and white physician parents felt standardized training with role play would be most helpful. Conclusions. Facilitating conversations about race and racism in the outpatient setting requires a patient-and family-centered, nuanced approach. Educators developing curricula to teach trainees how to have these conversations should consider including information on how racism impacts children's health, both broadly and locally. Recognizing the divergent perspectives between stakeholder groups, educators may consider developing structured, longitudinal curricula focused on the current and historical health impacts of race, racism, bias, and discrimination, incorporating experiential learning in the community setting instead of focusing on developing curricula specifically focused on teaching trainees how to discuss racism in the primary care setting.