Svetkey Laura P, Bennett Gary G, Reese Benjamin, Corsino Leonor, Pinheiro Sandro O, Fischer Jonathan E, Seidenstein Judy, Olsen Maren K, Brown Tyson, Ezem Natalie, Liu Evan, Majors Alesha, Steinhauser Karen E, Sullivan Brandy H, van Ryn Michelle, Wilson Sarah M, Yang Hongqiu, Johnson Kimberly S
Department of Medicine, Duke University Medical School, Durham, NC, United States.
Department of Psychology and Neuroscience, Duke University Medical School, Durham, NC, United States.
Front Med (Lausanne). 2024 Jun 6;11:1316475. doi: 10.3389/fmed.2024.1316475. eCollection 2024.
Clinician implicit racial bias (IB) may lead to lower quality care and adverse health outcomes for Black patients. Educational efforts to train clinicians to mitigate IB vary widely and have insufficient evidence of impact. We developed and pilot-tested an evidence-based clinician IB curriculum, "REACHing Equity."
To assess acceptability and feasibility, we conducted an uncontrolled one-arm pilot trial with post-intervention assessments. REACHing Equity is designed for clinicians to: (1) acquire knowledge about IB and its impact on healthcare, (2) increase awareness of one's own capacity for IB, and (3) develop skills to mitigate IB in the clinical encounter. We delivered REACHing Equity virtually in three facilitated, interactive sessions over 7-9 weeks. Participants were health care providers who completed baseline and end-of-study evaluation surveys.
Of approximately 1,592 clinicians invited, 37 participated, of whom 29 self-identified as women and 24 as non-Hispanic White. Attendance averaged 90% per session; 78% attended all 3 sessions. Response rate for evaluation surveys was 67%. Most respondents agreed or strongly agreed that the curriculum objectives were met, and that REACHing Equity equipped them to mitigate the impact of implicit bias in clinical care. Participants consistently reported higher self-efficacy for mitigating IB after compared to before completing the curriculum.
Despite apparent barriers to clinician participation, we demonstrated feasibility and acceptability of the REACHing Equity intervention. Further research is needed to develop objective measures of uptake and clinician skill, test the impact of REACHing Equity on clinically relevant outcomes, and refine the curriculum for uptake and dissemination.ClinicalTrials.gov ID: NCT03415308.
临床医生的隐性种族偏见（IB）可能导致黑人患者获得的医疗质量较低，并产生不良健康后果。为培训临床医生减轻隐性种族偏见所做的教育努力差异很大，且缺乏足够的影响证据。我们开发并进行了一项基于证据的临床医生隐性种族偏见课程“实现公平（REACHing Equity）”的试点测试。
为评估可接受性和可行性，我们进行了一项无对照的单臂试点试验，并在干预后进行评估。“实现公平”课程旨在让临床医生：（1）获取有关隐性种族偏见及其对医疗保健影响的知识；（2）提高对自身隐性种族偏见倾向的认识；（3）培养在临床诊疗中减轻隐性种族偏见的技能。我们通过7至9周内的三次线上互动辅导课程来实施“实现公平”课程。参与者为完成基线和研究结束时评估调查的医疗保健提供者。
在约1592名受邀临床医生中，37人参加，其中29人自我认定为女性，24人自我认定为非西班牙裔白人。每次课程的平均出勤率为90%；78%的人参加了全部三次课程。评估调查的回复率为67%。大多数受访者同意或强烈同意课程目标已达成，且“实现公平”课程使他们有能力减轻临床护理中隐性偏见的影响。与完成课程之前相比，参与者一致报告称在完成课程后减轻隐性种族偏见的自我效能感更高。
尽管临床医生参与存在明显障碍，但我们证明了“实现公平”干预措施的可行性和可接受性。需要进一步开展研究，以制定衡量吸收程度和临床医生技能的客观指标，测试“实现公平”对临床相关结果的影响，并完善课程以便推广和传播。临床试验注册号：NCT03415308。
