Pediatric Resident Perspectives on How to Teach About Neonatal Health Inequities: A Multisite Exploratory Study

Objective

To examine pediatric residents’ perspectives and education on neonatal health inequities, thereby identifying training needs and opportunities to improve health inequities for newborns.

Methods

We performed an Institutional Review Board (IRB)-approved multi-institutional, qualitative study. Over 18 months, we conducted 10 focus groups across Bay Area institutions. We developed focus group guides using literature review, expert consensus, and feedback from health equity experts. Focus groups were audio-recorded and transcribed verbatim. We used thematic analysis to code transcripts and develop themes until reaching thematic sufficiency, employing reflexivity and member checking.

Results

Five key themes emerged across 44 pediatric resident focus group participants. 1) Residents spotlight how neonatal inequities influence patient outcomes, finding difficulties in addressing them in real-time due to systems-level barriers and limited action-oriented knowledge. 2) Residents express a high level of moral distress and cognitive dissonance over the perceived inability to fully address inequities in the clinical setting, seeking a safe space to communicate these emotions. 3) Residents desire protected time for longitudinal reflection and action-oriented education about inequities throughout residency. 4) Residents emphasize the importance of faculty role modeling their knowledge and approach to addressing inequities, highlighting a need for ongoing faculty development. 5) Collaboration with multidisciplinary care team members, families, and community partners is central to a well-rounded curriculum.

Conclusions

These findings underscore the need to enhance action-based health equity education in pediatric training. Addressing these identified themes can improve resident preparedness to mitigate health disparities in neonatal care, fostering equitable outcomes for newborns.