Development and initial validation of the anti-racism behavioral inventory (ARBI)

Mitigating Microaggressions in Medical Education Through the TRAUMA Framework

ABSTRACT

Microaggressions are defined as brief communications directed at members of a stigmatized group that are received as derogatory but are unrecognized by the offender. Studies show that microaggressions are detrimental to those of all identities who endure them. Given that microaggressions can result in specific emotional, psychological, and physical challenges for underrepresented medical students from minoritized backgrounds, it is imperative that the medical education community focus efforts on reducing them and their impact through appropriate responses. The TRAUMA framework was developed by the authors and can be used to organize a thorough response to the threat that microaggressions create for all students. The framework includes improved student support, guidelines for faculty and institutional responses to microaggressions, improved faculty development for addressing microaggressions, recommendations to improve classroom environments, and interventions both to create and measure culture change in medical education.

Leveraging Resident-As-Teacher Training for Health Equity Education: A Transformative Approach

Issue: Resident teachers play an essential role in medical education and can support broader efforts to advance anti-racism and health equity in medicine. The Accreditation Council for Graduate Medical Education requires programs to provide education about health care disparities so residents can contribute to and lead work in this area. However, the literature includes few examples, frameworks, or strategies for preparing residents to develop the knowledge and skills needed to promote health equity, including in their role as clinical teachers. Evidence: In this article, the authors propose leveraging Resident-as-Teacher training to support residents in learning and teaching for health equity. Gorski's conceptualization of equity literacy provides an evidence-based framework for four main abilities (recognizing, responding, redressing, and cultivating/sustaining) residents and medical students can develop through co-learning about health equity in the clinical learning environment. The authors discuss preconditions, example activities, and assessments strategies for effective health equity education. Based on the principles of social learning theory, the authors recommend that Resident-as-Teacher training be part of an institutional strategy to cultivate a community of practice for health equity education. Implications: Incorporating health equity education into Resident-as-Teacher curriculum offers a potentially transformative part of the broader strategy needed to prepare the next generation of physicians to enact anti-racism and advance health equity.

A systematic review of diversity, equity, and inclusion and antiracism training studies: Findings and future directions

A growing number of organizations are prioritizing diversity, equity, and inclusion (DEI) and antiracism in the workplace, including investing resources in DEI or antiracism training. However, such trainings vary widely in curriculum, objectives, delivery, and evaluation, with little known about the efficacy of existing trainings. The aim of this systematic review is to evaluate training characteristics, measures, and results of peer-reviewed studies (published between 2000 and 2022) testing DEI or antiracism trainings. Studies were identified using Google Scholar, JSTOR, and a university library database. Key search terms included "diversity, equity, and inclusion training"; "antiracism training"; and "effect," "impact," "outcome," or "evaluation." The search yielded N = 15 DEI training studies and N = 8 antiracism training studies. The majority of studies (75% of antiracism training; 66.6% of DEI training) utilized a one-time training session. Content, objectives, measures, and impact varied widely across studies. Randomized designs were uncommon (13%), and over 70% of studies had majority female participants. Findings highlight several strategies to advance the field of DEI and antiracism training, such as shifting curriculum from targeting individual knowledge to supporting behavioral and organizational change, providing longitudinal training, standardizing outcomes of interest, and implementing rigorous evaluation methods.

How can white parents raise anti-racist children? Introducing the routes to effective anti-racist parenting (REAP) model

In response to highly publicized instances of overt racial injustice, there has been a recent resurgence of interest and commitment to identifying processes through which anti-racist behaviors develop among White individuals. One particularly important context in which anti-racist behaviors can develop is within families and as a result of childrearing. Theories of anti-racism typically neglect the role of families and family science research typically neglects a focus on anti-racist parenting outcomes. To further research and applied work on fostering anti-racism within White families, this paper introduces a new integrative model called routes to effective anti-racist parenting (REAP). The model draws on theories from various fields, including family science and social psychology, and uses a metaphor of nurturing a plant to explain the nuanced, multi-faceted approaches to anti-racist parenting. The model incorporates factors related to the "pot" (i.e., fundamental values and structure necessary to contain more specific anti-racist skills and behaviors), "soil" (i.e., characteristics that define anti-racist commitment), "seeds" (i.e., direct transmission of anti-racism skills), and "environment" (i.e., influential external factors). Finally, we describe the intended benefits that can be reaped from this intentional approach to anti-racist parenting. The REAP model contributes to the family science literature by providing an empirically grounded theoretical model describing the roles that parents can play in children's anti-racist development.

