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Implementation of a "Health Equity Rounds" Curriculum in a Military Internal Medicine Residency Program: A Pilot
Veronica Wright1, William Hirschfeld2, Erika Walker2
1Combined Internal Medicine/Psychiatry Residency Program, National Capital Consortium, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
Military Medicine
|May 21, 2024
Summary
This study shows case-based learning effectively trains military medical trainees to identify health disparities. The curriculum improved skills in recognizing bias and discrimination within the Military Health System (MHS).
Area of Science:
- Medical Education
- Health Equity
- Military Health System
Background:
- Health disparities persist in the Military Health System (MHS) despite equal access to care.
- Social Determinants of Health and healthcare factors like provider bias drive these disparities.
- Case-based learning effectively teaches health equity terminology but skill development in identifying disparities in clinical cases remains a gap.
Purpose of the Study:
- To determine if case-based learning can equip trainees with skills to identify factors contributing to health disparities in the MHS.
- To assess the effectiveness of a novel case-based curriculum in improving trainees' ability to recognize bias and discrimination.
Main Methods:
- A longitudinal case-based curriculum, "Health Equity Rounds," was implemented in the National Capital Consortium Internal Medicine Residency Program.
- Trainees analyzed clinical cases for evidence of healthcare provider bias and systemic discrimination in small groups.
- A retrospective pretest-posttest survey assessed trainee confidence and reactions to the curriculum, with data analyzed using paired samples t-test.
Main Results:
- A 60.8% response rate (14/23 trainees) was achieved for the survey.
- 93% of trainees found the cases engaging, the skills practice-changing, and the educational value good to excellent.
- Statistically significant increases in self-reported confidence were observed in identifying bias/discrimination (P<.001), mitigating personal biases (P<.001), and participating/leading discussions on these topics (P=.001, P=.002).
Conclusions:
- Health Equity Rounds, utilizing case-based learning, show promise as an optimal teaching approach for military Internal Medicine trainees.
- The curriculum effectively improved trainees' skills in identifying and recognizing the impact of healthcare provider bias and systemic discrimination within the MHS.
- Addressing health disparities requires military physicians to be adept at recognizing their drivers within the MHS.
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