P3C204: “teach”ing on Child Poverty: Qualitative Analysis of Residents’ Reflections on Racism and Health

Background: Pediatric residency programs are increasingly called to provide education on the impact of racism on health. Pediatric residents come from a variety of backgrounds, though the majority are White from middle and upper middle-class families. Little has been published about how residents’ own lived experience affects their perspectives on race and racism and how a curriculum can impact residents’ reflections on their role in reducing racial health disparities.

Objective: To describe pediatric residents’ reflections on (1) how their lived experience shaped their perspective on race and (2) how they plan to address racial health disparities based on what they learned from a child poverty curriculum.

Methods: We developed a 3-year child poverty curriculum called Trainee Education in Advocacy and Community Health (TEACH). Racism as a key driver of health inequities is woven throughout and concentrated in Year 2 activities, including:
-an interactive TEACH module discussing race as a social construct, and the structural discrimination framework within the social determinants of health (SDH);
-reading the American Academy of Pediatrics policy statement, The Impact of Racism on Child and Adolescent Health; and
-watching a publicly available presentation from an AAMC Center for Health Justice leader.

Residents then wrote responses to 2 reflection questions: (1) How have your personal and professional experiences shaped how you think about race and health? and (2) How do you plan to incorporate what you learned from the modules and other TEACH curriculum learning activities to reduce racial health disparities in your future practice?

Three authors inductively coded reflection responses, first developing codes and clusters independently, then meeting to develop and refine the themes. To increase trustworthiness we triangulated data by asking the same questions to the diverse group of residents, collecting data for over 2 years, and having multiple researchers involved in coding.

Results: From July 2020 through October 2022, 91 residents participated in Year 2 of the TEACH curriculum and completed the reflection questions. The majority of participants self-identified as White (50.5%), Black or African-American (19.8%), or Asian (17.6%). 14.3% self-identified as Latino/Hispanic ethnicity. Tables 1 and 2 detail the themes and representative quotations.

Conclusion: Residents begin the journey toward health equity from different starting points. For many in this study, secondary education and residency training were their openings to learning about racism and health disparities, while those from marginalized groups think about race often.

Despite different lived experiences, the TEACH curriculum on poverty and health disparities was universally valuable, as the themes pointed to a desire for increased learning and action. Residency programs seeking to move residents along the continuum from knowledge to action can consider incorporating the TEACH Curriculum.