July 29, 2015--(BRONX, NY)--An innovative three-month elective course has helped make some first-year medical students at Albert Einstein College of Medicine more confident about dealing with health disparities they'll likely encounter as physicians, according to a follow-up study published online today in the journal Academic Medicine.
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.
Read related blog post.
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.
The paper is titled "The Evolution of an Elective in Health Disparities and Advocacy: Description of Instructional Strategies and Program Evaluation." Co-authors were Aaron Fox, M.D., M.S., and Paul Marantz, M.D., M.P.H., both at Einstein and Montefiore.
The study was supported by grants from the Health Resources and Service Administration (D3 EHP16488-03), National Institutes of Health (K23 DA03454, R25 DA023021, 1R25HD068835, 5UL1RR025750, 5KL2RR025749, and 5TL1RR025748) and the Robert Wood Johnson Foundation Amos Medical Faculty Development Program. The authors declare no financial conflicts of interest.
About Albert Einstein College of Medicine of Yeshiva University
Albert Einstein College of Medicine of Yeshiva University is one of the nation's premier centers for research, medical education and clinical investigation. During the 2013-2014 academic year, Einstein is home to 743 M.D. students, 275 Ph.D. students, 103 students in the combined M.D./Ph.D. program, and 313 postdoctoral research fellows. The College of Medicine has more than 2,000 full-time faculty members located on the main campus and at its clinical affiliates. In 2013, Einstein received more than $150 million in awards from the National Institutes of Health (NIH). This includes the funding of major research centers at Einstein in aging, intellectual development disorders, diabetes, cancer, clinical and translational research, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Its partnership with Montefiore Medical Center, the University Hospital and academic medical center for Einstein, advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. Through its extensive affiliation network involving Montefiore, Jacobi Medical Center -- Einstein's founding hospital, and three other hospital systems in the Bronx, Brooklyn and on Long Island, Einstein runs one of the largest residency and fellowship training programs in the medical and dental professions in the United States. For more information, please visit www.einstein.yu.edu, read our blog, follow us on Twitter, like us on Facebook, and view us on YouTube.