Witnessing racism against racial minority individuals online and loneliness among White emerging adults: Anti-racism advocacy as a moderator

Extant literature suggests that racism is associated with difficult emotional reactions and feelings of social disconnect among White individuals. These feelings of social disconnect may be particularly salient in today's digital era in which racism against racial minority individuals is conveniently and frequently witnessed via online platforms. Thus, we examined whether witnessing racism online may be associated with feelings of loneliness among White emerging adults. We also tested whether anti-racism advocacy buffered loneliness given its potential for relationship building and community organizing to promote racial justice and equity. Using data from 227 White emerging adults (M_age  = 20.86, SD = 4.82), we conducted a latent moderated structural equation modeling to test individual and institutional anti-racism advocacy as moderators in the link between witnessing racism online (racial victimization of racial minority individuals in online interactions and online content on cultural devaluation/systemic racism against racial minority individuals) and loneliness. Greater exposure to online content on systemic racism and cultural devaluation of racial minority groups significantly predicted greater loneliness. Engagement in individual anti-racism advocacy (mean to high levels) buffered this link. White allies must engage in anti-racism practice to address racism in our society, and our findings advance our understanding of the associated psychosocial costs. Implications for research and practice are discussed.

Teaching the Teachers: Development and Evaluation of a Racial Health Equity Curriculum for Faculty

INTRODUCTION

Faculty are increasingly expected to teach about the impact of racism on health and to model the principles of health equity. However, they often feel ill-equipped to do so, and there is limited literature on faculty development on these topics. We developed a curriculum for faculty education on racism and actions to advance racial health equity.

METHODS

The curriculum design was based on a literature review and needs assessments. Implementation consisted of four live virtual 1-hour sessions incorporating interactive didactics, cases, reflection, goal setting, and discussion offered to a multidisciplinary group of pediatric faculty at a children's hospital. Topics included the history of racism, racism in health care, interacting with trainees and colleagues, and racial equity in policy. Evaluation consisted of pre- and postsurveys at the beginning and end of the curriculum and a survey after each session.

RESULTS

A mean of 78 faculty members attended each session (range: 66-94). Participants reported high satisfaction and increased knowledge at the end of each session. Qualitative themes included self-reflection on personal biases, application of health equity frameworks and tools, becoming disruptors of racism, and the importance of systemic change and policy.

DISCUSSION

This curriculum is an effective method for increasing faculty knowledge and comfort. The materials can be adapted for various audiences.

Antiracist Curriculum Implementation for Pediatric Residents

Objectives

Racism has been recognized as a public health crisis, with calls for greater focus on antiracism in medical training. We sought to evaluate a longitudinal antiracist curriculum among pediatric residents.

Methods

In 2020-2021, we delivered seven educational sessions to pediatric trainees in a single residency program. We administered pre-/post-surveys to assess changes in awareness of structural racism, knowledge of health inequities, antiracist clinical skills, and individual/institutional advocacy behaviors. Awareness was measured with 27 Likert-type items spanning five conceptual domains (schools, healthcare, justice system, employment, and housing/transportation). We evaluated knowledge with 18 true/false or multiple-choice questions. Participants indicated comfort with clinical skills using 13 Likert-type items drawn from national toolkits and policy statements. Individual/institutional advocacy behaviors were measured with 14 items from the Antiracism Behavioral Inventory. McNemar or paired Wilcoxon signed-rank tests compared measures before and after implementation.

