A study recently published in the Journal of the American Medical Association points to a significant opportunity to improve health disparities training provided to medical residents in U.S. internal medicine programs.
Researchers from Mayo Clinic and other academic medical centers examined a data set that merged two national survey samples from 2015: internal medicine program director and internal medicine residents. They found that, despite mandates from governing bodies in medical education, only 40% of residencies provide health disparities curricula. In addition, they found that resident perceptions of training and its quality were not associated with the existence of an actual curriculum.
Why such a big disconnect?
Denise Dupras, M.D., Ph.D., first author, says competing curricular priorities are a major barrier, as is the expertise to teach this topic. In addition, she says, “most program directors did not have the data about the diversity of the patients they serve, so customizing the education to best meet the needs of their local population is not possible for most of them.”
Mark Wieland, M.D., a co-author and a health disparities researcher at Mayo Clinic, adds that limited time to devote to teaching about health disparities “may prevent the implementation of authentic community-engaged curricula,” which leaves “efficient but insufficient” didactic teaching as the only practical option.
According to the study, more than 70% of residents say they’ve received health disparities training and most would rate their training as either very good or excellent. The authors suggest that residents may receive much of that training on the job.
Residents tend to care for a larger proportion of underserved patients, observe the authors, providing an opportunity for meaningful learning at the point of care. However, without a formal curriculum in place, there is concern that residents “may overestimate acquisition of needed skills.”
The authors say it’s vital to offer robust health disparities curricula in medical education. “It’s an opportunity to be seized upon,” says Dr. Dupras.
“As physicians, we are interested in the health of our patients, not just their health care,” says Dr. Wieland. “Since social determinants of health and structural racism shape the health of our patients, it is important for physicians in training to understand these mechanisms so that we may help to systematically address them.”
Dr. Dupras says, “We need to move beyond a checkbox mentality of learning about generalities to teach cultural humility and instill a genuine curiosity about the patient in front of us and the factors that impact his or her health. We don’t treat white people, or Black people or gay people. We treat the entire person and need to consider all the things that make them unique.”
How should outcomes of this teaching be measured?
Dr. Dupras says, “While we can measure a resident’s knowledge, attitudes, and a patient’s satisfaction with their care, in the in the end the most important outcome remains quality of care and patient outcomes.”
Asked about Mayo Clinic’s current health disparities curricula, Dr. Dupras says, “This is a work in progress. We continue to introduce curricular elements and experiences outside of a formal curriculum to enhance residents’ exposure to our diverse patient populations.”
Dr. Wieland notes that Mayo Clinic is involved in a variety of initiatives designed to promote health equity and to enhance the diversity of Mayo’s student body and workforce.
“Mayo Clinic is leading a coalition that recently released a statement with an action plan on how to eliminate racism and promote health equity in workforce training,” says Dr. Wieland. “Medical education is an important platform for combating health disparities. Equity is achievable, in part, if we make it a core part of our mission as educators.”
Tags: Center for Health Equity and Community Engagement Research, Denise Dupras, Education, Findings, general internal medicine, health disparities, health equity, Mark Wieland, Mayo Clinic School of Graduate Medical Education