Health Care Disparities: a Practical Approach to Teach Residents about Self-Bias and Patient Communication
- 45 Downloads
Studies have shown that the education of resident physicians on health care disparities (HCDs) needs improvement. We implemented a system-wide program on HCD for residents and evaluated outcomes across 1 year. Designed in 2015 by a multidisciplinary team, the HCD program incorporated information about our health system’s patient population and the tenets of unconscious bias. We used the ask-tell-ask model of communication to teach trainees how to identify patients’ barriers to health care. In 2016, resident participants in the HCD program were asked to complete a modified version of the Bonham and Sellers RACE survey, which measures consideration of race in clinical care, at four time-points (pre-, post-, 3-months post-, and 1-year post-intervention). Of 186 PGY2 residents who completed the HCD program, 108 (58%) completed all 4 surveys across 1 year. The modified Bonham and Sellers RACE survey yielded a Cronbach’s alpha of 0.885 and communality for the six questions ranging from 0.543 to 0.727. Using the modified RACE survey, resident respondents showed overall significantly increased consideration of race in clinical care from pre- to post-intervention time-points (p < 0.001). This study of our program on health care disparities showed that resident survey respondents increased self-reported consideration of race in clinical care after the intervention across 1 year.
KeywordsHealth care disparities Bias/stereotyping Personal bias Communication skills Multicultural health Patient safety Patient care Medical education Physician training Community health
We thank members of the multidisciplinary team who developed the framework for the HCD program: Denise White Perkins, MD, PhD, Director of the Institute on Multicultural Health; Mary Voutt-Goos, MSN, RN, CCRN, CPPS, Director of Patient Safety Initiatives, Clinical Care Design and Interpreter Services; Susan Craft, MSA, BSN, RN, Director of Care Coordination Initiatives; Megan Brady, MPH, MSW, Project Manager, Institute on Multicultural Health; and residents Matthew Cerasale, MD, Warren Swegel, MD, Sharmista Dev, MD, Jayne Gardner-Gray, MD, and Kelly Rosso, MD.
The development of the Henry Ford Health System Unequal Care Program was supported in part by the Alliance for Academic Internal Medicine (AAIM) Innovation Grant Program (no. 12807433).
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 1.Agency for Healthcare Research and Quality. 2016 National Healthcare Quality and Disparities Report https://www.ahrq.gov/research/findings/nhqrdr/nhqdr16/summary.html#Key. Accessed 27 June 2018.
- 4.Wagner R, Koh N, Bagian JP, Weiss KB. CLER 2016 National report of findings. Issue brief #4: health care disparities. Accreditation Council for Graduate Medical Education, Chicago, Illinois USA. ISBN-13: 978–1–945365-07-2. http://www.acgme.org/Portals/0/PDFs/CLER/CLER_Health_Care_Disparities_Issue_Brief.pdf. Accessed 4 Feb 2018.
- 5.Taylor YJ, Davis ME, Mohanan S, Robertson S, Robertson MDJ. Awareness of racial disparities in diabetes among primary care residents and preparedness to discuss disparities with patients. J Racial Ethn Health Disparities. 2018;6:237–44.Google Scholar
- 14.VitalTalk. Responding to emotion: articulating empathy using NURSE statements. Available at: https://www.vitaltalk.org/guides/responding-to-emotion-respecting/. Accessed 14 Dec 2018.
- 15.Gallo C. The science behind Ted’s 18-minute rule. https://www.linkedin.com/pulse/20140313205730-5711504-the-science-behind-ted-s-18-minute-rule. Accessed 28 June 2018.