Preparing Medical Students to Address Health Disparities Through Longitudinally Integrated Social Justice Curricula: A Systematic Review

A rapid review of critical theory in health professions education

INTRODUCTION

Critical theories, such as Critical Race Theory, are a group of theories developed to explicate structural, historical, and social issues that perpetuate inequities and might inform institutional efforts. This study reviewed critical theory use in health professions education with the primary objectives of understanding how and to what extent these theories have been applied.

METHODS

A rapid review was performed in October 2021 with four electronic databases. Scholarship was screened with Covidence based on inclusion (critical theory and health professions education) and exclusion (gray literature, not written in English, not critical theory, not education setting, not peer reviewed) criteria. Data were extracted, charted, and analyzed by three reviewers through Excel, with findings reviewed by the entire research team.

RESULTS

A total of 154 pieces of scholarship were included. Most scholarship emerged between 2010 and 2019 (n = 69, 44.8%) and nursing (n = 93, 54.4%) was most represented. Scholars were most frequently from the United States (n = 62, 35.6%), used theoretical methodologies (n = 84, 50.3%), and leveraged Critical & Critical Social Theory (n = 67, 30.7%). In scholarship with major theory use (n = 52, 33.8%), scholars also most commonly used Critical Theory & Critical Social Theory (n = 25, 34.2%).

CONCLUSIONS

This review exposed gaps in the use of critical theory in health professions education. Scholars should consider expanding the application of critical theories, additional research methodologies, and aspects of education that were largely absent. Expanding critical theory to further explicate aspects of training programs and institutions could deepen our understanding of the mechanisms impacting student development and success in health professions.

Development and delivery of justice, equity, diversity, inclusion, and anti-oppression concepts in entry-level health professional education: A scoping review: BEME Guide No. 88

PURPOSE

Justice, equity, diversity, inclusion (JEDI), and anti-oppression (AO) concepts are necessary in healthcare settings to promote culturally safe and high-quality care; however, entry-level healthcare program curricula (EHPPC) may lack adequate integration and/or delivery of these concepts. The primary aim of this scoping review is to identify what guidelines, frameworks, and models (GFMs) are used, and how they are used, to develop and deliver JEDI, and AO concepts in mandatory EHPPC.

METHODS

A search of Ovid MEDLINE, Ovid EMBASE, and CINAHL was conducted for studies published in English from 2015 onwards that discuss what GFMs are included in mandatory EHPPC and how they guide the development and/or delivery of JEDI and/or AO concepts. Data from the included studies was collated into themes which were presented in tables and figures and described in narrative summaries.

RESULTS

Sixty-one studies from various healthcare programs including medicine, nursing, pharmacy, dentistry, and dietetics were included in this review. Data from the studies were organized into eight categories: GFMs, concepts, methods of evaluation, length and frequency of sessions, modes of delivery, learning activities, and training of curricular developers and facilitators.

CONCLUSIONS

GFMs are used in a variety of ways to integrate JEDI and/or AO concepts into health professional curriculum. Variability in the training of developers and facilitators of curricular concepts also exists. Future research is needed to determine if consistent or variable GFMs, as well as JEDI and/or AO developer and facilitator training, would be more effective for students' learning of these concepts.

Simulation-Based Trauma-Informed Care Education Instills Empathy and Improves Clinician Practices Towards Refugee and Migrant Populations

Introduction

Refugee and migrant communities carry histories wrought with trauma. These traumas and trauma-related responses often contribute to feelings of mistrust towards Western health care systems and can additionally foster negative clinician biases (conscious or unconscious) and attitudes towards these communities. Consequently, clinicians often fail to uncover underlying causes of poor health and distress for their refugee and migrant patients.

Methods

To dismantle biases and cultivate empathy towards refugee and migrant patients, we developed a 1-hour simulation-based educational workshop to train clinicians to think critically about incorporating trauma-informed care (TIC) for these patients' unique needs. We introduced this tool to the GME curricula at Texas Tech University (n = 36) and to the UME curricula at Albany Medical College (n = 43). Using pre- and postquestionnaires, we analyzed the impact of this workshop on participants' knowledge, attitudes, and practices regarding TIC for migrant and refugee populations (n = 44).

Results

This tool positively influenced students' and residents' knowledge and attitudes regarding TIC and displaced peoples, and learners expressed greater willingness to incorporate TIC into clinical practice (p < .001). Additionally, residents self-reported percentage increases in behaviors that promote equitable care for refugee and migrant patients 6 months postintervention.

