Resident, Faculty, and Latino/a/x Patient Perspectives on Racism: A Mixed-Methods Study to Inform Anti-Racism and Advocacy Curricula.

Abstract

Systemic racism in healthcare perpetuates disparities for Black, Indigenous, and People of Color (BIPOC), particularly Latino/a/x patients, who face high rates of underinsurance and chronic illness. Medical training inadequately prepares residents to address bias, structural racism, and communication barriers, creating an urgent need for anti-racist education in Graduate Medical Education (GME). This study assessed gaps in anti-racism and advocacy training for internal medicine residents caring for Latino/a/x patients to inform the Health Equity and Advocacy Learning Series (HEALS) curriculum. A mixed-methods, community-engaged curricular themes exploration was conducted using focus groups and faculty surveys, guided by a liberatory design framework. Participants included Latino/a/x patients (n = 16), internal medicine residents (n = 6), and faculty members (n = 15). Focus groups with patients and residents explored experiences of racism in healthcare, using Dr. Camara Jones' three levels of racism as a theoretical framework. Qualitative data was analyzed using reflexive thematic analysis. Patients reported internalized racism due to language barriers and provider dismissiveness, personally mediated racism through delays and negative interactions, and institutionalized racism via inconsistent interpreter services and systemic barriers. Residents acknowledged gaps in training and a lack of inclusive education. Faculty surveys revealed limited confidence in treating BIPOC patients, with only 20% reporting adequate training. Findings underscore the need for anti-racist medical education. The HEALS curricular objectives address racism at multiple levels through self-reflection, communication training, and advocacy skills. Community-informed training with Latino/a/x may help inform approaches to more equitable care for marginalized populations. Further research is needed to assess its impact on medical practice and patient outcomes.