Innovative health care disparities curriculum for incoming medical students.
ABSTRACT 1) To pilot a health disparities curriculum for incoming first year medical students and evaluate changes in knowledge. 2) To help students become aware of personal biases regarding racial and ethnic minorities. 3) To inspire students to commit to serving indigent populations.
First year students participated in a 5-day elective course held before orientation week. The course used the curricular goals that had been developed by the Society of General Internal Medicine Health Disparities Task Force. Thirty-two faculty members from multiple institutions and different disciplinary backgrounds taught the course. Teaching modalities included didactic lectures, small group discussions, off-site expeditions to local free clinics, community hospitals and clinics, and student-led poster session workshops. The course was evaluated by pre-post surveys.
Sixty-four students (60% of matriculating class) participated. Survey response rates were 97-100%. Students' factual knowledge (76 to 89%, p < .0009) about health disparities and abilities to address disparities issues improved after the course. This curriculum received the highest rating of any course at the medical school (overall mean 4.9, 1 = poor, 5 = excellent).
This innovative course provided students an opportunity for learning and exploration of a comprehensive curriculum on health disparities at a critical formative time.
- SourceAvailable from: David J PaulJournal of Nurse Education and Practice. 08/2014; 4(10).
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ABSTRACT: The purpose of this article is to propose an elective social work course as a means of better preparing social workers entering practice in healthcare to meet the challenges of promoting health and reducing health disparities in minority and underserved communities. Course offerings specifically targeting health or medical social work training vary widely. The additional training provided at places of employment and through continuing education after the master's degree is often inadequate for competently addressing the issues clinicians face in practice.Journal of Teaching in Social Work 11/2012; 32(5):471-486.
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ABSTRACT: Background: The varying treatment of different patients by the same physician are referred to as within provider disparities. These differences can contribute to health disparities and are thought to be the result of implicit bias due to unintentional, unconscious assumptions. Purposes: The purpose is to describe an educational intervention addressing both health disparities and physician implicit bias and the results of a subsequent survey exploring medical students' attitudes and beliefs toward subconscious bias and health disparities. Methods: A single session within a larger required course was devoted to health disparities and the physician's potential to contribute to health disparities through implicit bias. Following the session the students were anonymously surveyed on their Implicit Association Test (IAT) results, their attitudes and experiences regarding the fairness of the health care system, and the potential impact of their own implicit bias. The students were categorized based on whether they disagreed ("deniers") or agreed ("accepters") with the statement "Unconscious bias might affect some of my clinical decisions or behaviors." Data analysis focused specifically on factors associated with this perspective. Results: The survey response rate was at least 69%. Of the responders, 22% were "deniers" and 77% were "accepters." Demographics between the two groups were not significantly different. Deniers were significantly more likely than accepters to report IAT results with implicit preferences toward self, to believe the IAT is invalid, and to believe that doctors and the health system provide equal care to all and were less likely to report having directly observed inequitable care. Conclusions: The recognition of bias cannot be taught in a single session. Our experience supports the value of teaching medical students to recognize their own implicit biases and develop skills to overcome them in each patient encounter, and in making this instruction part of the compulsory, longitudinal undergraduate medical curriculum.Teaching and Learning in Medicine 01/2014; 26(1):64-71. · 1.12 Impact Factor
ADDRESSING TEACHING AND TRAINING GAPS
Innovative Health Care Disparities Curriculum for Incoming
Monica B. Vela, MD1, Karen E. Kim, MD2, Hui Tang, MS, MS3, and Marshall H. Chin, MD, MPH1
1Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA;2Section of Gastroenterology,
Department of Medicine, University of Chicago, Chicago, IL, USA;3Center for Health and the Social Sciences, University of Chicago, Chicago,
PURPOSE: 1) To pilot a health disparities curriculum
for incoming first year medical students and evaluate
changes in knowledge. 2) To help students become
aware of personal biases regarding racial and ethnic
minorities. 3) To inspire students to commit to serving
METHODS: First year students participated in a 5-day
elective course held before orientation week. The course
used the curricular goals that had been developed by
the Society of General Internal Medicine Health Dispa-
rities Task Force. Thirty-two faculty members from
multiple institutions and different disciplinary back-
grounds taught the course. Teaching modalities includ-
ed didactic lectures, small group discussions, off-site
expeditions to local free clinics, community hospitals
and clinics, and student-led poster session workshops.
The course was evaluated by pre-post surveys.
