Research published last year found that resident physicians believe training on medical racism and bias would help improve their preparation to excel in residency. Furthermore, the institutions that oversee medical training also have shown the necessity of training on these topics. Namely, the Accreditation Council for Graduate Medical Education and the Association of American Medical Colleges have created competencies for training related to diversity, equity and inclusion.
While residents, faculty and administrators seem to understand how such training can help increase physician workforce diversity, build safe and inclusive learning environments and promote health equity, getting that content to busy residents remains a challenge. Enter the AMA GME Competency Education Program, which has launched a series of health equity educational courses and curriculum.
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The aim of the health equity curriculum is to ensure that resident physicians are equipped to understand and address the root causes of health inequities, including racism and other structural determinants of health. To that end, courses include case scenarios and quizzes tailored for resident and fellow learners.
“The goal of creating this content is to fill what we believe is a gap in available content for residents who are looking to deepen their understanding of diversity, equity and inclusion,” said Emily Cleveland Manchanda, MD, MPH, director of social justice education and implementation at the AMA Center for Health Equity. “From wherever they are when they enter a residency program, we are trying to get them up to speed to the level we think is necessary—an understanding of the skills to address equity in medicine—before they take on independent practice.”
The curriculum includes:
- “Basics of Health Equity for GME,” an introductory course that grounds learners in common definitions, concepts and frameworks of health equity and encourages further investigation, engagement and reflection.
- “Racism in Medicine: An Introduction,” an interactive course that takes learners though the historical social construction of race and the obstacles racism poses for the attainment of health and wellness.
- “Social Determinants of Health,” which helps build a foundation for recognizing and addressing the structural drivers and social determinants of health during a clinical encounter in order to improve outcomes and health equity.
- “Improving Population Health,” a course that introduces learners to population and public health and explains recent changes in health care delivery to improve U.S. health.
- “Racism in Medicine: Distrust and Mistrust,” which explores the distinctions between medical distrust and mistrust and how, for patients from marginalized racial and ethnic groups, they are driven by the history of medical experimentation and substandard care.
- “Racism in Medicine: Race and Pain,” which details the history of racist beliefs about pain tolerance in people of color, specifically in Black people, and how implicit, unconscious bias can affect patient care.
The uses for these courses are many, Dr. Cleveland Manchanda said. One key gap some residency programs may have is that they lack a faculty member with specific health equity expertise. These modules can help.
“If you're in a training institution or a program where you don't have a dedicated faculty member with expertise in teaching about health equity, racism in medicine, and other core topics, then these modules can help support programs and ensure that their trainees are able to meet those competencies,” she said. “We hope that the modules are also useful for faculty who are looking to advance their own understanding.”
The work to achieve health equity across the U.S. health system is vast. Ultimately, Dr. Cleveland Manchanda said, these modules help empower residents to advance racial justice and equity.
“Diversity trainings or implicit-bias trainings don’t really get to some of the root causes of health inequities,” she said. “We’ve created content that helps doctors develop an understanding of structural forces that create inequities. From there we can develop, identify and change policy that perpetuates inequity. We can identify the ways in which it shows up in our institutions and create pathways for redress and restoring trust with the communities that have been harmed. That's what I'm hoping that folks will take away from this.”