Discussion

This training enhanced clinicians' trauma-informed practices towards refugee and migrant patients, with learners qualitatively expressing a greater sense of empathy towards this community. While measuring the impact on learners' empathy requires further assessment, this educational innovation's preliminary success provides a foundation for the role of simulation-based learning in medical education.

When I say … social justice

Explore the term "Social Justice" in this new "When I Say" article. The authors consider its origin, advocate for a broader definition, and encourage renewed focus in the field.

Health Justice and Systems of Care: A Required Longitudinal Course for MD Students

Problem & Background

Medical education has acknowledged the impact of structural societal factors on health, prompting the need for curricula seeking to eliminate health inequities upstream while simultaneously caring for downstream effects of existing inequities. The Keck School of Medicine of USC (KSOM) implemented one such comprehensive curriculum, Health Justice and Systems of Care (HJSC), integrating health systems science, structural competency, and service-learning in a required course spanning the pre-clerkship and clerkship phases with an optional post clerkship elective.

Approach

The HJSC course addresses topics including racism in medicine, health inequities, and health systems science. Using transformative learning theory, it fosters critical consciousness and structural competency. Assessments include case analyses, reflections, team-based learning sessions, and group projects related to social justice in healthcare. The program aims to instill cultural humility and practical application, fostering a holistic approach to medical education that implores physicians to become advocates for health justice.

Outcomes of the Innovation

Feedback from students indicated generally positive perceptions of the curriculum. Students provided overall positive comments about discussions with guest speakers. However, students expressed a desire for more concrete examples of how health inequities can be remedied. Some found small-group activities less engaging. Other challenges included providing students of different readiness levels with tailored experiences and seamlessly integrating HJSC content within basic and clinical sciences courses.

Critical Reflection

Next steps include continuing to integrate content into the science curriculum and clerkships, improving opportunities for meaningful student interactions, and enhancing faculty development to address health justice concerns in clinical settings.

Development and delivery of justice, equity, diversity, inclusion, and anti-oppression concepts in entry-level health professional education: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to identify the frameworks, guidelines, and models used to develop and deliver justice, equity, diversity, inclusion (JEDI), and anti-oppression (AO) principles in mandatory, entry-level health care professional program curricula (EHCPPC). A secondary objective will be to examine how these frameworks, guidelines, and models are used.

INTRODUCTION

Health inequities are perpetuated globally, as observed by the suboptimal quality of care and health outcomes among equity-deserving groups. An understanding of JEDI and AO concepts is necessary in health care settings to promote culturally safe and high-quality care; however, entry-level health care programs may lack adequate integration of content and/or delivery of these principles. This scoping review will summarize the international literature on frameworks, guidelines, and models used to develop and deliver JEDI and AO concepts in EHCPPC.

INCLUSION CRITERIA

This review will consider articles that discuss frameworks, models, or guidelines included in EHCPPC that guide the development and/or delivery of JEDI and AO principles in any country. Studies will be considered if they were published from 2015 to the present and are in English. All study designs will be considered for inclusion.

METHODS

This review will be conducted in accordance with the JBI methodology for scoping reviews. A search of MEDLINE (Ovid), Embase (Ovid), and CINAHL (EBSCOhost) will be conducted. Two or more independent reviewers will assess titles and abstracts, screen full-text studies, and extract data from included studies. Data from the included studies will be collated into tables or figures and described in a narrative summary.

REVIEW REGISTRATION

Open Science Framework osf.io/ewqf8.

The promise and challenges of multi-cancer early detection assays for reducing cancer disparities

Since improvements in cancer screening, diagnosis, and therapeutics, cancer disparities have existed. Marginalized populations (e.g., racial and ethnic minorities, sexual and gender minorities, lower-income individuals, those living in rural areas, and persons living with disabilities) have worse cancer-related outcomes. Early detection of cancer substantially improves outcomes, yet uptake of recommended cancer screenings varies widely. Multi-cancer early detection (MCED) tests use biomarkers in the blood to detect two or more cancers in a single assay. These assays show potential for population screening for some cancers-including those disproportionally affecting marginalized communities. MCEDs may also reduce access barriers to early detection, a primary factor in cancer-related outcome disparities. However, for the promise of MCEDs to be realized, during their development and testing, we are obligated to be cautious to design them in a way that reduces the myriad of structural, systematic, and personal barriers contributing to disparities. Further, they must not create new barriers. Population studies and clinical trials should include diverse populations, and tests must work equally well in all populations. The tests must be affordable. It is critical that we establish trust within marginalized communities, the healthcare system, and the MCED tests themselves. Tests should be expected to have high specificity, as a positive MCED finding will trigger additional, oftentimes invasive and expensive, imaging or other diagnosis tests and/or biopsies. Finally, there should be a way to help all individuals with a positive test to navigate the system for follow-up diagnostics and treatment, if warranted, that is accessible to all.

