Pathways to equity: A pilot study implementing a health equity leadership curriculum in residency education as an antidote to systemic racism.

BACKGROUND: Health disparities negatively impact the lives of patients and are a product of the social categorization of medicine. In dismantling the systemic racism and biases that create health disparities, health equity curricula can be implemented that improve resident physician awareness and competency in caring for patients from vulnerable populations. OBJECTIVE: The objective of this study is to assess the impact of a resident-led health equity curriculum on the self-efficacy of family medicine residents in caring for vulnerable populations and managing challenging patient scenarios. METHODS: The Health Equity Leadership Concentration (HELC) curriculum was implemented in the fall of 2019. Residents self-selected their participation in the concentration and completed pre- and 6-month post- implementation surveys on self-efficacy. Deidentified survey data were analyzed with α = 0.05 significance level. RESULTS: Eight residents of 26 residents self-selected to participate (30%) with pre- and post- implementation survey response rates of 100% and 87.5% (HELC) and 66.7% and 88% (general residents). A significant increase in self-efficacy was observed in caring for the uninsured (p=0.007), LGBTQ (P=0.047), and Immigrant (p=0.04) populations and managing food insecurity (p=0.01) after 6 months in the HELC curriculum. No significant increases were seen in the general resident curriculum. HELC residents had a significant increase in self-efficacy in caring for the Medicaid population (p=0.048) in comparison with the general residents. CONCLUSIONS: The HELC was successful in increasing self-efficacy in caring for vulnerable populations and managing challenging patient scenarios at 6-months. Further evaluation is needed for generalizability and determination of true statistical significance.

Could Telehealth Improve Equity During the COVID-19 Pandemic?

In response to the COVID-19 pandemic, many physicians and health care systems have shifted to providing care via telehealth as much as possible. Although necessary to control spread of the virus and preserve personal protective equipment, this shift highlights existing disparities in access and care. Patients without the skills and tools to access telehealth services may increase their risk of exposure by seeking care in person or may delay care entirely. We know that patients need internet access, devices capable of visual communication, and the skills to use these devices to experience the full benefits of telehealth, yet we also know that disparities are present in each of these areas. Currently, federal programs have given physicians greater flexibility in providing care remotely and have expanded internet access for vulnerable patients to promote telehealth services. However, these changes are temporary and it is uncertain which will remain when the pandemic is over. Family medicine physicians have an important role to play in identifying and addressing these disparities and facilitating more equitable care moving forward.