Transferring past inquiry: a secondary qualitative evaluation on selling racial justice in scientific care | BMC Medical Training
study design
This study is a secondary qualitative analysis of responses from a nationwide online survey of medical students and practicing clinicians conducted between December 2020 and February 2021 during the development and evaluation of the P5RJ curriculum. Participation was voluntary and written informed consent was obtained from all participants. There was no incentive to complete the survey. The study was approved by the Stanford School of Medicine IRB.
Survey development and distribution
The P5RJ curriculum and survey is based on the Presence 5 Framework for Humanism in Medicine and was developed by the Presence 5 for Racial Justice research team (including all authors) at Stanford University School of Medicine. The original Presence 5 framework was developed through a systematic literature review, patient and clinician interviews, and a Delphi panel. This framework was used to develop an anti-racism curriculum for medical education, the P5RJ curriculum, which aims to teach medical students evidence-based anti-racism communication strategies to promote health equity for black patients. The P5RJ curriculum was developed through literature review, online Qualtrics feedback survey, and structured feedback synthesis by the research team. The feedback survey surveyed clinicians and medical trainees with DEI experience including health inequalities, health equity, anti-racism, medical education and racial justice. Respondents were recruited through convenience sampling and email listservs (N=52) from clinicians and medical trainees with experience in DEI; These listservs contained chapters of national medical school diversity organizations (e.g., White Coats for Black Lives, American Medical Students Association, Student National Medical Association). In addition, the survey was distributed to individual professional contacts (N=123) involved in DEI efforts and medical education. Participation in the survey was limited to medical trainees and clinicians. The P5RJ curriculum has been implemented in various medical education settings, including local academic institutions and national conferences, and participants were unfamiliar with this curriculum.
The survey questions included feedback on the P5RJ strategies, examples and suggestions for additional recommended language/phrases to be used for communicating against racism in the clinical encounter. Survey participants were provided with the titles and descriptions of each of the P5RJ strategies: (1) Prepare Consciously, (2) Listen Carefully and Fully, (3) Agree What Matters Most, ( 4) Connect to the patient’s story, and (5) Explore emotional cues. Participants were asked to record free-text style responses with specific phrases or actions that they use directly in their communication with patients as they clearly relate to the given definition of each strategy, e.g. B. “What specific phrases or sample language do you use with patients? for this practice (preparation on purpose)?” Respondents could submit more than one answer per question, and each question was optional. Respondents were also asked about demographics, role/level of clinical practice, and DEI involvement.
secondary analysis
We performed a secondary analysis of survey participants’ qualitative feedback, focusing on specific phrases/languages and actions used for each of the P5RJ strategies using inductive qualitative analysis [7]. To develop the codebook, authors BK and RG (medical students and medical students at the time of the study) derived key terms from previous research on anti-racism communication [8] can be found in the survey responses. We then conducted a literature search in PubMed on these terms such as “empathetic statement”, “allyship” and “self-accountability”. We developed codebook definitions by snowball sampling from relevant articles in the initial literature search. The codebook was validated by JC, DZ and MS (a qualitative researcher, physician-scientist and physician-educator) through independent review and group discussion. Authors BK and RG independently and manually coded all responses using Microsoft Excel, and then discussed the coding of each response until thematic saturation was achieved according to definitions from the literature. All answers were coded with one or more of the four codes.