Results

Out of 121 residents, 79 (65%) completed pre-surveys, 47 (39%) completed post-surveys, and 37 (31%) were eligible for matching across responses. 78% of respondents were female and 68% identified as White. We found significant increases in awareness across several conceptual domains (schools: p = 0.03; healthcare: p = 0.004; employment: p = 0.003; housing/transportation: p = 0.02). Mean knowledge score increased after implementation (p = 0.03). Self-reported clinical skills improved significantly (p < 0.001). Individual advocacy behaviors increased (p < 0.001); there were no changes in institutional advocacy.

Conclusion

We demonstrate improvements in several educational constructs with a novel antiracist curriculum. Efforts to scale and sustain this work are ongoing, and additional teaching and evaluation methodologies may be incorporated in the future.

Coping with online racism: Patterns of online social support seeking and anti-racism advocacy associated with online racism, and correlates of ethnic-racial socialization, perceived health, and alcohol use severity

Given the emerging public health concerns of online racism, we examined potential coping approaches for racial/ethnic minority adults. Using a latent class regression model (N = 407), we examined patterns of online social support seeking and anti-racism advocacy engagements that were associated with online racism among racial/ethnic minority adults. We also examined whether these patterns were associated with ethnic-racial socialization messages (cultural socialization, promotion of mistrust, preparation for racial bias), perceived health, and alcohol use severity. Three distinct latent groups were identified with meaningful group differences: triggered/reactive (alcohol use risk, higher promotion of mistrust), moderate engagement (no risk), disengaged/non-reactive (higher promotion of mistrust, higher cultural socialization, alcohol use risk) groups. Online social support seeking and advocacy engagement may have both benefits and costs in coping with online racism. Those who engage at optimal/balanced levels appear to report better well-being. Implications for research and practice are discussed.

Advancing scholarship on anti-racism within developmental science: Reflections on the special section and recommendations for future research

To date, theoretical and conceptual scholarship on anti-racism has been advanced through leading contributions from several disciplines (e.g., sociology, education, psychology). Still, there remain fewer empirical studies on anti-racism constructs, and we know little about the development of anti-racism among diverse youth across key stages of development. In this special section of Child Development, we sought to address this gap by highlighting scholarship in developmental science that attends to the development of anti-racism in children across contexts (e.g., families, schools) and developmental stages (e.g., early childhood through emerging adulthood). In our introduction to the special section, we review the collective contributions of included studies and outline recommendations for future research in the development of anti-racism in youth.

Anti-racism activism among Black adolescents and emerging adults: Understanding the roles of racism and anticipatory racism-related stress

This study examines associations between individual racism, anticipatory racism‐related stress, and anti‐racism activism among Black adolescents (n = 443; M_age = 15.6; 57.4% female) and emerging adults (n = 447; M_age = 23.8; 77.6% female). The authors tested competing hypotheses about associations between individual racism and anti‐racism activism on anticipatory racism‐related stress. Findings indicated anticipatory racism‐related stress may be both a catalyst and consequence of engagement in anti‐racism activism for Black adolescents and emerging adults. Results for each age group varied by type of stress (physiological; psychological) and activism (low‐risk; high‐risk). Supporting youth engagement in anti‐racism activism without increasing anticipatory racism‐related stress is a key priority for meaningfully advancing scholarship on the development of anti‐racism and pursuit of racial justice.

The impact of anticipated, vicarious, and experienced racial and ethnic discrimination on depression and suicidal behavior among Chicago youth

There is a growing body of research linking racial and ethnic discrimination to adverse youth outcomes. Beyond experienced racial and ethnic discrimination, this study considers the relevance of anticipated and vicarious racial and ethnic discrimination for depression and suicidal behavior. Hierarchical regression models on a diverse sample of 1147 youth (50.31 % female) within 79 neighborhoods from the Project on Human Development in Chicago Neighborhoods indicated that experienced, anticipated, and vicarious racial and ethnic discrimination were associated with an increased risk of depression and suicidal behavior. Additionally, African American and Hispanic youth were disproportionately exposed to-but not differentially impacted by-racial and ethnic discrimination. Findings suggest that developmental research should account for experienced, anticipated, and vicarious racial and ethnic discrimination.