RESULTS: Sixty-four students (60% of matriculating
class) participated. Survey response rates were 97–100%.
Students’ factual knowledge (76 to 89%, p<.0009) about
health disparities and abilities to address disparities
issues improved after the course. This curriculum re-
ceived the highest rating of any course at the medical
school (overall mean 4.9, 1 = poor, 5 = excellent).
CONCLUSIONS: This innovative course provided stu-
dents an opportunity for learning and exploration of a
comprehensive curriculum on health disparities at a
critical formative time.
KEY WORDS: health disparities; curriculum; education; medical
J Gen Intern Med 23(7):1028–32
© Society of General Internal Medicine 2008
Health care disparities in the quality of care and clinical out-
comes are important national problems, and there is a critical
need to develop innovative curricula to teach medical students
about these issues.1,2Key medical professional organizations
like the Institute of Medicine and educational accreditation
agencies, including the Accreditation Council for Graduate
Medical Education (ACGME) and the Liaison Committee on
Medical Education (LCME), recommend training for health care
professionals in the broad issues of health disparities.3–5
However, there is currently no consensus regarding the best
timing, setting or teaching modalities to effect changes in
attitudes, behaviors, and skills.6,7Moreover, the major training
focus has been on cultural competency, not the broader issue of
A systematic review of cultural competency education pro-
grams shows that they improve provider attitudes, knowledge,
and skills regarding cultural issues.8Unfortunately, cultural
competency programs have been criticized as lacking a com-
prehensive skill set, being limited in scope by not sufficiently
addressing important social, political, and economic factors
that contribute to health and health care disparities, and failing
to demonstrate improved health outcomes or diminished health
disparities.9,10The few existing evaluations of disparities
courses are limited by the small number of students participat-
ing,11or evaluation tools that measured significant changes in
attitudes but did not measure changes in knowledge or skills
regarding health disparities.12Therefore, we developed and
evaluated an elective course on health care disparities designed
to: 1) introduce incoming first year medical students to health
disparities issues and improve their knowledge, skills, and
attitudes, 2) help medical students to become aware of personal
biases regarding racial and ethnic minorities, 3) inspire medical
students to make a commitment to serve indigent popula-
tions.13,14This paper describes the course and analyzes
changes in knowledge.
Overview. The course “Health Care Disparities in America” was
offeredto all matriculating students to the University of Chicago
Pritzker School of Medicine. The course was an intensive 5-day
elective course the week before orientation week. Course
requirements included presence at all lectures, small group
discussions, and community site visits, as well as active
participation in discussion. Recommended readings were
provided in a syllabus and teams of students were required to
makea posteron 1of 5healthdisparity topics. Allgrades during
the first 2 years are pass/fail.
Goals. We incorporated the goals that the Society of General
Internal Medicine (SGIM) Health Disparities Task Force developed
for courses on health disparities15: 1) learners should gain
knowledge of the existence and magnitude of health disparities,
including the multifactorial etiology of health disparities and the
multiple solutions required to eliminate them, 2) learners should
bias and stereotyping that practitioners or patients or both may
bring to the clinical encounter, 3) learners should acquire the
skills to effectively communicate and negotiate across cultures,
including trust-building and timely utilization of culturally
appropriate interpreter services, and 4) learners should develop
a commitment to reduce health disparities, particularly those
caused by disparate health care.
Teaching Methods. Several teaching modalities were employed:
didactic lectures lasting 50–60 minutes, 20-minute lectures on
specific diseases important in Chicago’s South Side com-
munity, small group discussions led by 2 faculty members,
and poster session workshops led by the resident teachers that
utilized a teach back method designed to help students
recognize their roles in teaching others about health dispa-
rities. Students had onsite access to the internet and Medline
throughout the course.
The course primarily took place at the University of Chicago.
However, 3 of the 5 afternoons were spent off site. Students
traveled via buses to the University of Chicago Emergency
Room, Stroger (formerly Cook County) Hospital, and local
community health centers. At each site, the students were
greeted by physicians who provided a tour of the facilities and
described the patient population they serve, insurance pat-
terns, resources, and specific needs.
and different disciplinary backgrounds participated. Half were
women. Over a third were African American or Latina.
