The Impact of Racial Bias in Patient Care and Medical Education: Let's Focus on the Educator

Implicit and Explicit Race and Weight Biases Among Physician Assistant Preceptors and Trainees

INTRODUCTION

As new equity, diversity, and inclusion programs emerge in physician assistant/associate (PA) education, there is a need to assess baseline levels of implicit and explicit biases among PA preceptors' and trainees. The objectives of this study were (1) to measure implicit and explicit race (Black/White) and weight (fat/thin) biases among PA preceptors and trainees and (2) to identify potential gaps in PA preceptor and trainee education.

METHODS

This is a cross-sectional study of PA preceptors and trainees from one program operating in several US states; implicit and explicit race and antifat biases and receipt of prior education were measured.

RESULTS

Preceptor response rate was 6.4% (N = 78) from an eligible population of 1222, and trainee response rate was 25.7% (n = 43) from an eligible population of 167. Sixty-eight preceptor participants (87.2%) and 23 trainees (53.5%) identified as White. Preceptors held strong (Cohen d = 0.81), and trainees held moderate (Cohen d = 0.43) pro-White implicit bias. Overall, preceptors and trainees held little and no explicit race bias (Cohen d = 0.18 and d = 0.0, respectively). Preceptors and trainees held strong implicit antifat bias (Cohen d = 1.24 and Cohen d = 0.76). Preceptors held moderate explicit antifat bias (Cohen d = 0.65); trainees held strong explicit antifat bias (Cohen d = 0.95). Trainees received significantly more education on working with diverse populations compared with preceptors (100% vs. 57.7%, P < 0.001) and working with patients who are overweight (74.4% vs. 41.0%, P < 0.001).

DISCUSSION

Implicit race and antifat bias exists among our sample of PA preceptors and trainees. A gap in education for preceptors on working with diverse populations and patients who are overweight was identified. Future research should address both.

Scholars in Health Equity: A Program of Structured Physician Faculty Development

BACKGROUND

Structured faculty development programs focused on integrating health equity into medical education curricula remain limited.

AIM

To describe an interdisciplinary faculty development program grounded in adult learning theory and to assess its impact on participants' professional growth.

SETTING AND PARTICIPANTS

Twenty-one faculty members across six academic-affiliated health systems.

PROGRAM DESCRIPTION

Fourteen 2-h monthly sessions were delivered over one full year. Course topics included health equity, adult learning theory, curriculum development, implicit bias, social determinants of health, racism, oppression, and collaborating with community partners. Educational strategies included reflections, small group discussions, logic models, and capstone development.

PROGRAM EVALUATION

Using a Likert-type scale, participants rated all aspects of the program highly favorably, with median ratings ranging from 4 (agree) to 5 (strongly agree). Focus group results demonstrated that faculty experienced well-needed personal empowerment and professional growth in unexpected ways and identified several opportunities for programmatic growth.

DISCUSSION

Program strengths included its interdisciplinary nature, creating a space to address isolation experienced by faculty working to advance health equity within their departments, advancement of skills to integrate health equity into their teaching contexts, and the opportunity for participants to envision their scholarship as part of a more extensive approach within the social determinants of health, health equity, and community health framework.

Evaluation and Bias Analysis of Large Language Models in Generating Synthetic Electronic Health Records: Comparative Study

BACKGROUND

Synthetic electronic health records (EHRs) generated by large language models (LLMs) offer potential for clinical education and model training while addressing privacy concerns. However, performance variations and demographic biases in these models remain underexplored, posing risks to equitable health care.

OBJECTIVE

This study aimed to systematically assess the performance of various LLMs in generating synthetic EHRs and to critically evaluate the presence of gender and racial biases in the generated outputs. We focused on assessing the completeness and representativeness of these EHRs across 20 diseases with varying demographic prevalence.

METHODS

A framework was developed to generate 140,000 synthetic EHRs using 10 standardized prompts across 7 LLMs. The electronic health record performance score (EPS) was introduced to quantify completeness, while the statistical parity difference (SPD) was proposed to assess the degree and direction of demographic bias. Chi-square tests were used to evaluate the presence of bias across demographic groups.

