Barriers to Implementing a Racial Justice Curriculum: CERA Comparison of Family Medicine Program Directors' and Residents' Perspectives.

Background and objectives: The 2023 Accreditation Council for Graduate Medical Education (ACGME) program requirements for family medicine residencies state that family physicians must have the competence to address racial and ethnic health disparities experienced by their patients. Racial justice curricula (RJC) or antiracism curricula can provide residencies with the tools faculty and residents need. This study explores the differences in perceived barriers between family medicine program directors (PDs) and residents.

Methods: Survey questions on RJCs were included in the 2020 Council of Academic Family Medicine Educational Research (CERA) survey of PDs and 2021 CERA survey of residents. Participants' perceived top two barriers to implementing an RJC in their residency program were illustrated with Sankey diagrams. We used the χ2 test and logistic regression for analysis.

Results: Of the 578 participants included, 312 (54%) were PDs and 266 (46%) were residents. Compared to PDs, residents were more likely to identify as female, less likely White, and more likely from community-based, nonuniversity-affiliated residency programs. PDs ranked lack of faculty training as the most important barrier, while residents ranked lack of time as the top barrier. Residents also were significantly more likely to rank lack of faculty interest and resident interest as barriers.

Conclusions: Family medicine PDs and residents identified different barriers to implementing an RJC. Additional research is needed to investigate the impact of knowledge and culture on residency programs' receptiveness to addressing racial and ethnic health disparities.