Creating a more equitable future: development, implementation, and evaluation of a novel surgical disparities curriculum for medical students

Abstract

PurposeThe AAMC has expanded its focus on healthcare disparities training during undergraduate medical education (UME). Currently, no standardized published curriculum dedicated to surgical disparity training exists. Therefore, our purpose was to develop, implement, and evaluate a novel Surgical Disparities Curriculum to equip medical students to recognize peri-operative disparities.MethodsThe Surgical Disparities Curriculum was developed based on the Surgical Disparity Framework created by the NIH-American College of Surgeons Summit on Health Disparity using Kern’s Model of Curriculum Development. The curriculum includes four components which are illustrated in Fig. 1: (1) a pre-session review of a journal article and multimedia adjunct highlighting one category within the framework, (2) a didactic session highlighting key elements of the state of surgical disparities and teaching the NIH-ACS framework, (3) a review of a clinical vignette and articles highlighting a framework factor, and (4) a discussion session applying all elements of the framework to disparities identified in pre-session materials, clinical vignette, and personal clinical experiences. The curriculum was administered at a single large academic institution to 223 third-year medical students. Curriculum evaluation was performed using Kirkpatrick’s Model of Training Evaluation and included post-participation surveys to evaluate participant reaction to the curriculum as well as pre- and post-course assessments to evaluate learning. Results were pooled and a Fisher’s exact test or independent samples t test was used for relevant analysis with p < 0.05 considered significant. Thematic analysis, using common word groupings, was also performed on post-survey comments.Fig. 1Outline of novel Surgical Disparities Curriculum for Medical Students. Pre-session preparation includes a survey and a guided reading with a relevant journal article and a multimedia adjunct. Next is a didactic session that introduces a Surgical Disparities Framework established by the ACS in 2016 and gives students a background in the language of discussing disparities. Next is a clinical vignette that highlights a framework factor and several disparities of interest. This is followed by a guided discussion on the pre-session materials, the didactic component, and the clinical vignette within the framework accompanied by a discussion on how to apply the framework and identify and prevent disparities. This was followed by a post-session surveyResultsParticipants stated they had prior dedicated training in recognizing health disparities integrated throughout the UME curriculum during pre-clinical (83%) and clinical (89%) experiences. Only 31% of students agreed surgical disparities had been discussed during their rotation prior to curriculum implementation. After curriculum participation, 90% of students endorsed an improved understanding of surgical disparities in healthcare and there was a 20% improvement in self-reported identification of peri-operative disparities from 68 to 88% (20% [CI 12–28%], p < 0.0001). Participation in the curriculum also resulted in knowledge acquisition with students scoring better (78% v 59% at baseline; p < 0.0001) on post-participation assessment.ConclusionThe Surgical Disparities Curriculum provides a novel solution for bridging the gap in training medical students to recognize disparities in the care of surgical patients. Future work will be done to assess long-term retention and behavioral changes because of our intervention. In addition, we will be working on the translatability of our curriculum to other institutions with the goal of training clerkship students across the country to better recognize surgical disparities.