Quick facts

Year: 2016–17, 2017–18, 2018–19 (3 cohorts) 

Country: United States of America 

Institution: Rutgers New Jersey Medical School (NJMS) 

Learners: Pre-qualifying first year medical students  

Aims:

• To increase awareness of how racism shapes clinical encounters, health outcomes and addressing the gaps in the curriculum. 

• To equip students with practical frameworks (CHARGE2, INTERRUPT) to reflect on their own biases and address microaggressions and racialised clinical decision-making, particularly within hierarchal clinical environments. 

• To foster a safe, peer-led environment for dialogue and reflection that acknowledges the burden of racism in medical training and supports preparation for future clinical practice.  

Why was the education intervention developed?

This intervention was developed in response to a growing recognition that racism experienced by minority communities is linked to a higher risk for poor mental and physical health. Whilst experiences of racism lead to increased stress and social disadvantage, poorer health is also significantly driven by the implicit bias of health care professionals (HCPs). In turn, racial bias amongst physicians reinforces the misconceptions that medical students and trainees are exposed to during their training. 

The launching of the mandatory Health Equity and Social Justice (HESJ) course was therefore a direct response togaps in the “silent curriculum” surrounding racism and health. By mandating the course, NJMS formally acknowledgesracism in healthcare as a real and relevant issue, underscoring its importance alongside clinical content as a core component of medical education.  

What was involved in the education intervention?

The HESJ course was launched as a mandatory component of the medical curriculum, designed to engage medical students throughout their pre-clinical years and establish health equity as a priority.  Prior to the session, students completed an interactive lecture on unconscious bias, undertook an Implicit Association Test, and wrote reflective essays as part of the HESJ course, providing a necessary foundation. The intervention uniquely incorporated both a 50-minute large-group lecture and a 120-minute small-group case-based discussion, combining approaches that are often delivered separately. To support action beyond the lecture setting, students were introduced to two practical frameworks: CHARGE2, for self-reflection on bias and INTERRUPT, for responding to microaggressions. The frameworks were built on prior work and earlier HESJ teaching. 

The case discussions were in multiple rooms, with groups of 10-12 learners and a senior student peer facilitator. This aimed to reduce power dynamics and encourage open discussion. The design was co-developed by faculty and a student working group, with five cases drawn from real student experiences of racism in clinical contexts.  

How was the education intervention evaluated?

The intervention was evaluated using an online quiz, course evaluations, and focus groups.  

The quiz was composed of: 

• Four multiple-choice questions, which tested student knowledge of the lecture content. 

• One short-answer question on key messages from the small-group discussions, which captured the student’s level of reflection and future application. 

The evaluations were anonymous surveys for students to rate how well objectives were met, inviting free-text comments on strengths and improvements.

End-of-course focus groups occurred annually with self-selected students to explore experiences in depth and co-plan improvements. 

What was the impact of the education intervention?

There was a clear positive impact on students’ understanding of racism, their attitudes toward bias in healthcare, and their preparedness to respond to discriminatory situations. Across all three years, most learners reported that the session’s objectives were achieved to a considerable or very high degree.

Students consistently described the small-group discussions as the most meaningful aspect of the intervention. Many noted that the format allowed them to explore multiple perspectives, practise applying the CHARGE2 and INTERRUPT frameworks, and speak more openly about their own biases and experiences.

Students also reported heightened awareness of how racism influences both clinical encounters and broader health outcomes, as well as a clearer grasp of how medical hierarchy can make it difficult to challenge biased behaviour. 

Overall, the intervention was well received by students, demonstrating meaningful self-reported learning, and clear potential for continued development within the wider curriculum. Ultimately, it illustrated that interventions of this kindhave considerable potential to shape students’ emerging professional identities.  

Key learnings

• Early placement in the curriculum is vital to support the development of students’ clinical mindsets and engagement with issues of racism in healthcare. 

• Peer facilitation creates psychological safety, enables open discussion and is key to enabling students to reflect on their own assumptions and biases. 

Challenges 

• Use of real student experiences may be emotionally challenging for racially minoritised students with similar lived experiences. 

Recommendations 

• Co-develop educational content with faculty and students to maintain academic standards and enhance credibility with learners. 

• Integrate anti-racism teaching across undergraduate medical training, rather than as a standalone session, to reinforce its role in shaping future clinical practice. 

• Ensure clear pathways for students emotionally affected by the discussions to seek support or debrief, including opportunities for reflection and follow-up beyond the session.