Improving Health Equity Training with an Integrated Simulation-Based Curriculum

Socioeconomic and environmental factors play a significant role in shaping an individual's overall health. Despite longstanding recommendations to integrate cultural competency and multidisciplinary training, health equity remains underemphasized in US medical schools. The Emergency Medicine (EM) clerkship is ideal to address this gap, given the diverse Emergency Department (ED) patient population.

A health equity curriculum was integrated into clerkship simulations. Using the AAMC Core Entrustable Professional Activities (EPA), a score was assigned between 1-4 based on a scaled evaluation of students' ability to incorporate responses appropriate to age, gender, race, religion, disabilities, and/or sexual orientation into patient encounters. Beginning and end- of-rotation simulation were compared pre- and post- implementation using t-tests. Students were surveyed regarding experiences at the end of the rotation.

Mean scores were similar pre-implementation (2.48 vs 2.46; not significant). Post-implementation mean scores increased from 2.5 to 3.3 (p<0.01). Baseline scores were similar pre- and post-implementation, while end-of-rotation scores improved (p<0.01). Fifty-six students participated in the health equity curriculum; evaluations were sent to all students with an 87.5% response rate; 83.7% agreed or strongly agreed it helped build knowledge, 85.7% agreed or strongly agreed it improved patient care skills, and 89.8% agreed or strongly agreed that topics were relevant to future clinical practice.

Incorporating a focused health equity curriculum into EM clerkship simulations is feasible, impactful, well-received by students, and improved EPA scores. The curriculum equips learners with tools that can be applied to real-world patient care, which may enhance the physician-patient experience.