Medical Learner Perspectives on Restorative Practices to Address Medical Racism.

Abstract

The use of restorative practices may be an alternative approach to responding to patients and families harmed by medical racism. Little research has explored its implementation in health care settings or the perspectives of residents and fellows (ie, medical learners) regarding its use in academic clinical settings. To elicit perspectives from medical learners on using restorative practices to address patient and family concerns about racism and other identity-based harms in the health care context. This qualitative study consisted of one-on-one semistructured interviews with residents and fellows between May and July 2024. Participants were invited from 76 adult and pediatric training programs affiliated with the University of Washington. The interview guide was developed by the study team, and interviews were conducted via videoconferencing and lasted approximately 30 minutes. Each participant received a $50 gift card as compensation. Medical learners' perspectives and concerns about implementing restorative practices to address racism in health care settings. Thematic analysis was used to identify these perspectives. Interviews were conducted until thematic saturation was reached. A total of 20 medical learners were interviewed. These participants had a mean (SD) age of 32.3 (3.2) years; 13 (65%) were women and 8 (40%) identified as Asian, 4 (20%) as Black, and 8 (40%) as White individuals. Eight participants (40%) had heard of restorative practices, mostly in the criminal justice and educational settings; 5 (25%) were confident in explaining what restorative practices entailed; and 2 (10%) had participated in restorative circles. In general, medical learners were supportive of using restorative practices to address medical racism and other harms experienced by patients and families. However, medical learners identified important concerns regarding preparation for this work (prework and intention setting), burden of participation (time barriers and personal and professional risks), and goals and outcomes (patient and family willingness, goals identification, and healing and harm mitigation). This qualitative study found that medical learners were open to working with patients and families using restorative practices to address medical racism and other identity-based harms; these participants also identified additional concerns regarding implementation such as preparation, barriers and risks, and meaningful goals and outcomes. Future studies should investigate potential solutions to these concerns as well as include perspectives from patients and families to support evidence-based implementation.