Addressing health disparities in the undergraduate curriculum: an approach to develop a knowledgeable biomedical workforce

Grow502: Centering Community in Medical Education via a Student-Created Organization Focused on Cultivating a Healthy Community

The COVID-19 pandemic continues to disproportionately impact communities of color and expose health inequities. Minoritized communities experience disparities in chronic diseases, premature death, and cancer, and gaps continue to widen; systemic injustice in housing, nutrition, and environment are major contributors. At the height of the COVID-19 pandemic and racial justice movement, students at the University of Louisville School of Medicine created Grow502 to speak truth to the challenges of health disparities in Louisville, Kentucky. The goal was to pursue a healthier community by raising awareness. Community leaders and health professionals provided expert consultation. This partnership led to the co-creation of a curriculum focused on education, advocacy, community engagement, and creative media. Grow502 sought to support communities impacted by injustices due to racism, limited health literacy, redlining, and limited green space by creating programming centered on education and empowerment. Effective strategies to reduce disparities involve creating interventions with authentic engagement and context. Grow502 involves community stakeholders as active partners. We continue to intentionally seek effective collaborations and interventions that merge our mission and our diverse communities impacted by health disparities.

Evaluation of AIML + HDR-A Course to Enhance Data Science Workforce Capacity for Hispanic Biomedical Researchers

Artificial intelligence (AI) and machine learning (ML) facilitate the creation of revolutionary medical techniques. Unfortunately, biases in current AI and ML approaches are perpetuating minority health inequity. One of the strategies to solve this problem is training a diverse workforce. For this reason, we created the course "Artificial Intelligence and Machine Learning applied to Health Disparities Research (AIML + HDR)" which applied general Data Science (DS) approaches to health disparities research with an emphasis on Hispanic populations. Some technical topics covered included the Jupyter Notebook Framework, coding with R and Python to manipulate data, and ML libraries to create predictive models. Some health disparities topics covered included Electronic Health Records, Social Determinants of Health, and Bias in Data. As a result, the course was taught to 34 selected Hispanic participants and evaluated by a survey on a Likert scale (0-4). The surveys showed high satisfaction (more than 80% of participants agreed) regarding the course organization, activities, and covered topics. The students strongly agreed that the activities were relevant to the course and promoted their learning (3.71 ± 0.21). The students strongly agreed that the course was helpful for their professional development (3.76 ± 0.18). The open question was quantitatively analyzed and showed that seventy-five percent of the comments received from the participants confirmed their great satisfaction.

Public Engagement with Biotechnology Inside and Outside the Classroom: Community-Focused Approaches

Biotechnology offers vast benefits to the environment, animals, and human health, and contributes to improving socioeconomic conditions for the public. However, biotechnology innovations continue to trigger public concern and opposition over their potential social, health, and ecological risks. There is an opportunity to increase knowledge and acceptance of biotechnology through engagement, education, and community participation. In this perspective, we highlight crucial factors that shape the public perception of biotechnology and present opportunities for scientists to effectively communicate their ideas while engaging with local and global communities. Initiatives that seek to involve communities in design, development, and adoption processes are crucial for the successful implementation of biotechnology-based solutions.

Engineering Solutions to COVID-19 and Racial and Ethnic Health Disparities

The role of engineers in response to the COVID-19 pandemic and in the elimination of health disparities, while not always visible, has important implications for the attainment of impactful solutions. The design skills, systems approach, and innovative mindset that engineers bring all have the potential to combat crises in novel and impactful ways. When a disparities lens is applied, a lens that views gaps in access, resources, and care, the engineering solutions are bound to be more robust and equitable. The disproportionate impact of COVID-19 on the Black community and other communities of color is linked to inequities in health rooted in a centuries long structural racism. Engineers working collaboratively with physicians and healthcare providers are poised to close equity gaps and strengthen the collective response to COVID-19 and future pandemics.

Naming racism in the public health classroom

OBJECTIVE

The discussion of racism within undergraduate public health classrooms can be highly influenced by local and national conversations about race. We explored the impact of local and national events on students' ability to name racism on a public health exam highlighting the impact of racism on maternal and infant health disparities for Black mothers.

METHODS

We undertook this research within the context of an undergraduate introductory public health course at a primarily white institution in the Northeastern part of the United States. A qualitative content analysis of undergraduate student responses to a final exam question soliciting the importance of racism to health outcomes among Black mothers in the United States was undertaken. ANOVA tests were run to assess differences on naming racism, using semantic alternatives, and providing alternative explanations during three main time periods: prior to the election of the 45th president of the United States (pre-Trump), after the election (post-Trump), and after a nationally recognized racist campus incident.