RESULTS

Larger models exhibited superior performance but heightened biases. The Yi-34B achieved the highest EPS (96.8), while smaller models (Qwen-1.8B: EPS=63.35) underperformed. Sex polarization emerged: female-dominated diseases (eg, multiple sclerosis) saw amplified female representation in outputs (Qwen-14B: 973/1000, 97.3% female vs 564,424/744,778, 75.78% real; SPD=+21.50%), while balanced diseases and male-dominated diseases skewed the male group (eg, hypertension Llama 2-13 B: 957/1000, 95.7% male vs 79,540,040/152,466,669, 52.17% real; SPD=+43.50%). Racial bias patterns revealed that some models overestimated the representation of White (eg, Yi-6B: mean SPD +14.40%, SD 16.22%) or Black groups (eg, Yi-34B: mean SPD +14.90%, SD 27.16%), while most models systematically underestimated the representation of Hispanic (average SPD across 7 models is -11.93%, SD 8.36%) and Asian groups (average SPD across 7 models is -0.77%, SD 11.99%).

CONCLUSIONS

Larger models, such as Yi-34B, Qwen-14B, and Llama 2 to 13 B, showed improved performance in generating more comprehensive EHRs, as reflected in higher EPS values. However, this increased performance was accompanied by a notable escalation in both gender and racial biases, highlighting a performance-bias trade-off. The study identified 4 key findings as follows: (1) as model size increased, EHR generation improved, but demographic biases also became more pronounced; (2) biases were observed across all models, not just the larger ones; (3) gender bias closely aligned with real-world disease prevalence, while racial bias was evident in only a subset of diseases; and (4) racial biases varied, with some diseases showing overrepresentation of White or Black populations and underrepresentation of Hispanic and Asian groups. These findings underline the need for effective bias mitigation strategies and the development of benchmarks to ensure fairness in artificial intelligence applications for health care.

Addressing a Gap in Health Equity Education: A Qualitative Analysis of a Longitudinal GME Course

BACKGROUND

Graduate medical education (GME) on diversity, equity, and inclusion rarely teaches strategies for developing anti-racist mindsets and behaviors, and understanding of the impact of these programs and particular curricular components is lacking.

OBJECTIVE

To evaluate the format, content, and impact of a longitudinal anti-racism conference series (ARC) on resident physicians within an urban internal medicine program through a qualitative analysis, with the goal of informing the development and implementation of other evidence-based anti-racism curricula in graduate medical education (GME).

DESIGN

The ARC consisted of eight mandatory, 60-min virtual conferences held between August 2020 and June 2021 within an internal medicine residency program's primary care track sub-group. The conference's content synthesized previous anti-racism curricula, scholarly readings, and practical experiences, and emphasized internal reflection and behavior change.

PARTICIPANTS

Thirty internal medicine resident physicians and six faculty members.

MAIN MEASURES

Seven voluntary, semi-structured, hour-long focus groups were conducted to document resident perspectives on the ARC's format, content, and impact of the curriculum on learner's professional and personal development. Constructivist grounded theory was used to analyze resident responses.

KEY RESULTS

In total, 17/30 (57%) residents participated in focus groups. Analysis of course format, content, and impact revealed the following: (1) The most valued aspect of the course's instructional format was its perceived psychological safety. (2) Residents desired course content with more outward action steps than were offered. (3) Residents noted personal and professional impact across three main domains: intrapersonal, interpersonal, and institutional.

CONCLUSIONS

In this longitudinal GME internal medicine anti-racism curriculum, participants felt that the curriculum format provided safe spaces to engage with topics on systemic racism and patient care, but content lacked sufficient action-oriented strategies. The curriculum's impact was multi-dimensional and could be studied more deeply in the future through simulation or direct observation.

Developing a Novel Integrative Health Equity and Anti-racism Tool (IHEART) for Pilot Application in a Multicenter Integrative Health Elective for Medical Students and Resident Physicians: A Study Protocol

Background

This study protocol introduces the Integrative Health Equity and Anti-Racism Tool (IHEART), an innovative instrument designed to infuse equity, diversity, and inclusion (EDI) into Integrative Health (IH) education. Recognizing the gaps in current IH training that fail to address social and systemic inequities adequately, the IHEART is intended to respond to the growing need for inclusivity in IH practices and educational materials. The tool is mainly focused on addressing issues such as accessibility of complementary and integrative health (CIH) therapies, cultural misappropriation, anti-racism, gender diversity, disability justice, trauma-informed care, weight inclusivity, and planetary health, which are currently inconsistently covered in IH training.

