Health Care Disparities: a Practical Approach to Teach Residents about Self-Bias and Patient Communication

Studies have shown that the education of resident physicians on health care disparities (HCDs) needs improvement. We implemented a system-wide program on HCD for residents and evaluated outcomes across 1 year. Designed in 2015 by a multidisciplinary team, the HCD program incorporated information about our health system's patient population and the tenets of unconscious bias. We used the ask-tell-ask model of communication to teach trainees how to identify patients' barriers to health care. In 2016, resident participants in the HCD program were asked to complete a modified version of the Bonham and Sellers RACE survey, which measures consideration of race in clinical care, at four time-points (pre-, post-, 3-months post-, and 1-year post-intervention). Of 186 PGY2 residents who completed the HCD program, 108 (58%) completed all 4 surveys across 1 year. The modified Bonham and Sellers RACE survey yielded a Cronbach's alpha of 0.885 and communality for the six questions ranging from 0.543 to 0.727. Using the modified RACE survey, resident respondents showed overall significantly increased consideration of race in clinical care from pre- to post-intervention time-points (p < 0.001). This study of our program on health care disparities showed that resident survey respondents increased self-reported consideration of race in clinical care after the intervention across 1 year.