Learning to Action: Finding Your Anti-Racism and Equity Lens

The coronavirus disease 2019 pandemic and brutal police killings of George Floyd and numerous other racial and ethnic minorities have highlighted the public health crisis stemming from racism and xenophobia.^1,2  The medical community is not immune to the effects of systemic racism and social injustice, and racial inequities and health disparities continue to disproportionately affect the lives of racial and ethnic minority patients,³  including children.⁴  Likewise, underrepresented in medicine practitioners experience discrimination, barriers to career advancement and leadership opportunities, and lack of mentorship and representation.⁵ 

To address this crisis, health care organizations and professional societies have taken a stance against racial injustice and are taking action to promote anti-racism and equity within their institutions.^6–9  Likewise, the Academic Pediatric Association’s (APA’s) board of directors created the Anti-Racism and Diversity Task Force in 2020 as one of its initiatives to advance anti-racism and promote the diversity, equity, and inclusion (DEI) goals as set by APA’s Diversity and Inclusion Committee.¹⁰  Within the Task Force, the Toolkit Subcommittee created a widely available repository of resources to equip pediatric practitioners, leadership, and trainees with necessary tools and resources to assess and facilitate culture change and continual growth in antiracist practices, equity, and inclusivity. The APA’s Anti-Racism and Equity Toolkit was published online in early 2022.¹¹  Although originally created with pediatric academicians in mind, the resources are applicable to all practitioners, including community pediatricians, family medicine, and internal medicine health care providers. Here, we highlight how clinicians can integrate this toolkit’s resources (which can be used to claim American Board of Pediatrics Maintenance of Certification Part 2 credits for DEI education) into their practice to effect change on the journey toward anti-racism and equity.

Deciding to promote change toward anti-racism and equitable practice is a personal choice and journey, requiring tools for both learning and action. Through self-regulated learning,¹²  this toolkit can serve as a resource to guide any provider or organization on this journey to learn the history behind this choice, bridge gaps, and operationalize equity and anti-racism in their practice or institution, respectively. While engaging with the toolkit, it is important to consider what one’s goals are for reviewing or utilizing the toolkit. Questions to ask include: Are you doing this to increase your knowledge, or to teach and support others? How can your actions impact your patients? Each section of the toolkit can be used to address these questions. When a provider seeks personal knowledge acquisition, books and articles may become the main source of information. While teaching others, a provider might reference workshop materials or toolkits as resources to build the framework for handouts and PowerPoint materials. The motivation behind a provider’s growth in anti-racism culture, equitable practice, and potential health outcomes will drive the toolkit’s utilization. The Anti-Racism and Equity Toolkit complements the education domain of the American Academy of Pediatrics Equity Agenda⁸  by providing a user-friendly guide to help practitioners on their journey to effect practice and culture change toward health equity. Figure 1 depicts the conceptual framework used to format the toolkit.

The Tools for Learning section of the toolkit guides the user through the definitions of antiracism terminology, training and development resources, and assessment tools. Defining racism and antiracism can be explored by reading “How to Be an Antiracist,”¹³  by Dr Ibram Kendi or by listening to Dr Camara Jones on the “Allegories on Race and Racism.”¹⁴  Although implicit bias and microaggression training and resources have become commonplace, the Assessments and Surveys subsection is enhanced with suggestions for needs assessments and climate and engagement surveys to objectively assess the work environment. These assessments are foundational for monitoring progress over time, facilitating the lifelong learning process, and aligning with organizational mission priorities.

The next portion of the toolkit contains Tools for Action that providers can use to create an environment of inclusivity and equity in their academic practice and organization. These tools consist of educational, organizational, and patient care action items. The educational action items provide concrete primers that encourage engagement with DEI topics within a department/division. At the organizational level, actions focus on systemic factors that can advance equity by supporting policy and procedural changes. These action items may also empower professionals to work toward effecting change in their individual spheres, which work together with institutional efforts. Finally, patient care action items affirm best practices to provide equitable care and create clinical environments that actively confront racism by addressing biases and promoting cultural pride. Altogether, these action items span the range of experiences common to most providers, providing structure to operationalize their well-intended interests.

The concluding section, titled Curated Resources, provides easy-to-access resources in various modalities (including video resources and patient education tools) to further explore the topics of anti-racism and DEI. Utilizing these resources will unveil suggestions that are minor tweaks to the excellent care providers strive to give patients daily. So, whether it is a reminder of how to use gender-neutral terms in the psychosocial history¹⁵  or an expansion of a practice’s Reach Out and Read program to more intentionally feature books with diverse characters,¹⁶  patients will benefit from the provider’s journey.

As the pediatric community collectively works toward anti-racism to improve the health of patients, updating the toolkit with additional resources remains an active, ongoing process. Analytical tracking is being used to monitor traffic through the toolkit and a survey will be added to assess its utility. Also, the toolkit’s impact on clinicians’ practices will be evaluated with qualitative assessments of organizations and institutions.

The current sociopolitical climate challenges our collective efforts to advance DEI and social justice, and institutions’ DEI efforts are now under the microscopic lens. This toolkit provides the tools to guide practitioners on their journeys toward personal growth and facilitate the integration of practices to operationalize anti-racism and equity at the individual and organizational levels. With continued health disparities in marginalized communities and increasing limitations on how knowledge and education are disseminated, we must all individually commit to personal growth and practice enhancements.