Table 1. Course Topics Stratified by Goals and Teaching Modalities
Goal 1. Learn
Magnitude of Health
Goal 2. Examine and
Understand Mistrust, Bias,
Goal 3. Improve
Goal 4. Develop Commitment
to Reduce Health Disparities
Lecture1.Overview of Health
1. Race and Ethnicity 1. Cultural Efficacy 1. Community Physicians Describe
2. Role of Free Clinics
3. Hospital Roles in Reducing
Health Disparities: Community
Affairs Office. Describes Its
Mission, Resources and Limitations
4. Medical Students as Leaders:
Medical Students Describe Their
Roles and Impact on the Community
2. Racial/Ethnic Biases
3. Tuskegee Experiment
2. Health Literacy
3. Language Barriers/
4. Breast Cancer4. Latino Health 4. Social Worker Roles
5. Asian American Health
6. Immigrant Populations
7. Women and Children
8. Lesbian, Gay, Bisexual,
‘First Thought’ Exercise
1. Language Barrier Role
Academic Faculty, Community
Physicians, Researchers and
Administrators Share Personal
Stories, and Provide Inspiration
2. Role of Patient–Doctor
Vs. Psychosocial Model
1. Populations at RiskAfrican American
Potential Solutions to Health
2. Access to Health
Care on the South Side
3. History of Medicare
1. Understand Access
2. University of
3. Cook County Stroger
4. Local Community
View Health Care Delivery On Site at:
1. The University of Chicago
2. Cook County Stroger Public
3. Local Community Clinics
* First Thought exercise description: students privately listed the first words that came to their minds when they heard the words “physician” and
“welfare recipient.” The results were tallied and shared with the class for comments on potential biases.
Vela et al.: Disparities Curriculum for Incoming Medical Students
Course Content. Table 1 shows how different educational
modalities addressed each course goal.
Resources. Course director Dr. Vela’s time (0.125 full-time
equivalent × 4 months) and the posters ($500) were funded by
the Department of Medicine. The Office of Medical Education
funded buses for site visits ($2,500).
This study was exempted by the University of Chicago
Institutional Review Board.
Pre-Course Survey. The anonymous numbered pre-course
survey was comprised of several parts. Part one required the
students to rate their own ability to describe health disparities
and potential solutions, Chicago’s patient population, the
history of health care for African Americans, and which
populations are at high risk for common illnesses. The
students were asked to rate their abilities using a quantitative
scale of poor, fair, good, very good, or excellent. Part 2 assessed
knowledge and asked the students 13 true/false questions on
cultural competency, health literacy, Medicare and Medicaid,
Table 2. Student Knowledge of Health Disparities
Factual Knowledge of Health Disparities (%)*
Pre-course N=62 Post-course N=64
1. Physicians should attempt to ignore their own cultural background and biases when
delivering health care to patients. (F)
2. If all patients are offered the same amount and type of medical care in exactly the same
way and time, gender and cultural issues should not impact outcome. (F)
3. The Tuskegee Experiment was conducted to treat adult African Americans suffering
from syphilis. (F)
4. Research has found different referral patterns for treatment by physicians based
on the patient’s race and gender. (T)
5. From 1997 to 2001, the proportion of physicians serving Medicaid patients steadily
6. Certain racial/ethnic groups may have variable responses to medications. (T)
7. If you are poor, then you qualify for Medicaid insurance. (F)
8. About 50% of adult US citizens have deficient reading skills (functionally illiterate or
have marginal reading skills). (T)
9. Young children within a non-English patient’s family should be used as interpreters as
they are an excellent resource to diminish language barriers. (F)
10. Although Americans are healthier today, the gaps between minority and white groups
remain nearly the same as they did a decade ago. (T)
11. Patient satisfaction tends to be higher if the patient and provider come from the same
racial or ethnic background. (T)
12. Even after adjustment for insurance status and income racial and ethnic minorities
tend to have lower-quality health care than non-minorities. (T)
13. 15–20% of the US population cannot afford access to health providers. (T)
Average correct answers
*F false, T true
Table 3. Ability to Describe Health Disparities Issues*
Rate your present ability to describe:1strow: Pre-course(%), N=62
2ndrow: Post-course(%), N=64
Poor/Fair Good Very Good/Excellent
The hospitals, community health centers, and free clinics in Chicago
that serve poor patients and racial and ethnic minorities.
The history of health care for African Americans in the United States
31The causes of health disparities in America<.001
Potential solutions to health disparities in America 21
Which populations are at risk for hypertension, diabetes and HIV<.001
*Scale: “Poor, Fair, Good, Very Good, Excellent”
Vela et al.: Disparities Curriculum for Incoming Medical Students
racial and ethnic disparities, language barriers and use of
interpreters, historical discrimination issues, and trends in
disparities. Part 3 asked a series of demographic questions
including race, ethnicity, age, and gender.
