Foundations in Racism: a Novel and Contemporary Curriculum for Child and Adolescent Psychiatry Fellows

Abstract

Studies have documented the far-reaching health consequences of racism for over two decades [1]. Despite this, the medical profession has avoided identifying racism as a root cause of health inequities [2]. Within psychiatric education, racism has primarily been conceptualized as part of cultural competency and the social determinants of health, with implicit bias as a more recent focal point [3]. However, in a recent study, child and adolescent (CAP) fellowship directors reported that structural and historical social determinants (e.g., “institutionalized poverty and racism, community history”) are taught less effectively than all other social determinant categories [4]. This educational gap exists, despite growing evidence that systemic racism contributes to the disproportionality of Black compared to white youth in child welfare, juvenile justice, and special education systems [5]. The deaths of Trayvon Martin, George Floyd, Breonna Taylor, and countless other individuals due to police brutality have triggered critiques of the silence on racism in medical training. Faculty and students have insisted on integrating structural competency and antiracist pedagogy into medical education, so the next generation of physicians can eliminate racism from clinical practice and challenge societal injustice more broadly [6]. Furthermore, the history of white supremacy in America is increasingly considered requisite learning for diagnosing and combatting structural racism, which sustained equity requires [7, 8]. To our knowledge, however, few published models about racism in residency education exist. A search for “racism” in the Association of American Medical College’s medical education database (MedEdPORTAL) reveals six curricula involving race or racism, but only four explicitly state those terms in their titles and are directed towards medical trainees. Only one curriculum is for psychiatry trainees, from the Massachusetts General Hospital/McLean Psychiatry residency program, comprised of four 50-min interactive sessions on addressing racial inequities [9]. None is for child psychiatry fellows. Furthermore, few scientific publications have described curricula for psychiatry trainees that focus on the historical roots of racism and how to develop and implement such curricular materials [9]. This educational case report strives to address this gap by describing the University of California Los Angeles (UCLA) CAP Fellowship Program’s novel Foundations in Racism curriculum, first piloted in 2017 to first-year child psychiatry fellows. The curriculum emphasizes how the American Indian Genocide and slavery shaped racism’s many forms, drive (mental) health inequities, and influence the practice of psychiatry. Beyond highlighting the curricular content, we emphasize our process, providing a roadmap for other psychiatry training programs aiming to develop and deliver similar curricula.