Methods/Design

Developed by a team seeking to embed EDI more consistently in IH education, the IHEART provides reflection questions tailored to the unique philosophy and topics of IH. These questions are intended for use by IH educators in creating and delivering educational content, including handouts, slides, textbooks, and curricula. This tool differentiates itself from existing health equity tools used in general medical education by catering to the nuanced needs of IH training. The article outlines the iterative development process of the IHEART and plans for future pilot implementation and revision.

Discussion

By introducing this tool, the study protocol aims to enhance the inclusivity and relevance of IH education, aligning it more closely with contemporary social justice imperatives. The IHEART is positioned as a crucial step towards transforming IH education and practice, making it more accessible and equitable for diverse communities and ensuring that IH continues to evolve as a holistic and inclusive field.

A critical qualitative study to understand current black women medical student perspectives on anti-racist reform in US medical education

PURPOSE

The US medical education system has a long-standing history of omitting evidence and perpetuating false pseudo-scientific beliefs on the complex and nuanced relationships between race, racism, and health disparities. There is an urgent need to identify and address the historical influence of systemic racism on the current curriculum, organization, and culture of US medical education. The goal of this study was to understand Black women medical student perspectives on race and racism in current medical school training and their recommendations to inform anti-racist action in US medical education.

METHOD

The authors conducted a critical qualitative study to understand the perspectives of Black women medical students on issues surrounding race and racism in relation to US medical education. To their knowledge, this is the first study to use qualitative research methods to understand current thinking on the need for anti-racist pedagogy in medical school education among Black women medical students in the US.

RESULTS

The interviews revealed critical limitations in the teaching of race, racism, and racial disparities, including a lack of historical depth, continuity, and evaluation of this content; lack of actionable guidance to address racial disparities in clinical practice; and dissonance between emerging anti-racist content and national licensing examinations. The qualitative data yielded several anti-racist strategies and practices that can be implemented in US medical schools to redress historical curriculum limitations and better prepare future generations of physicians to care for marginalized populations.

CONCLUSIONS

This study provides actionable feedback on needed reforms to redress US medical school curriculum limitations as it relates to race, racism, and racial disparities.

Acknowledging and Addressing Microaggressions: A Virtual Experiential Learning Approach for Faculty

Introduction

Although the ACGME and other accrediting organizations are increasingly emphasizing the importance of clinical learning environments that value diversity, equity, and inclusion, faculty development surrounding behavioral skills that promote inclusivity in the learning environment still needs cultivation. We designed a virtual longitudinal faculty development curriculum focused on direct observation, feedback, and practice of behavioral skills to acknowledge and address microaggressions in the learning environment.

Methods

We used Kern's six steps of curriculum development to create four voluntary virtual workshops offered twice throughout the academic year, with topics including: (1) recognizing and naming microaggressions, (2) apologizing when harm has been experienced, (3) setting expectations surrounding microaggressions, and (4) debriefing microaggressions. Participant learners included residency program directors, associate program directors, and other leaders across all medical and surgical departments from one institution.

Results

Thirty-one faculty from 10 departments participated in this yearlong curriculum. Pre- and postworkshop surveys analyzed participants' self-assessments of confidence and comfort in applying learned skills. Participants were more confident in openly naming bias, delivering expectations surrounding microaggressions, and debriefing microaggressions with learners. Participants also reported greater comfort in apologizing to learners when harm has occurred in public, in person, and electronically.

Discussion

To create an inclusive learning environment, faculty can increase their comfort and confidence with addressing bias and microaggressions through practice and feedback. Our curriculum demonstrates how experiential learning allows for continual practice to solidify a new skill.

