Annie Hoopes, MD, MPH, FAAP
WCAAP Equitable Care Work Group
What are some things you learned in training that you have had to unlearn?
Wait until 2 years of age to introduce peanuts in the diet
Never offer an intrauterine device (IUD) to a nulliparous teen.
Calculate the glomerular filtration rate (GFR) differently for patients who identify as Black or African American.
These are just a few examples of practices in pediatrics that are no longer evidence based. As trainees, we all learned clinical information that we have subsequently “unlearned” as new evidence has emerged to guide our care. When we chose careers in pediatrics, we committed ourselves to a journey of lifelong learning so we can provide safe, effective care to our patients and families long after we have completed our formal training. The field of medicine is always changing based on emerging research, innovative technology and therapeutics, and a dynamic society. The formal systems in place to train and maintain certification – such as medical school, residency, and board certification – not only have a clear role in establishing standardized competencies, training, and maintaining oversight of the pediatric workforce, but also have limitations in addressing lack of diversity, systemic bias and racism in medicine and medical training.
Addressing structural racism and bias in medicine and medical training
As the medical community gains insight into the social and structural determinants of health, we have also acknowledged the harms that physicians and the medical system have inflicted and/or perpetuated on our patients due to explicit and implicit bias, racism, and an incomplete understanding of our patients’ lived experiences. We as pediatricians have the responsibility to unlearn biases we may hold as part of our socialization and medical training. These biases have been shown in research to lead to inequitable care: offering less pain medication to a Black patient than to a White patient, assuming that a patient who identifies as queer or gender diverse is engaging in riskier sex practices than one who identifies as straight or cisgender, or concluding that a patient with a larger body is overeating based solely on their body mass index.
We are imperfect as humans and as physicians, and none of us get it right all the time. Continuous learning and unlearning are values that we can embrace and encourage in each other to promote safety and health in the communities we serve. Acknowledging that clinical training has gaps and limited diversity in representation means we need to find new and innovative solutions to meet the needs of all our patients and families.
A learning tool to promote equity in our pediatric care
One way to build knowledge and expertise in new areas of pediatric medicine is through knowledge sharing and practice. As part of the WCAAP Equitable Care Toolkit, we developed a dynamic resource of board-style questions that build awareness and competence in caring for diverse pediatric patients and promote skills in reducing health disparities in one’s clinical practice. These questions are designed to go beyond what may have be found in textbooks or research studies, often because certain populations and communities, such as Black, Indigenous, or persons of color and those who identify LGTBQ2+, historically were excluded from or exploited in medical research and clinical teaching. They are also intended to facilitate recognition of and examination of our implicit biases.
Share your knowledge and expertise
A number of WCAAP members have already begun to submit questions, and we invite you to contribute as well. The instructions are simple, and the process is flexible:
- Choose a topic you have developed an expertise in through clinical practice, lived experience, or both.
- Draft a question (100-200 words), 1 best response and 3 incorrect or problematic responses.
- Draft an explanation (200-500 words) of why the best response is most appropriate and include any information or evidence to support this selection.
- Include 3-5 references or learning resources that promote deeper learning on the topic. These may be peer-reviewed publications or books, but can also include reputable websites, books, films, or news articles.
- Consider writing a “why” at the end of the question if there are personal experiences or de-identified patient care scenarios that might resonate with learners.
- We want to make sure every person involved in pediatric care in Washington is represented. Patients, parents, medical staff, non-clinical staff – all are encouraged to share their stories so we can all learn. Consider partnering with your families or staff to develop a question as a team.
- Please send your case, responses, and references to admin@wcaap.org.
- Our team will review for clarity, ensure no patient identifiers are included, and upon review of any changes with the question authors, add to our online question bank for WCAAP members to engage with.
If you would like to participate as a case reviewer, please contact admin@wcaap.org . We hope that this question bank will be a “living” resource, and we will continually welcome feedback regarding existing questions or the process of question development. We look forward to learning alongside all of you.