Post-Course Survey. The students completed an anonymous
numbered post-course survey. Parts 1 through 3 were
identical to the pre-course survey. The students also filled out
the medical school’s standard course evaluation form.
Data Analysis. We performed analyses to describe student
characteristics as well as their changes in knowledge and
abilities to work with diverse populations. We used tests on the
equality of proportion to compare the proportion of correct
answers for students’ pre- and post-course knowledge, as well
as Pearson chi-square test to compare students’ pre and post
course responses to their abilities to describe health care
disparities issues. All testing was performed in STATA 9.2 at a
two sided significance level of p<.05.
The pre- and post-course survey response rates were 97% and
Sixty-four (60%) of 104 incoming first year students elected to
participate in the course. About 50% were women, 10% were
Hispanic, and 5% were African American. Nearly 20% of
students had received or knew someone who had received
inferior care because of disparities in health, and over 90%
recalled reading or hearing about health disparities before the
course. A survey (response rate 53%) of the students who did
not take the course revealed no significant demographic
differences compared with course participants.
Student Knowledge About Health Care Disparities
Overall students’ factual knowledge (76 to 89%, p<.0009)
about health disparities and abilities to address disparities
issues improved after the course (Tables 2 and 3).
Summary Course Evaluation
This course received the highest ratings in the entire curricu-
lum. On a 5-point scale where 5 is the best, the mean+SD
ratings for 3 key summary questions were: “The course met its
objectives.” (4.8+0.40); “I would recommend this course to my
peers.” (4.9+0.25); “Overall, this course was a valuable learning
Our health disparities curriculum for incoming medical stu-
dents improved their knowledge. The timing of the course
before the start of medical school rather than during the school
year allowed students to learn the content with fewer compet-
ing demands on the students’ time and attention.
interested and motivated students might have favorably skewed
our results. Second, we did not use a preexisting psychometri-
our purposes. Third, many of the questions were the same in
both pre- and post-course surveys, and thus students’ post-
course responses may have been influenced by their earlier
exposure to the questions. Fourth, longer follow-up of both
participating and non-participating students will be needed to
determine impact on student behavior. Nonetheless, our course
is innovative in that it is the first health disparities course for
medical students incorporating the SGIM Health Disparities
Task Forcegoals,15ituseda varietyofteachingmodalities,andit
occurred early in students’ medical school careers.
The University of Chicago is now requiring this course for all
first year medical students in the week immediately after
orientation. Future plans include increasing patient contact
by offering the course after students have completed HIPAA
training, devoting more time to reflection and discussion, and
reducing the number of lectures. We plan to create electives on
health disparities for upperclassmen.
This study supports the adoption of the curriculum goals
established by the SGIM Health Disparities Task Force.15
Future research should focus on the prevalence and evalua-
tion of other existing health disparities courses, adaptability of
this curriculum to other medical schools, and its implementa-
tion as a required course.
Acknowledgments: This study was supported by the Department
of Medicine, University of Chicago, the Office of Medical Education at
the Pritzker School of Medicine, University of Chicago, and the
National Institute of Diabetes and Digestive and Kidney Diseases
Diabetes Research and Training Center (P60 DK20595). Dr. Chin is
supported by a Midcareer Investigator Award in Patient-oriented
Research from the National Institute of Diabetes and Digestive and
Kidney Diseases (K24 DK071933).
This paper was presented in part at the 2007 Society of General
Internal Medicine Annual Meeting, Toronto, Ontario, and the 2007
Association of American Medical Colleges Annual Meeting, Washing-
The authors would like to thank Dean Holly Humphrey and the
staff at the University of Chicago Pritzker School of Medicine for their
generosity and active support in accommodating this course into the
medical school curriculum. We would like to thank Dr. Joe G.N.
Garcia, Chairman of Medicine at the University of Chicago for his
mentorship, leadership, and support in the development and imple-
mentation of this course. This course would not have been successful
without the passionate and inspiring lecturers who devoted hours of
their time and shared their personal histories with our students.
Conflict of Interest: None disclosed.
Corresponding Author: Monica B. Vela, MD; Section of General
Internal Medicine, Department of Medicine, University of Chicago,
5841 S. Maryland Ave., MC 3051, Chicago, IL 60637, USA
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