Racial and Ethnic Health Disparities Curricula in US Medical Schools: A CERA Study.

INTRODUCTION: Health disparities among African Americans are an historic and pervasive problem in US health care. We examined the presence, requirements, and content of curricula in US medical schools dedicated to racial and ethnic health disparities. METHODS: We conducted a national CERA survey of Family Medicine department chairs. Chairs were asked about disparities curricula in their institutions. RESULTS: Ninety-two percent reported that their medical school curriculum included focus on racial and ethnic disparities. However, many were dissatisfied with the content and quality of their curricular offerings. There were no significant departmental predictors of the quality of health disparities curricula. CONCLUSION: The majority of medical schools address health disparities in their curricula, but optimally covering this important content remains a persistent challenge in medical school education.

A Curriculum on Care for Complex Patients: Resident Perspectives.

BACKGROUND AND OBJECTIVES: Caring for patients with a challenging mix of medical, psychological, and social problems may easily overwhelm residents. We developed a month-long "Care for Complex Patients" curriculum for second-year residents to improve their ability to care for this group of patients by increasing their understanding of why the care is complex and by building communication, teamwork, and resource management skills. METHODS: Surveys and focus groups were used to assess the impact of the curriculum. Quantitative and qualitative methods were used to evaluate responses. RESULTS: Between 2008 and 2010, 24 residents completed our rotation. Eighty-three percent completed the pre-curriculum and post-curriculum surveys. Residents' self-ratings significantly improved in all 11 complex care management skills, and residents reported increased confidence when working with patients whose care was complex. Residents were surprised to learn about all the community resources and began using these resources when providing care for these patients. Despite rating themselves improved, a large number of residents still rated themselves as not competent in many of the skills. CONCLUSIONS: A curriculum for residents focused on education in 11 key skill areas in the care of complex patients led to increased self-confidence and willingness to provide complex care. However, 1 month of training is an insufficient amount of time to help most learners achieve self-assessed ratings of capable and competent in using these key skills when caring for complex patients.

Medical Student Participation in Family Medicine Department Extracurricular Experiences and Choosing to Become a Family Physician.

BACKGROUND AND OBJECTIVES: Many factors influence a medical student's decision to choose a family medicine career. The impact of participation in extracurricular programs sponsored by family medicine departments is currently unclear. Medical student participation in four University of Washington Department of Family Medicine-sponsored programs (Community Health Advancement Program, Family Medicine Interest Group, Rural Underserved Opportunity Program, and the Underserved Pathway) could be associated with becoming a family physician. METHODS: Demographic data, results from a matriculation career interest survey, records indicating participation in the four extracurricular programs, and Match lists showing the specialty of each graduate were linked. Based on responses to the matriculation survey, graduates were categorized into four levels of initial family medicine interest. Chi-square tests compared both demographic data with initial family medicine interest levels and initial family medicine interest levels with program participation. For residency-matched graduates, odds ratios of matching to family medicine versus other specialties for specific family medicine programs and number of programs were calculated, controlling for demographic variables and initial family medicine interest levels. RESULTS: Older age, female graduates, a rural upbringing, and high level of initial family medicine interest were independently and significantly associated with choosing family medicine. Participation in the Family Medicine Interest Group (OR 2.45) and the Underserved Pathway (OR 4.37) and two or more family medicine programs (OR 2.01--2.22) was significantly associated with entering family medicine. CONCLUSIONS: Certain demographic factors and high initial interest in family medicine is associated with entering the specialty. Some, but not all, family medicine department-sponsored extracurricular programs were associated with choosing family medicine.