Teaching med students about health disparities builds their confidence

Health disparities--gaps in health and healthcare that mirror differences in socioeconomic status, race, ethnicity and education--remain pervasive in the United States. They are especially pronounced in the Bronx, a racially and ethnically diverse borough with high rates of poverty and disease.

Professional organizations emphasize that learning about health disparities is essential to physician training, but few medical school curricula cover the topic. "We designed an elective course that makes medical students aware of how they may inadvertently contribute to health disparities and of systemic causes of health disparities, and offers them skills for working to reduce them," said Cristina Gonzalez, M.D., M.Ed., Einstein class of 2004, associate professor of clinical medicine at Einstein and attending physician, internal medicine at Montefiore Health System.

Dr. Gonzalez's work as a hospitalist in the division of hospital medicine has made her aware of the need to uncover the social determinants of health and for doctors to become aware of and manage their subconscious biases and advocate for their patients on a regular basis. "Our positive experience with this elective makes it a potential candidate for the required curriculum," added Dr. Gonzalez.

A key element early in the 13-session course was a role-playing vignette of a patient with AIDS and end-stage renal disease who was refusing hemodialysis. "Role playing helped the students recognize their own biases and develop strategies to manage them," said Dr. Gonzalez. Students were later offered instruction in skills such as strategic planning, grass-roots organizing, meeting with legislators and media communications.

Dr. Gonzalez and her team tested 48 students before and after the course. The researchers found that:

• Mean self-reported confidence scores increased significantly between the course's start and its conclusion, from 10.7 to 14.4 on a scale of 16.
• Student knowledge about disparities increased significantly, from an average of 63.6 to 76.4 on a scale of 100.

As their next step, Dr. Gonzalez and her team will assess how their curriculum affects student behaviors in standardized patient encounters. Later they hope to see how students who took the course retain and apply the knowledge during clinical rotations and other patient interactions.