453 - Advancing Antiracism for Pediatric Faculty: A Train-the-Trainer Implementation Strategy for Bias Reduction in Medicine-Pediatrics+

Publication Number: 453.3722

Thida Ong, Seattle Children's Hospital/ University of WA, Seattle, WA, United States; Hannibal Person, Seattle Children's Hospital, SEATTLE, WA, United States; Roberto Montenegro, University of Washington School of Medicine, SEATTLE, WA, United States; Marshall Brown, Seattle Children's, Seattle, WA, United States; Christine Stoffels, Seattle Children's, Seattle, WA, United States; Stephanie Tavarez, University of Hartford, Bergenfield, NJ, United States; Richard Shugerman, University of Washington, Seattle, WA, United States; Jason Deen, University of Washington School of Medicine, Seattle, WA, United States; Freda F.. Liu, University of Washington School of Medicine, Seattle, WA, United States

Background: Healthcare provider bias contributes significantly to racial and ethnic inequities in pediatric care. However, pediatricians often lack training in antiracism practices, including racial literacy, bias awareness, and antibias action planning. Effective strategies to implement antiracism training could enhance its spread and impact. We recruited and trained pediatric faculty champions using a train-the-trainer approach to deliver an institution-wide, Department of Pediatrics-sponsored 6-hour, 3-part workshop series, Bias Reduction in Medicine – Pediatrics+ (BRIM-Peds+).

Objective: To assess the acceptability, appropriateness, and feasibility for a local champion (train-the-trainer) implementation strategy to facilitate antiracism training for pediatric faculty.

Design/Methods: With departmental leadership support, we recruited antiracism champions from 20 divisions within a large pediatric academic center of 600+ faculty. Faculty applied to become division champions (DCs) with division head recommendations. Selected DCs completed three intensive 2-hour sessions on content overview, caucus facilitation, and antiracism skills. DCs rated the training using the Acceptability, Feasibility, and Appropriateness Scale (AFAS; 1=not at all, 5=extremely) and the NASA task load index (1=very low, 21=very high). Pre- and post-training measures assessed content knowledge, bias awareness, self-efficacy, and bias management behaviors on 7-item scales, and were analyzed by paired t-tests.

Results: Among 14 DCs, 6 (43%) identified as Black or non-Black people of color, and 8 (57%) as white. Mean (SD) for acceptability, 4.2 (0.8), feasibility, 4.2 (0.7), and appropriateness, 4.2 (0.7), were above the a priori benchmark (>4). Mean (SD) task load for the overall training was 10.3 (1.4) with the highest domain being mental load, 15 (2.2) out of 21. Scores on a 10-item knowledge quiz improved from 71% at baseline and 76% after intensive training. Mean bias awareness (5.5 to 6, p=0.016) and self-efficacy (5.1 to 6.2, p=0.001) both increased significantly. Self-reported practice of bias management behaviors like “I challenged a clinical decision thought influenced by bias” was 1.1 pre- and 1.3 post-training (p = 0.11). Ten of 14 DCs have taught or will teach the BRIM-Peds+ series by December 2024.

Conclusion(s): We demonstrate high feasibility, acceptability, and appropriateness of a train-the trainer approach to engage with peer pediatric faculty to disseminate BRIM-Peds+ series in a large, academic institution. Future efforts will assess the spread and impact of BRIM-Peds+ on faculty learners.