Abstract
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. To describe and compare the curriculum on health disparities from the perspective of program directors and perceptions of training among internal medicine residents. 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. Questions were included on the annual Association of Program Directors in Internal Medicine survey and the Internal Medicine In-Training Examination. 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. 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. 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.
Highlights
IntroductionMany trainees do not feel prepared to care for patient populations most at risk for health disparities.[6,7,8]
In 2002, the Institute of Medicine, the National Academy of Medicine, produced their seminal report “Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare,”[1] which summarized the stark differences in health and health care outcomes between patients in minority groups vs those not in minority groups
Of residents who reported receiving training, 10 494 (79.2%) rated the quality as very good or excellent. 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
Summary
Many trainees do not feel prepared to care for patient populations most at risk for health disparities.[6,7,8] While these recommendations have existed for at least a decade,[9] a 2014 review of health care disparities training in residency programs in the US10 demonstrated few published reports of graduate medical education programs that ensure that residents are competent to address disparities. The first national report of findings for the CLER program,[11] highlighted health disparities as an area of challenge and opportunity for graduate medical education.[12] The major findings were that the primary source of learning involved clinical experiences with patients who were at risk, mainly occurring in primary care settings and was generic, not tailored to the specific populations served by their medical center or hospital. In the second report based on residency site visits, 32.8% of residents and fellows reported their health disparities training was specific to their at-risk populations.[13]
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