The nature and validity of implicit bias training for health care providers and trainees: A systematic review

The number of health care educational institutions/organizations adopting implicit bias training is growing. Our systematic review of 77 studies (published 1 January 2003 through 21 September 2022) investigated how implicit bias training in health care is designed/delivered and whether gaps in knowledge translation compromised the reliability and validity of the training. The primary training target was race/ethnicity (49.3%); trainings commonly lack specificity on addressing implicit prejudice or stereotyping (67.5%). They involved a combination of hands-on and didactic approaches, lasting an average of 343.15 min, often delivered in a single day (53.2%). Trainings also exhibit translational gaps, diverging from current literature (10 to 67.5%), and lack internal (99.9%), face (93.5%), and external (100%) validity. Implicit bias trainings in health care are characterized by bias in methodological quality and translational gaps, potentially compromising their impacts.

Curriculum Mapping to Enhance Antiracism Education in an Undergraduate Medical Education Program

Antiracism education (ARE) is critical in developing culturally competent physicians. At our institution, the Sidney Kimmel Medical College (SKMC) at Thomas Jefferson University in Philadelphia, United States, the Office of Diversity and Inclusion Initiatives and Educational Leadership created and examined a map of its ARE curriculum. Our efforts were meant to describe our local educational processes with regards to ARE; we did not intend to compare our curriculum and its outputs to national benchmarks. To this effect, diversity deans of other local Philadelphia-area medical schools were queried on their respective ARE maps and educational offerings. Potential changes to SKMC's ARE would be considered, but no other school that was queried had a formal ARE map in place. While all schools had a variety of lectures, modules, and electives, none appeared to have a systematic method to teach ARE. As a result, modifications to SKMC's ARE were made based on an intrinsic examination of its own ARE map. Changes that were made included modifying a pre-clerkship lecture on "Racism and Microaggressions" to a small group discussion session. Additionally, a clerkship-specific lecture on "Bias and Microaggressions" was changed from four 1-hour lectures to 90 minutes of lecture followed by a 2-hour small group session, to reduce content redundancy and promote more student reflection. For both of these changes, faculty participated in a newly developed faculty development session. To guide prospective work, a multidisciplinary task force was created to include formal student input in the process of examining ARE. Future directions to query institutions outside the Philadelphia region for their ARE offerings will also be considered.

The American Society for Bone and Mineral Research Task Force on clinical algorithms for fracture risk report

Using race and ethnicity in clinical algorithms potentially contributes to health inequities. The American Society for Bone and Mineral Research (ASBMR) Professional Practice Committee convened the ASBMR Task Force on Clinical Algorithms for Fracture Risk to determine the impact of race and ethnicity adjustment in the US Fracture Risk Assessment Tool (US-FRAX). The Task Force engaged the University of Minnesota Evidence-based Practice Core to conduct a systematic review investigating the performance of US-FRAX for predicting incident fractures over 10 years in Asian, Black, Hispanic, and White individuals. Six studies from the Women's Health Initiative (WHI) and Study of Osteoporotic Fractures (SOF) were eligible; cohorts only included women and were predominantly White (WHI > 80% and SOF > 99%), data were not consistently stratified by race and ethnicity, and when stratified there were far fewer fractures in Black and Hispanic women vs White women rendering area under the curve (AUC) estimates less stable. In the younger WHI cohort (n = 64 739), US-FRAX without bone mineral density (BMD) had limited discrimination for major osteoporotic fracture (MOF) (AUC 0.53 (Black), 0.57 (Hispanic), and 0.57 (White)); somewhat better discrimination for hip fracture in White women only (AUC 0.54 (Black), 0.53 (Hispanic), and 0.66 (White)). In a subset of the older WHI cohort (n = 23 918), US-FRAX without BMD overestimated MOF. The Task Force concluded that there is little justification for estimating fracture risk while incorporating race and ethnicity adjustments and recommends that fracture prediction models not include race or ethnicity adjustment but instead be population-based and reflective of US demographics, and inclusive of key clinical, behavioral, and social determinants (where applicable). Research cohorts should be representative vis-à-vis race, ethnicity, gender, and age. There should be standardized collection of race and ethnicity; collection of social determinants of health to investigate impact on fracture risk; and measurement of fracture rates and BMD in cohorts inclusive of those historically underrepresented in osteoporosis research.