Ending the School-to-Prison Pipeline: Perception and Experience with Zero-Tolerance Policies and Interventions to Address Racial Inequality

This study expands the current research on anti-Black racism and student discipline in schools. It examines perception, experiences, and alternatives of zero-tolerance policies in education, in relation to the call for action by Black Lives Matter at Schools. Black, Indigenous, and People of Color (BIPOC) students are affected at a disproportionate rate when it comes to school discipline, leading to high, inequitable incarceration rates. However, behavior analysis already has powerful tools and interventions that can stop this "school-to-prison pipeline" effect. A survey of school professionals investigated awareness of adverse outcomes from zero-tolerance policies and the use of effective, behavioral alternatives to exclusionary disciplinary practices. Results confirmed zero-tolerance policies still exist in North American schools, but that school professionals, including behavior analysts, support Black Lives Matter at School's call to end such practices. It is important to note that participants report already having the necessary skills to combat zero-tolerance; however, many still feel uncomfortable or ill-prepared to implement interventions specifically intended to decrease anti-Black racism in schools.

Does Witnessing Racism Online Promote Individual and Institutional Anti-Racism Advocacy Among White Individuals? The Role of White Empathy, White Guilt, and White Fear of Other Races

The current study examined the role of White emotional responses (White empathy, guilt, and fear of other races) to (a) witnessing racism online (seeing racial/ethnic minorities discriminated in online interactions) and (b) exposure to online content on the group- and systemic-level racism against racial/ethnic minorities on White individuals' individual and institutional advocacy behaviors. Path analysis using data from 227 White adults revealed that White empathy explained significant indirect relations of witnessing online content on systemic- and group-level racism in society on individual and institutional advocacy behaviors. No significant indirect relations were found regarding witnessing racial/ethnic minorities being discriminated online interactions, but a significant direct link was observed on individual advocacy. In response to witnessing racism online, White empathy appeared to be promotive for advocacy engagement, whereas guilt and fear of other races seemed to be barriers. Limitations and implications for research are discussed.

The Relationships of Intergroup Ideologies to Ethnic Prejudice: A Meta-Analysis

This meta-analysis summarizes the results of research on the relationships of majority group members' endorsement of assimilation, colorblindness, multiculturalism, and the relative relationships of colorblindness and multiculturalism to ethnic prejudice. Random effects analyses found that assimilation was positively related to explicit prejudice (g. = 0.80), multiculturalism was negatively related to both explicit (g. = -0.26) and implicit prejudice (g. = -0.19), and colorblindness was negatively related to explicit prejudice (g. = -0.07). Multiculturalism was more closely associated with low prejudice than colorblindness (g. = 0.15). Effect sizes varied as a function of methodology (experimental vs. correlational), country in which research was conducted (United States vs. other countries), and, in experimental studies of multiculturalism, type of prime used (abstract vs. concrete). Discussion points include methodological issues, groups used as targets of prejudice, national diversity norms, additional issues raised in the studies reviewed, and directions for future research.

Tackling racism as a "wicked" public health problem: Enabling allies in anti-racism praxis

Racism is a "wicked" public health problem that fuels systemic health inequities between population groups in New Zealand, the United States and elsewhere. While literature has examined racism and its effects on health, the work describing how to intervene to address racism in public health is less developed. While the notion of raising awareness of racism through socio-political education is not new, given the way racism has morphed into new narratives in health institutional settings, it has become critical to support allies to make informing efforts to address racism as a fundamental cause of health inequities. In this paper, we make the case for anti-racism praxis as a tool to address inequities in public health, and focus on describing an anti-racism praxis framework to inform the training and support of allies. The limited work on anti-racism rarely articulates the unique challenges or needs of allies or targets of racism, but we seek to help fill that gap. Our anti-racism praxis for allies includes five core elements: reflexive relational praxis, structural power analysis, socio-political education, monitoring and evaluation and systems change approaches. We recognize that racism is a modifiable determinant of health and racial inequities can be eliminated with the necessary political will and a planned system change approach. Anti-racism praxis provides the tools to examine the interconnection and interdependence of cultural and institutional factors as a foundation for examining where and how to intervene to address racism.