By Jennifer Liu, MD, UNMC Department of Family Medicine, Omaha, NE; Mark Carter, MD, HO1, UNMC Department of Family Medicine, Omaha, NE; Donovan Allen, MD, HO3, University of Alabama Department of Internal Medicine, Birmingham, AL

Introduction

In 2003, the Institute of Medicine released Unequal Treatment, highlighting how bias, prejudice, and stereotyping contribute to disparities in health care.¹ Yet, racial and ethnic minorities continue to experience worse health outcomes for many chronic, treatable conditions.² In 2020, two major events brought racial injustice to the forefront: the death of George Floyd and the COVID-19 pandemic, which disproportionately affected Black, Hispanic/Latino, American Indian/Alaska Native, and Native Hawaiian communities.³

Amid growing calls for racial justice, medical students and others demanded curricular changes to address racism’s role in health disparities. Recognizing this gap in our curriculum, we created a QR code walking tour across our medical school campus. The goal was to make information about racism in medicine more accessible and engaging. By using QR codes, we aimed to increase awareness of historical and structural racism in medicine while capturing engagement through the number of scans.

Methods

Development

This project was deemed exempt by the institutional review board (IRB 0065-22-EX).

A QR code (quick response code, figure 1) is a type of barcode that smartphones can scan to access text, websites, images, or videos. In medical education, QR codes have been used in poster presentations, lecture slides, and interactive learning tools.

We placed QR codes at 27 locations (figure 2) across the medical campus, chosen in collaboration with faculty, the Office of Diversity, Equity, and Inclusion, and hospital administrators.

Figure 1

Figure 2

Each QR code linked to media content—videos, articles, interviews, quizzes, and e-modules—highlighting racial inequities in research, education, and health care.

Tables

Table 1. University campus location and health equity information link

Departmental diversity, equity, and inclusion (DEI) teams offered suggestions about which issues to highlight within their specialties that affect racial and health equity. For example, the pulmonology QR code linked to discussions about race-based adjustments in spirometry; the pathology QR code featured the story of Henrietta Lacks and HeLa cells; and the admissions office QR code provided data on underrepresented minorities in medicine.

To maximize engagement, QR codes were placed in clerkship areas where third-year medical students rotate. They were located in visible areas near departmental signage and outside badge-access doors, ensuring access to faculty, students, and staff at all times.

Upon scanning a QR code, users had the option to complete a pre-survey that collected:

1. Demographic information
2. Self-reported knowledge of institutional racism in medicine
3. Attitudes toward providing care for racial minorities
4. Prior involvement in caring for racial minority populations

A follow-up survey was sent 6 months after a user’s initial scan to reassess these areas. Users could opt in to receive the follow-up via their mobile phone number.

Results

The QR codes launched in April 2022 and remain active. As of this writing, we have recorded:

• 1300 total clicks
• 937 unique clicks
• 361 unique visitors
• All 27 codes were scanned at least once

The most frequently scanned QR codes were for family medicine, transgender health, and obstetrics/gynecology.

Figure 3

A total of 103 users completed the pre-survey, but only 7 completed the 6-month follow-up, limiting our ability to assess long-term changes in knowledge, attitudes, or behavior. The majority of respondents were students aged 19 to 29 years. The QR codes captured engagement from a racially diverse participant pool.

Additionally, the QR code walking tour was incorporated into the Summer Health Professions Education Program (SHPEP) curriculum in 2022. The Office of Medical Education used the tour as an orientation activity to help students explore the campus while learning about racism in medicine.

Table 2

Table 2. Demographics

Conclusion

Medical educators must recognize and address racism to create a health care system that serves all patients equitably. Our project offered a curated set of resources—some newly developed, others preexisting—to engage learners in understanding racism’s impact in medicine. The QR codes, developed through cross-departmental collaboration, highlighted efforts within various specialties to reduce racial disparities—from dermatology’s skin-of-color clinic to updated kidney function measurements and initiatives to increase colorectal cancer screening among Black communities.

The QR codes received more than 1000 clicks, primarily from students, demonstrating strong interest and engagement. Many students found the tour valuable, though some noted challenges with the walking aspect and suggested group discussions to accompany the material.

As DEI efforts face headwinds across institutions, our QR codes serve as a lasting, visible tool for education. They offer a scalable and accessible way to address racism in medicine, even as broader institutional initiatives encounter uncertainty.

References

1. Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academies Press; 2003.
2. Office of Minority Health. Black/African American—The Office of Minority Health. Published August 22, 2019. Accessed June 19, 2025. https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=61
3. Tai DBG, Sia IG, Doubeni CA, Wieland ML. Disproportionate impact of COVID-19 on racial and ethnic minority groups in the United States: a 2021 update. J Racial Ethn Health Disparities. 2022;9(6):2334-2339. doi:10.1007/s40615-021-01170-w

Acknowledgements

Special thanks to our allies: UNMC Office of Medical Education and supporting grant, Department Chairs, Departmental DEI teams (Dr Ly, Dr Amoura, Dr Marcelin), Dr Strong, Dr Delair, Dr Fadul, E-learning lab, Facilities Mandy Ottenberg, Graphic Design Tom Waples, Ellen Jeffries web design, Chris Christen, Dr Gordon, Dr Khandalavala and Dr Geske.