Teaching about health care disparities in the clinical setting

Health Disparity Curricula for Ophthalmology Residents: Current Landscape, Barriers, and Needs

Background  Social determinants of health play a critical role in visual health outcomes. Yet, there exists no structured curriculum for ophthalmology residents to identify and address health disparities relevant to eye care or no a standard assessment of health disparities education within ophthalmology residency programs. This study aims to characterize current health disparity curricula in ophthalmology residency programs in the United States, determine resident confidence in addressing health disparities in the clinical setting, and identify perceived barriers and needs of program directors (PDs) and residents in this area. Design  This was a cross-sectional survey study. Methods  A closed-ended questionnaire with comments was distributed to the Accreditation Council for Graduate Medical Education-accredited ophthalmology residency PDs and residents in April 2021 and May 2022. The questionnaire solicited characteristics of any existing health disparity curricula, PD and resident perceptions of these curricula, and residents' experience with and confidence in addressing health disparities in the delivery of patient care. Results  In total, 29 PDs and 96 residents responded. Sixty-six percent of PDs stated their program had a formal curriculum compared to fifty-three percent of residents. Forty-one percent of PDs and forty-one percent of residents stated their program places residents in underserved care settings for more than 50% of their training. Most residents (72%) were confident in recognizing health disparities. Sixty-six percent were confident in managing care in the face of disparities and fifty-nine percent felt they know how to utilize available resources. Residents were most concerned with the lack of access to resources to help patients. Forty-five percent of PDs felt the amount of time dedicated to health disparities education was adequate. Forty-nine percent of residents reported they felt the amount of training they received on health disparities to be adequate. The top barrier to curriculum development identified by PDs was the availability of trained faculty to teach. Time in the curriculum was a major barrier identified by residents. Conclusions  Roughly half of ophthalmology residency programs who responded had a health disparity curriculum; however, both PDs and residents felt inadequate time is dedicated to such education. National guidance on structured health disparity curricula for ophthalmology residents may be warranted as a next step.

Assessment of Training in Health Disparities in US Internal Medicine Residency Programs

IMPORTANCE

Health disparities continue to exist despite the call to increase education of health care practitioners. An assessment of health disparities education has not been previously studied in a national cohort.

OBJECTIVE

To describe and compare the curriculum on health disparities from the perspective of program directors and perceptions of training among internal medicine residents.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional survey study used a survey of US internal medicine program directors, the 2015 Association of Program Directors in Internal Medicine annual survey, which included questions about health disparities curriculum, and a 1-time survey of US internal medicine residents that asked questions related to their training in health disparities on the American College of Physicians 2015 Internal Medicine In-Training Examination. All internal medicine program directors who were members of Association of Program Directors in Internal Medicine (368 of 396 accredited programs), and internal medicine residents who took the Internal Medicine In-Training Examination were eligible. Final analysis of the merged data set was completed in 2018.

EXPOSURES

Questions were included on the annual Association of Program Directors in Internal Medicine survey and the Internal Medicine In-Training Examination.

MAIN OUTCOMES AND MEASURES

Program directors reported on presence of health disparities curriculum, educational methods, quality, barriers and challenges to curriculum, and Clinical Learning Environment Review. Residents reported whether they received training and quality of the training in health disparities.

RESULTS

A total of 227 program directors (response rate, 61.7%) and 22 723 residents (response rate, 87.2%) responded to the surveys. A total of 90 program directors (39.6%) reported a curriculum in health disparities, but among these, only 16 program directors (17.8%) felt quality of their education was very good or excellent. In more than half of the programs (52 programs [55.9%]), outcomes of the curriculum were not measured. After merging, the combined data set included 18 883 residents from 366 APDIM member programs with 225 program director responses. Among these, 13 251 residents (70.2%) reported some training in caring for patients at risk for health disparities. Of residents who reported receiving training, 10 494 (79.2%) rated the quality as very good or excellent.

CONCLUSIONS AND RELEVANCE

These findings suggest that that despite the Clinical Learning Environment Review mandate and Accreditation Council for Graduate Medical Education required competencies for training in health disparities, relatively few internal medicine programs in the US provided educational curriculum. Additionally, the existence of health disparities curricula in internal medicine training programs was not associated with resident's perception of training or its quality.