Core Competencies of an Anti-racist Physician: Elective Course for Undergraduate Medical Students

Introduction

Medical schools seeking to correct and reform curricula towards anti-racist perspectives need to address anti-Black forms of racism specifically and teach students critical upstander skills to interrupt manifestations of racism. We developed a course to teach preclinical medical students basic anti-racism competencies including recognition and awareness of anti-Black racism in medicine and upstander skills to advocate for patients and colleagues.

Methods

In 2021 and 2022, we designed, implemented, and evaluated an elective course for second-year medical students (N = 149) to introduce competencies of anti-racism focusing on upstander skills for addressing anti-Blackness. We designed three patient cases and one student-centered case to illustrate manifestations of anti-Black racism in medicine and used these cases to stimulate small-group discussions and guide students toward recognizing and understanding ways of responding to racism. We designed pre- and postassessments to evaluate the effectiveness of the course and utilized anonymous feedback surveys.

Results

Participants showed significant improvement in pre- to postassessment scores in both years of the course. The anonymous feedback survey showed that 97% of students rated the course at least somewhat effective, and the qualitative responses revealed five core themes: course timing, case complexity, learner differentiation, direct instruction, and access to resources.

Discussion

This course reinforces upstander competencies necessary for advancing anti-racism in medicine. It addresses a gap in medical education by reckoning with the entrenched nature of anti-Black racism in the culture of medicine and seeks to empower undergraduate medical students to advocate for Black-identifying patients and colleagues.

Large language models for generating medical examinations: systematic review

BACKGROUND

Writing multiple choice questions (MCQs) for the purpose of medical exams is challenging. It requires extensive medical knowledge, time and effort from medical educators. This systematic review focuses on the application of large language models (LLMs) in generating medical MCQs.

METHODS

The authors searched for studies published up to November 2023. Search terms focused on LLMs generated MCQs for medical examinations. Non-English, out of year range and studies not focusing on AI generated multiple-choice questions were excluded. MEDLINE was used as a search database. Risk of bias was evaluated using a tailored QUADAS-2 tool.

RESULTS

Overall, eight studies published between April 2023 and October 2023 were included. Six studies used Chat-GPT 3.5, while two employed GPT 4. Five studies showed that LLMs can produce competent questions valid for medical exams. Three studies used LLMs to write medical questions but did not evaluate the validity of the questions. One study conducted a comparative analysis of different models. One other study compared LLM-generated questions with those written by humans. All studies presented faulty questions that were deemed inappropriate for medical exams. Some questions required additional modifications in order to qualify.

CONCLUSIONS

LLMs can be used to write MCQs for medical examinations. However, their limitations cannot be ignored. Further study in this field is essential and more conclusive evidence is needed. Until then, LLMs may serve as a supplementary tool for writing medical examinations. 2 studies were at high risk of bias. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

From Theory to Action: Evaluation of a Longitudinal Project-Based Antiracism Course for Post-Graduate Physicians

Objectives

Few opportunities exist for postgraduate physicians to learn to address racism in their professional practice. We created a virtual, 5-session antiracism course that included the development of a formal action project to address racism at participants' home institution.

Methods

We delivered this curriculum virtually to 2 cohorts (2021 and 2022) of postgraduate physicians, nationally. The curriculum had 3 educational aims: (1) to increase knowledge on antiracism, (2) to increase comfort and engagement in discussing antiracism at home institutions, and (3) to increase self-efficacy to execute an institution-based project. Theory-informed practice, community building, and project-based learning were used to achieve our educational aims. We analyzed changes in these domains in addressing racism using matched 7-item Likert-scale questions from pre- and post-course surveys and the Wilcoxon signed rank test. We assessed perceptions and impacts of the course with post-course survey items using descriptive statistics.

Results

Forty-three of 50 participants (86%) who completed pre- and post-course surveys were included in the analysis. We found pre-post course increases in mean scores (converted from Likert scales), for all 15 paired questions. For example, we found improvements in understanding the historical context of racism in medical institutions (mean score change: 5.12 [SD 1.00] to 6.42 [SD 0.76], P < .001), comfort in talking to colleagues about racism (5.21 [SD 1.08] to 6.19 [SD 0.70], P < .001), and capacity to address racism in patient care at their home institution (4.51 [SD 1.35] to 5.56 [SD 0.91], P < 0.001). 93% reported the course increased the likelihood of working to address racism at their institution.