RESULTS

Between the pre- and post-Trump periods we see no differences in naming racism or providing alternative explanations. We do see a reduction in the proportion of students providing semantic alternatives for racism in the post-Trump period (32.2 vs. 25.2%, p = 0.034). After the racist campus incident, we see increases in the proportion of students naming race (53.6 vs. 73.8%, p = 0.021) and decreases in the proportion providing an alternative explanation (43.1 vs. 12.9%, p = 0.004), but no differences in the proportion of students who used semantic alternatives.

DISCUSSION

This work lends itself to our understanding of how local climate affects public health teaching and may also influence students' learning about important social and structural determinants of health. National and local climate should frame and guide public health teaching.

A Peer-Led Social Media Intervention to Improve Interest in Research Careers Among Urban Youth: Mixed Methods Study

BACKGROUND

Novel methods to boost interest in scientific research careers among minority youth are largely unexplored. Social media offers a unique avenue toward influencing teen behavior and attitudes, and can therefore be utilized to stimulate interest in clinical research.

OBJECTIVE

The aim of this study was to engage high-achieving minority youth enrolled in a science pipeline program to develop a targeted social media marketing campaign for boosting interest in clinical research careers among their peers.

METHODS

Students enrolled in the Training Early Achievers for Careers in Health program conducted focus groups in their communities to inform themes that best promote clinical research. They then scripted, storyboarded, and filmed a short video to share on social media with a campaign hashtag. Additionally, each student enrolled peers from their social circle to be subjects of the study. Subjects were sent a Career Orientation Survey at baseline to assess preliminary interest in clinical research careers and again after the campaign to assess how they saw the video, their perceptions of the video, and interest in clinical research careers after watching the video. Subjects who did not see the video through the online campaign were invited to watch the video via a link on the postsurvey. Interest change scores were calculated using differences in Likert-scale responses to the question "how interested are you in a career in clinical research?" An ordinal logistic regression model was used to test the association between watching a peer-shared video, perception of entertainment, and interest change score controlling for underrepresented minorities in medicine status (Black, American Indian/Alaska Native, Native Hawaiian, or Pacific Islander), gender, and baseline interest in medical or clinical research careers.

RESULTS

From 2014 to 2017, 325 subjects were enrolled as part of 4 distinct campaigns: #WhereScienceMeetsReality, #RedefiningResearch, #DoYourResearch, and #LifeWithoutResearch. Over half (n=180) of the subjects watched the video via the campaign, 227/295 (76.9%) found the video entertaining, and 92/325 (28.3%) demonstrated baseline interest in clinical research. The ordinal logistic regression model showed that subjects who viewed the video from a peer (odds ratio [OR] 1.56, 95% CI 1.00-2.44, P=.05) or found the video entertaining (OR 1.36, 95% CI 1.01-1.82, P=.04) had greater odds of increasing interest in a clinical research career. Subjects with a higher baseline interest in medicine (OR 1.55, 95% CI 1.28-1.87, P<.001) also had greater odds of increasing their interest in clinical research.

CONCLUSIONS

The spread of authentic and relevant peer-created messages via social media can increase interest in clinical research careers among diverse teens. Peer-driven social media campaigns should be explored as a way to effectively recruit minority youth into scientific research careers.

Teaching a Health Equity Course at a Midwestern Private University—A Pilot Study

Teaching about health disparities and health equity at a 4-year institution is imperative. Unfortunately, there is a lack of empirical research demonstrating this concept and the proper way to develop a course. As a result, this research attempted to assess the effectiveness of developing and teaching this course centered on the social determinants of health (SDH). Using a 30-question Attribution of Health Disparities Assessment, data were collected on students’ attitudes and beliefs about the relevancy of these two concepts before and after they took the health equity course. All participants ( n = 42) were seniors, 80% self-identify as Caucasian and 66% were female. Overall, there was a statistically significant change in attitudes and beliefs about health disparities and the relevancy of these issues. It appears that in the eyes of the students, the SDH are more relevant and related to these issues than a person’s individual responsibility. As a result, the relevancy of many of the SDH discussed in class had a profound effect on the students who took this course as indicated by their statistically significant change. Finally, our research demonstrates how a health equity course could be taught to effectively change undergraduate students’ views on issues related to the SDH.

Engagement of Urban, Pregnant Puerto Rican Women in Health Disparities Research

Persistent challenges surround the recruitment of minority women from marginalized communities in health disparities research. These challenges include lack of the following: interest in research participation, trust, positive relationships between researchers and participants/community, and principal investigators from minority groups. The purpose of this article is to describe successful recruitment strategies used in health disparities research with pregnant Puerto Rican women and to suggest ways to ensure the future success of studies on health disparities. Suggested strategies include creating trust, facilitating active participation of stakeholders, and strengthening the research pipeline with undergraduate and graduate nursing students.