A Comparative Multimetric Assessment of English and Spanish Carpal Tunnel Syndrome Materials

BACKGROUND

Spanish-speaking Hispanics living in the United States utilize the internet as a primary means to obtain health information. Accurate, accessible information is important for English speakers; however, it could have even greater utility for Spanish speakers who have lower health literacy levels. The aim of this study was to evaluate and compare online English and Spanish carpal tunnel surgery materials provided by using a multimetric approach.

MATERIALS AND METHODS

A web search using the English term "carpal tunnel surgery" was performed. The first 10 institutional/organizational websites that provided carpal tunnel surgery information in English and Spanish were included. All relevant online materials were evaluated using the Patient Education and Materials Assessment Tool (PEMAT), Cultural Sensitivity Assessment Tool (CSAT), and Simplified Measure of Gobbledygook, Spanish (SOL) to assess understandability and actionability, cultural sensitivity, and readability, respectively.

RESULTS

There were no statistically significant differences in understandability or actionability scores between Spanish and English materials. Average cultural sensitivity scores for Spanish materials were significantly lower than English materials (P = 0.015). The average reading grade level of online English materials was greater than that for Spanish materials (P = 0.011). Both mean values were above the recommended sixth-grade reading level.

CONCLUSIONS

Online patient-directed information regarding carpal tunnel surgery exceeded the recommended reading grade level for both English and Spanish-speaking populations. Most Spanish materials were often direct translations and were not contoured to the elevated literacy needs of this demographic. Institutions must caution their authors to tailor their web material in a way that is sensitive to their target population to optimize understanding.

Taking Advantage of the Teachable Moment: A Review of Learner-Centered Clinical Teaching Models

When working in a chaotic Emergency Department (ED) with competing priorities, clinical teaching may be sacrificed for the sake of patient flow and throughput. An organized, efficient approach to clinical teaching helps focus teaching on what the learner needs at that moment, incorporates regular feedback, keeps the department on track, and prevents over-teaching. Effective clinical teaching in a busy environment is an important skill for senior residents and faculty to develop. This review will provide a critique and comparison of seven structured teaching models to better prepare readers to seize the teachable moment.

An Examination of Cultural Competence Training in US Medical Education Guided by the Tool for Assessing Cultural Competence Training

In the United States, medical students must demonstrate a standard level of "cultural competence," upon graduation. Cultural competence is most often defined as a set of congruent behaviors, attitudes, and policies that come together in a system, organization, or among professionals that enables effective work in cross-cultural situations. The Association of American Medical Colleges developed the Tool for Assessing Cultural Competence Training (TACCT) to assist schools in developing and evaluating cultural competence curricula to meet these requirements. This review uses the TACCT as a guideline to describe and assess pedagogical approaches to cultural competence training in US medical education and identify content gaps and opportunities for curriculum improvement. A total of 18 programs are assessed. Findings support previous research that cultural competence training can improve the knowledge, attitudes, and skills of medical trainees. However, wide variation in the conceptualization, implementation, and evaluation of cultural competence training programs exists, leading to differences in training quality and outcomes. More research is needed to establish optimal approaches to implementing and evaluating cultural competence training that incorporate cultural humility, the social determinants of health, and broader structural competency within the medical system.

Case writing as a vehicle for promoting cultural competency: a retrospective, descriptive qualitative analysis

BACKGROUND

A variety of approaches are available that provide cultural competency education for practicing physicians. There is, however, still a need for additional, innovative approaches that address continuing education and professional improvement regarding cultural competency for physicians after their training.

OBJECTIVE

To assess the potential impact on established clinicians of writing an extended case narrative on cultural competency.

METHODS

We conducted structured interviews of physician contributors (n = 14) to a book of cases on cultural competency. Authors were invited to contribute to the book based on their experiences as established clinicians, and previous expertise in cultural competency research or education was not required. Because of this, the editors employed a process in which they worked with contributors in a one-on-one manner to develop their case(s).

RESULTS

The participants were experienced physicians (all > 10 years since medical school graduation), most of whom were white (64%) and affiliated with an academic medical center (86%). The majority of the contributors (1) reported that writing their case(s) increased their awareness of, and sensitivity to, issues of cultural competency; (2) indicated that the writing of their case(s) changed their approach to patient care and/ or their education of medical students or graduate medical trainees; and (3) would recommend case writing as a vehicle for promoting cultural sensitivity and awareness.

CONCLUSIONS

Although preliminary, these data suggest that the cultural awareness, sensitivity, and competence of established physicians might be enhanced by a process in which clinicians are facilitated in the writing of cases that address issues of culture that are pertinent to their practice and patient experiences.