Race, Bias, and Advocacy in Medicine
The Race, Bias, and Advocacy in Medicine (RBAM) distinction pathway aims to provide residents with the tools to understand and combat racism and structural/ cultural bias. In particular, participants will reflect on the impact of bias and systems of oppression on the healthcare system, medical education, and physician practice. Residents will partner with the greater New Haven community to better understand disparities in access, intensity, and quality of healthcare and improve healthcare delivery.
Graduates will be able to apply an antiracist framework to their career pathway of choice, whether that is in academic medicine, community practice, general medicine, or subspecialty practices. The knowledge, skills, and attitudes cultivated in the pathway are applicable to research in clinical medicine/epidemiology/implementation sciences, work in quality improvement, innovation in medical education, and leadership in diversity, equity, and inclusion. This is the pathway for agents of change in medicine.
Residents are officially eligible to join in the PGY-2 year, but if interested in being a part of the RBAM working group to help build the distinction, please contact the Yale Traditional Internal Medicine Chief Residents at yimchiefs2021@yale.edu.
Core Pillars
The core pillars of the Race, Bias, and Advocacy in Medicine distinction pathway are:
Introspection:
Focuses on enhancing the resident’s awareness of the legacy and impact of race and bias in clinical medicine and the position of Yale in the greater New Haven community.
Residents examine how they have been affected by and/or complicit in bias in medicine. In addition, participants will consider how race influences interactions within the hospital system - between a patient and a physician, between healthcare providers (physicians, students, nurses, advanced practitioners), and between a physician and the greater community and society. Finally, participants will strive to improve their understanding of the greater New Haven community and its relationship with Yale. As such, the introspection pillar is focused on empowering residents to develop the anti-racist, anti-bias framework for which they can approach medicine and the care of patients, with a more holistic perspective on the barriers to and limitations of equity in healthcare. This is accomplished by a combination of a series of lectures, reading, written reflections, facilitated small-group discussions, and workshops.
Citizenship:
Involves developing participants as educators, ambassadors, and advocates of anti-racism within the medical school, residency program, hospital system, community, and world. At the medical school and residency level, resident participants will propose and deliver educational content for multiple venues including morning report, noon conference, student education, and others. At the hospital level, residents will propose initiatives for change within the hospital. At the community level, participants will partner with residents of New Haven to better understand the barriers to equity in healthcare. Participants will also develop their communication skills to advocate for equity in healthcare.
Capstone:
The capstone allows the resident to develop his or her passion within the topics of anti-racism, anti-bias, and advocacy work in the form of a project of his or her choice. A capstone project can manifest in many ways – be it community-based participatory research, quality improvement, narrative medicine, clinical research, clinical practice interventions, physician advocacy, and/or community engagement.
- Community engagement: examples of relevant past accomplishments include the “Walk with a Doc” program, as well as experience in existing clinical opportunities such as the street medicine elective and experience in the refugee clinic.
- Clinical practice interventions: examples include an electronic referral system connecting patients with race- and language-concordant mental health providers.
- Clinical research: one of our residents has already brought up a relevant project investigating the efficacy of an EPIC alert to reduce bias in prescription practices for acute pain.
- Quality Improvement: an example of which is the creation of a workflow to translate letters communicating the results of routine cancer screening to the patient’s preferred language.
- Physician Advocacy: including coalition-building, legislative advocacy, media appearances and authorship of opinion and editorial pieces.
- Community-Based Participatory Research:i.e., engaging community members in efforts that seek to improve diabetes outcomes in the population served by the Adult Primary Care Center.