Conclusion

This project-based antiracism course for postgraduate learners increased self-reported knowledge of, comfort with, and self-efficacy in addressing racism and was well received by participants.

DARE Training: Teaching Educators How to Revise Internal Medicine Residency Lectures by Using an Anti-racism Framework

Introduction

Systemic inequities and provider-held biases reinforce racism and further disparities in graduate medical education. We developed the Department of Medicine Anti-Racism and Equity Educational Initiative (DARE) to improve internal medicine residency conferences. We trained faculty and residents to serve as coaches to support other faculty in delivering lectures. The training leveraged a best-practices checklist to revise existing lectures.

Methods

We recruited internal medicine faculty and residents to serve as DARE coaches, who supported educators in improving lectures' anti-racism content. During the training, coaches watched a videotaped didactic presentation that we created about health equity and anti-racism frameworks. DARE coaches then participated in a workshop where they engaged in case-based learning and small-group discussion to apply the DARE best-practices checklist to sample lecture slides. To assess training effectiveness, coaches completed pre- and posttraining assessments in which they edited different sample lecture slides. Our training took 1 hour to complete.

Results

Thirty-four individuals completed DARE training. Following the training, the sample slides were significantly improved with respect to diversity of graphics (p < .001), discussion of research participant demographics (p < .001), and discussion of the impact of racism/bias on health disparities (p = .03). After DARE training, 23 of 24 participants (96%) endorsed feeling more prepared to bring an anti-racist framework to lectures and to support colleagues in doing the same.

Discussion

Training residents and faculty to use DARE principles in delivering internal medicine lectures is an innovative and effective way to integrate anti-racism into internal medicine residency conferences.

Barriers in Ophthalmology Residency Applications for Students Identifying as Underrepresented in Medicine: A San Francisco Match Analysis

OBJECTIVE

There is a significant lack of ophthalmologists who self-identify as underrepresented in medicine (URiM) in the physician workforce. Prior literature has revealed bias in traditional metrics for selection relied on by resident programs such as United States Medical Licensing Examination (USMLE) scores, letters of recommendation (LOR), and induction into medical honors societies such as Alpha Omega Alpha (AOA). The purpose of this study was to elucidate race-based differences in word usage within ophthalmology residency letters of recommendation that may disproportionately affect URiM applicants.

DESIGN

This was a retrospective, cohort study.

SETTING

This was a multicenter study across the Wilmer Eye Institute at Johns Hopkins, the University of California San Francisco, and the University of North Carolina at Chapel Hill.

PARTICIPANTS

San Francisco (SF) Match applications submitted to three ophthalmology residency programs between 2018 and 2020 were reviewed. URiM status, USMLE Step 1 score, and AOA membership were recorded. Letters of recommendation were analyzed using text analysis software. T-tests and chi-squared or Fisher's exact tests were used to compare continuous and categorical variables, respectively. Frequency of word/summary term usage in letters of recommendation were the main outcome measures.

RESULTS

Relative to non-URiM applicants, URiM applicants had lower USMLE Step 1 scores (mean difference=7.0; p<0.001). Non-URiM letters of recommendation were more likely to describe applicants as "dependable" (p=0.009) and highlight "research" (p=0.046). URiM letters were more likely to describe applicants as "warm" (p=0.02) and "caring" (p=0.02).

CONCLUSIONS

This study identified potential barriers for URiM ophthalmology residency applicants which can help guide future interventions to increase workforce diversity.

Teaching the Teachers: Development and Evaluation of a Racial Health Equity Curriculum for Faculty

INTRODUCTION

Faculty are increasingly expected to teach about the impact of racism on health and to model the principles of health equity. However, they often feel ill-equipped to do so, and there is limited literature on faculty development on these topics. We developed a curriculum for faculty education on racism and actions to advance racial health equity.

