Diversity, Equity, Inclusion, and Anti-Racism

Racism is a critical social determinant of health. ^1,3,4 Other forms of oppression, meaning the “interlocking forces that create and sustain injustice,”⁵ include forces such as sexism, ableism, heterosexism, xenophobia, weight bias, and gender normativity, among others. Social justice “refers to reconstructing society in accordance with principles of equity, recognition and inclusion… [and] involves eliminating injustice created when differences are sorted and ranked in a hierarchy that unequally confers power, social, and economic advantages, and institutional and cultural validity to social groups based on their location in that hierarchy.”⁵  Achieving social justice is crucial to achieving health equity, and requires disruption to many of our society’s current systems—including healthcare.

Resources were cultivated from a variety of sources—both within and outside of the medical field—including the fields of education, social work, psychology, as well as national organizations such as the National Museum of African American History and Culture, California Newsreel, Just Health Action, the National Equity Project, and more. Sessions are heavily discussion-based, facilitated by a diverse group of committed faculty and fellows. In addition to sessions for the residents, all of our program leadership, Department Chair, and a number of other faculty members have participated in the curriculum and we continue to disseminate the content throughout the Department. While the ultimate goal is to move toward a more just future, including achieving health equity for all patients and achieving a sense of belonging for all who work in our healthcare system, as a more proximate goal we focused this curriculum’s objectives on shifting learners’ knowledge, skills and attitudes.

1. Analyze how the history of racism and other forms of oppression impact our current state of health (in)equity, healthcare, and academic medicine. 
2. Examine the way systems of power and systems of oppression are at work in our daily lives, both within and outside of professional roles.
3. Assess one’s own identity and biases, and implement strategies to reduce the impact of these biases on interpersonal interactions while maintaining self-compassion. 
4. Intervene when witnessing or experiencing racism and other forms of oppression; recognize responsibilities of witnesses and rights (including the right to do nothing) for those experiencing aggression. 
5. Engage others in conversation and action related to social justice. 
6. Appreciate the benefits to ALL people, including both those in power and those experiencing oppression, of working for social justice. 
7. Demonstrate the abilities to sit with discomfort and to cause disruption as necessary steps toward a more equitable future.
8. Appraise one’s own unique talents and positions of power, and use this to plan individual, actionable steps to promoting a more just future.

Formal content is delivered primarily during our block education time, PEARL, and some Morning Report sessions. Interns receive a more intensive series throughout the course of their first year here, which we build upon as a whole program together in sessions both during intern year and in subsequent years of residency. Our hope is that ultimately all learning, research and care will incorporate a social justice perspective. As such, these topics are increasingly interwoven into discussions and learning that takes place at other times. Additionally, residents participating in the Global Health and PUBLISH pathways will examine issues related to these areas of focus more deeply.

Content is presented in both a rotating (3-year cycle) and sequential (specific to year of training) format, depending on the topic, and include:

All residents are encouraged to attend. Residents who may find the content traumatizing, redundant, or unnecessary because of their lived experiences and identity are welcome to opt out. Residents who are uncomfortable for other reasons, and particularly those who hold identities that put them primarily in positions of power or privilege, are encouraged to stay. Regardless, no explanation is required of anyone who opts out. As we strive to create an inclusive and responsive environment, we provide multiple mechanisms for feedback on the curriculum and environment.

• “I really enjoyed realizing how many people actually care about these issues and having a space to talk about this. I felt like we were a team going through the curriculum together. I also really appreciated the faculty perspectives.”
• “This curriculum challenged me to think and talk about things that were uncomfortable – thoughts/discussions I probably would have strayed from if not part of a mandatory curriculum.” 
• “The best part was getting to hear from other about their experiences, whether similar or different to mine. Sometimes things people said were ideas I have never thought about. It made me really think about my own actions or scenarios I have been in.”
• “Learning more about the history of race and racism was the best part.”
• “I feel so much more confident in my abilities to talk about social injustices and to further identify the endless areas that I need to learn more about. This curriculum gave me a great platform that I will continue to build and work on going forward as I progress in my career.”
• “I found it empowering to share my experiences with racism for the first time with people outside of my family.”
• “Change is slow but I’ve come away with strategies to meet people where they are in hopes of making small progress continually over time.”