Using Medical Education to Fight Racism

Bottom line: When trainees understand the impact of racism on health outcomes for children, they can be part of the solution.

Guest post by Dr. Ndidi Unaka.

When the leadership of the Association of Pediatric Program Directors (APPD) — on behalf of the American Board of Pediatrics (ABP) — approached me in the early fall of 2020 to lead a revision of the ABP’s entrustable professional activity (EPA) about population health and quality improvement, I did not hesitate to say, “Yes.”

Earlier that year, the COVID-19 pandemic and the killing of George Floyd forced our nation to confront the corrosive nature of racism and discrimination. The pandemic further exposed widespread health inequities impacting communities of color. More individuals now recognize that we urgently need to move beyond merely acknowledging these issues exist. We need to push organizations and institutions to be action-oriented, and we need to be explicit about the role the entire pediatric community should play in addressing the root causes of health inequities among marginalized populations.

For example, when medical educators seize opportunities to teach trainees about the contextual factors that contribute to pediatric health inequities, and when trainees understand the impact of racism in all its forms and discrimination on pediatric health outcomes, we create a community of physicians that can be part of the solution to ensure every child’s health and well-being is optimized. That is why I was so eager to play a role in revising the population health EPA.

EPAs are often used as an assessment framework to determine if a pediatrician can be entrusted to perform specific activities without supervision. All pediatricians should be knowledgeable about population health and quality improvement strategies and ready to use these principles to improve the quality of care for the patient populations they serve.

The EPA revision process started with formalizing the team. I was incredibly fortunate to work with such an engaged and diverse group of pediatricians who were not only leaders in medical education, but also passionate about reducing health inequities among children and adolescents. This work was a priority for all of us.

As we revised the EPA, we knew the importance of being intentional with our language, and we recognized that individuals have varying levels of understanding the systemic issues that lead to pediatric health inequities. To help, we provided definitions and associated citations for the terms that are commonly used in conversations about pediatric health inequities. We also offered references that might help inform initiatives that educators might develop as a result of the EPA. We wanted to make sure that the components could not only drive assessment, but also be used to inform curricula.

In addition to being explicit about racism, discrimination, and health inequities, the working group also recognized that measurable systems-level change across health care organizations and communities was paramount. Therefore, we highlighted quality improvement science and its core tenets as an essential means of addressing pediatric health inequities.

Curriculum development for and assessment of trainees is contingent upon well-informed educators. And yet, many practicing pediatricians did not receive significant education and training in these critical areas. One of our aspirations for this revised EPA is for it to serve as a tool to inform the professional development of practicing general pediatricians and pediatric subspecialists.

We also hope that this EPA will serve as a springboard for institutions who are thinking about how they can ignite culture and systems change within their health care organizations, including meaningful partnerships with patients and families. I hope work on this EPA inspires other medical specialties to follow in our footsteps.

I am honored to have partnered with my colleagues to revise this EPA, and I could not be more proud to be part of the larger pediatric community.

For a list of the working group members and more details about the revised EPA, visit the ABP’s news story. To learn more about EPAs or see the full list, visit our website.

About the Author

Dr. Ndidi Unaka

Ndidi Unaka, MD, MEd, is the Associate Program Director of the Pediatric Residency Training Program and an Associate Professor in the Division of Hospital Medicine at Cincinnati Children’s Hospital Medical Center (CCHMC). She is also the Medical Director of an inpatient hospital unit and the Medical Director of Quality Improvement for HealthVine, a network of pediatric care providers and organizations that connect to help more than 130,000 Medicaid-covered children be healthier. Dr. Unaka is also a member of the CCHMC Health Equity Network’s (HEN) operations team. She is maintaining certification in both General Pediatrics and Pediatric Hospital Medicine.