- Narrative medicine: Utilizing stories and the arts (drawing, theater, painting, sculpture, etc.) as a means of reflection and/or deeper understanding of the “art of medicine”
Distinction Requirements
Pillar 1: Introspection and Education
| *Minimum Credits Required in Introspection: 20 | ||
| Experience | Description | Credit |
|---|---|---|
| Didactics, Workshops |
Didactics and workshops will occur throughout the academic year in the form of morning reports, noon conferences, or evening distinction events as part of the RBAM curriculum to improve knowledge surrounding physician advocacy, health equity, social justice, and anti-racism in medicine. Evening distinction events will also be an opportunity to participate in small group discussions, reflections, and interactive workshops curated by established physicians and leaders in the New Haven community. |
Morning Report: 1 credit
Total Credits Possible: 16 credits |
| Clinical Experiences | Participation in certain clinical experiences and electives may be counted for distinction credit if they provide insight on racism and bias in medicine or a better understanding of the New Haven community, such as participation in HIV training track, refugee clinic, Community Health Care Van, etc. |
4 Credits Total Credits Possible: 16 credits |
| Walking Tours |
The Ethnic Heritage Center (EHC) of New Haven has created walking tours that tell the “pre-1970 stories of the experiences, contributions and hardships faced in New Haven by five of the cultural and ethnic groups that have enriched our community.” The goal is to embark on the walking tour together to better understand the community in which we practice medicine and how said hardships may have contributed to health and health outcomes we see in our patients. There are 4 tours which we will do every calendar year in the warmer months, April-October. Dates TBD. For more information on walking tours, see visit the Walk New Haven website |
3 credits per tour Total Credits Possible: 12 credits |
| Other (e.g. Book Club) |
There is no dearth of introspective/ educational activities related to anti-racism, social justice, and health equity that residents can pursue, and residents could earn distinction credit for additional experiences not expressly offered by the distinction pathway. Participation in certain book club meetings (Ex: How to be an Anti-Racist) can earn distinction credit. Distinction leaders will make clear which books count towards credits. |
2 credits Total Credits Possible: 10 credits |
| Conference Attendance |
Yale RBAM Distinction Annual Event Please check back for further information. |
3 credits Total Credits Possible: 3 credits |
Pillar 2: Citizenship
| *Minimum Credits Required in Citizenship: 20 | |||
| Locale | Experience | Description | Credit |
|---|---|---|---|
| Hospital/Residency/ Medical School | Teaching opportunities | Teaching co-residents and/or medical students in the form of morning report, noon conference, or other established educational venues on a topic related to social justice, advocacy, racism/bias in medicine. |
5 credits Total Credits Possible: 15 per year |
| Anti-Racism Curriculum Development |
The anti-racism curriculum created by this new distinction is just the beginning of our efforts in tackling race and bias in medicine. We envision expansion of the curriculum such that every internal medicine resident, even those who do not participate in the distinction, are equipped with basic knowledge and awareness of the role systemic bias and oppression plays in their practice of medicine. This could also be curriculum directed at the medical school or hospital system. There are several ongoing projects independent of the distinction that distinction members can help develop or participate in and earn credit toward the distinction.
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5 credits Total Credits Possible: 15 per year |
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| Institutional inquiry |
This credit focuses on the importance of critical inquiry on the hospital system, medical institution, and medical education as a racist and biased structure that requires constant evaluation and improvement towards becoming anti-racist. Participants would gain distinction credit for any efforts to motivate change within the hospital system. |
10 credits Total Credits possible: 10 credits |
|
| Community/National | Written scholarship |
Submission of an original op-ed piece (or other form of written scholarship) on race/ racism, bias, and/or healthcare disparities. This opportunity for distinction credit highlights the importance of writing as a form as advocacy work. |
10 credits Total Credits Possible: 10 credits |
| Community Partnership |
We are actively working to find ways our residents can be involved in volunteer efforts and community organizing/engagement. Attendance at RBAM-sponsored community partnership events would earn a participant distinction credit, and we would encourage longitudinal involvement with the organization as residents are able. |
5 credits Total Credits Possible: 15 credits |
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Pillar 3: Capstone
| Experience | Description | Credit |
|---|---|---|
| Capstone |
A capstone project can manifest in many ways be it community-based participatory research, quality improvement, narrative medicine, clinical research, physician advocacy, and/or community engagement. Access to high quality mentorship and guidance will be crucial to facilitating successful completion of desired capstone projects. |
N/A. Required for distinction graduation. |