A Narrative Review of Key Studies in Medical Education in 2022: Applying the Current Literature to Educational Practice and Scholarship

The expectation of every academic pediatrician is to stay updated on current evidence in their field; this is especially true of pediatric clinician educators who are training the next generation of pediatricians. Since 2016, select members of the Academic Pediatric Association Education Committee have curated educational research articles in order to distill the increasing volume of research related to medical education. The purpose of this narrative review is to summarize 14 articles published in 2022 related to medical education that may impact the work of pediatric clinician educators and educational leadership. These articles are organized into 6 overarching domains: selection and recruitment, promoting learner growth and development, learning environment and wellness, curriculum development, assessment, and educator development.

Examining the pedagogical practices that support cultural proficiency development in graduate health science students

BACKGROUND

Health disparities are often a function of systemic discrimination and healthcare providers' biases. In recognition of this, health science programs have begun to offer training to foster cultural proficiency (CP) in future professionals. However, there is not yet consensus about the best ways to integrate CP into didactic and clinical education, and little is known about the role of clinical rotations in fostering CP.

METHODS

Here, a mixed-methods approach was used to survey students (n = 131) from a private all-graduate level osteopathic health sciences university to gain insight into the training approaches students encountered related to CP and how these may vary as a function of academic progression. The research survey included instruments designed to quantify students' implicit associations, beliefs, and experiences related to the CP training they encountered through the use of validated instruments, including Implicit Association Tests and the Ethnocultural Empathy Inventory, and custom-designed questions.

RESULTS

The data revealed that most students (73%) had received CP training during graduate school which primarily occurred via discussions, lectures, and readings; however, the duration and students' perception of the training varied substantially (e.g., training range = 1-100 hours). In addition, while students largely indicated that they valued CP and sought to provide empathetic care to their patients, they also expressed personal understandings of CP that often fell short of advocacy and addressing personal and societal biases. The results further suggested that clinical rotations may help students attenuate implicit biases but did not appear to be synergistic with pre-clinical courses in fostering other CP knowledge, skills, and attitudes.

CONCLUSIONS

These findings highlight the need to utilize evidence-based pedagogical practices to design intentional, integrated, and holistic CP training throughout health science programs that employ an intersectional lens and empowers learners to serve as advocates for their patients and address systemic challenges.

The impact of a student-led anti-racism programme on medical students' perceptions and awareness of racial bias in medicine and confidence to advocate against racism

INTRODUCTION

Systemic racism impacts personal and community health; however, education regarding its role in perpetuating healthcare inequity remains limited in medical curricula. This study implemented and evaluated the impact of a student-led anti-racism programme on medical students' perceptions of racial bias in medicine, awareness of, and confidence to advocate against racism in medicine.

METHOD

A total of 543 early stage medical students were invited to participate in the programme. Participants were assigned readings and videos exploring racial injustice in medicine and attended a virtual small-group discussion facilitated by faculty and students. Online surveys were used to collect pre- and post-programme data using Likert scales for response items. Open-ended questions were independently reviewed by three authors using reflexive thematic analysis.

RESULTS

Sixty-three early-stage medical students enrolled in the programme, of which 42 completed the pre-programme survey. There was a 76% (n = 32) response rate for the post-programme survey. The majority of students (60%, n = 25) had no previous education about racism in medicine. From pre- to post-programme, there was a significant change in students' perceived definition of race from genetic, biological, geographical, and cultural factors to socio-political factors (P < 0.0001). Significant increases in almost all factors assessing student awareness of racism and confidence to advocate against racism were observed. Student-identified barriers to discussing racism included lack of education and lived experience, fear of starting conflict and offending others. All survey respondents would recommend this programme to peers and 69% (n = 32) engaged in further topical self-directed education.

CONCLUSION

This simple and reproducible programme improved awareness and confidence to advocate against racism in medicine and resulted in a change in opinion regarding race-based medical practice. These findings are in line with best practice towards addressing racial bias in medicine, decolonizing medical curricula and strengthening anti-racism teaching of future physicians.