Building Global Health Capacity at a Minority-Serving Institution in the Bronx: The Potential Role of PhotoVoice and the Geo-Social Pathway Framework in This Endeavor

Global health training programs for undergraduate students are expanding in the United States, which includes Minority-Serving Institutions (MSIs), but capacity building is needed at MSIs to develop career pathways into the field, especially for those institutions that serve low-income students who live in communities with high health disparities. Often, global health pathways begin by building a global lens through the examination of local health issues coupled with international educational experiences. This approach is limited for students who come from low-income settings with limited funding for international experiences, and as a result, may not see the feasibility of a global health career. However, there may be opportunity in harnessing student motivations and participatory research methods to build interest in a global health career. This article outlines the course, Fundamentals of Global Health, offered at a public MSI in the Bronx. The course was grounded in the Geo-Social Pathway Framework and utilized PhotoVoice to engage students in individual research projects. A constant comparison method was used to analyze papers, photos, reflections, and presentations in order to identify themes. Analysis of course materials submitted by students suggests that they were motivated to examine health disparities using PhotoVoice and that they focused their research projects on their family and community health disparities, or aligned with educational or professional goals to address their community health needs. This course model may inform future training in global health for students at MSIs, but community-based participatory research priority funding is needed to sustain global health at these key institutions.

Engaging Biomedical Engineering in Health Disparities Challenges

Health Disparities (HD) are community-based, biomedical challenges in need of innovative contributions from Science, Technology, Engineering and Math (STEM) fields. Surprisingly, STEM professionals demonstrate a persistent lack of HD awareness and/or engagement in both research and educational activities. This project introduced Health Disparities (HD) as technical challenges to incoming undergraduates in order to elevate engineering awareness of HD. The objective was to advance STEM-based, HD literacy and outreach to young cohorts of engineers. Engineering students were introduced to HD challenges in technical and societal contexts as part of Engineering 101 courses. Findings demonstrate that student comprehension of HD challenges increased via joint study of rising health care costs, engineering ethics and growth of biomedical-related engineering areas.

An Approach to Integrating Health Disparities within Undergraduate Biomedical Engineering Education

Health disparities are preventable differences in the incidence, prevalence and burden of disease among communities targeted by gender, geographic location, ethnicity and/or socio-economic status. While biomedical research has identified partial origin(s) of divergent burden and impact of disease, the innovation needed to eradicate health disparities in the United States requires unique engagement from biomedical engineers. Increasing awareness of the prevalence and consequences of health disparities is particularly attractive to today's undergraduates, who have undauntedly challenged paradigms believed to foster inequality. Here, the Department of Biomedical Engineering at The City College of New York (CCNY) has leveraged its historical mission of access-and-excellence to integrate the study of health disparities into undergraduate BME curricula. This article describes our novel approach in a multiyear study that: (i) Integrated health disparities modules at all levels of the required undergraduate BME curriculum; (ii) Developed opportunities to include impacts of health disparities into undergraduate BME research projects and mentored High School summer STEM training; and (iii) Established health disparities-based challenges as BME capstone design and/or independent entrepreneurship projects. Results illustrate the rising awareness of health disparities among the youngest BMEs-to-be, as well as abundant undergraduate desire to integrate health disparities within BME education and training.

Using a structural competency framework to teach structural racism in pre-health education

The inclusion of structural competency training in pre-health undergraduate programs may offer significant benefits to future healthcare professionals. This paper presents the results of a comparative study of an interdisciplinary pre-health curriculum based in structural competency with a traditional premedical curriculum. The authors describe the interdisciplinary pre-health curriculum, titled Medicine, Health, and Society (MHS) at Vanderbilt University. The authors then use a new survey tool, the Structural Foundations of Health Survey, to evaluate structural skills and sensibilities. The analysis compares MHS majors (n = 185) with premed science majors (n = 63) and first-semester freshmen (n = 91), with particular attention to understanding how structural factors shape health. Research was conducted from August 2015 to December 2016. Results suggest that MHS majors identified and analyzed relationships between structural factors and health outcomes at higher rates and in deeper ways than did premed science majors and freshmen, and also demonstrated higher understanding of structural and implicit racism and health disparities. The skills that MHS students exhibited represent proficiencies increasingly stressed by the MCAT, the AAMC, and other educational bodies that emphasize how contextual factors shape expressions of health and illness.