METHODS

The curriculum design was based on a literature review and needs assessments. Implementation consisted of four live virtual 1-hour sessions incorporating interactive didactics, cases, reflection, goal setting, and discussion offered to a multidisciplinary group of pediatric faculty at a children's hospital. Topics included the history of racism, racism in health care, interacting with trainees and colleagues, and racial equity in policy. Evaluation consisted of pre- and postsurveys at the beginning and end of the curriculum and a survey after each session.

RESULTS

A mean of 78 faculty members attended each session (range: 66-94). Participants reported high satisfaction and increased knowledge at the end of each session. Qualitative themes included self-reflection on personal biases, application of health equity frameworks and tools, becoming disruptors of racism, and the importance of systemic change and policy.

DISCUSSION

This curriculum is an effective method for increasing faculty knowledge and comfort. The materials can be adapted for various audiences.

Integration of Case-Based Dialogue to Enhance Medical Students' Understanding of Using Health Communication to Address Social Determinants of Health

BACKGROUND AND OBJECTIVES

With the ever-growing diversity within our communities, it is imperative that we integrate social determinants of health (SDOH) such as racial disparity, economic instability, lack of transportation, intimate partner violence, and limited social supports, and the importance of health literacy into undergraduate medical education. By incorporating evidence-based curriculum on the disproportionality within healthcare faced by racial and ethnic minorities, we have the opportunity to develop more culturally sensitive providers. The purpose of this study was to assess the impact of a case-based debrief experience on medical students' knowledge about how social determinants of health can impact health and healthcare within a family medicine clinical setting and their intent to practice in an underserved community.

METHODS

We utilized a retrospective paired-sample t-test analysis of program data from 640 third-year medical students who engaged in a family medicine clerkship between July 2020, and April 2022. For inclusion in the study, students must have engaged in a case-based exercise and corresponding small group debrief around the impact of social determinants of health on patient care.

RESULTS

We found a statistically significant improvement in students' reported knowledge about SDOH, as well as the confidence and intent to work with and care for individuals of diverse cultural and socioeconomic backgrounds.

CONCLUSION

Medical students must have the knowledge and self-efficacy to understand how social determinants of health can impact health and healthcare within a family medicine clinical setting. As a result of integrating more active learning strategies such as the case-base and debrief experience, students may have a more robust medical education experience.

A survey of implicit bias training in physician assistant and nurse practitioner postgraduate fellowship/residency programs

BACKGROUND

There has been renewed focus on advancing inclusivity within organized medicine to reduce health disparities and achieve health equity by addressing the deleterious effects of implicit bias in healthcare and clinical outcomes. It is well documented that negative implicit attitudes and stereotypes perpetuate inequity in healthcare. The aim of this study is to investigate implicit bias training in postgraduate physician assistant (PA) and nurse practitioner (NP) education; describe delivery of content to trainees; and detail program directors' attitudes toward this type of training. Although there is research examining implicit bias training in physician residency education, there are no published studies on implicit bias training in postgraduate PA and NP postgraduate residency/fellowship programs.

METHOD

A non-experimental, descriptive study was designed to obtain information via survey from members of the Association of Postgraduate Physician Assistant Programs (APPAP).

RESULTS

The response rate was 41%. The majority of respondents (76%) felt that PA and NP postgraduate programs should include implicit bias instruction. Educational strategies used by PA and joint PA/NP postgraduate programs or their sponsoring institution to deliver implicit bias content to trainees include: implicit bias training modules (50%), facilitated group discussions (36%), invited speaker on implicit bias (33%), case studies on implicit bias (16%), and implicit association test (10%); however, 30% of postgraduate programs do not provide implicit bias training to PA and/or NP trainees. Barriers to implementing implicit bias training expressed by some postgraduate programs include: uncertainty in how to incorporate implicit bias training (16%); lack of strategic alignment with training program or sponsoring institution (13%); time constraints (10%); financial constraints (6%); lack of access to content experts (6%); and unfamiliarity with evidence supporting implicit bias training (6%).

CONCLUSION

The present study sheds some light on the current state of implicit bias training in PA and joint PA/NP postgraduate residency/fellowship programs. While the majority of programs offer some sort of implicit bias training, there is a need to standardize this training in PA and joint PA/NP postgraduate education curricula using an actionable framework.