Members of the Society of General Internal Medicine (SGIM) recognized the need for an effective module for educating physicians on the underpinnings of health care disparities and ultimately formed the Disparities Task Force (DTF). This group includes volunteers from the Society of General Internal Medicine membership, many of whom have experience teaching ethics, health disparities, and cross-cultural care at their institutions. The contributing faculty were primarily junior and mid-level health professions educators, clinician-educators and clinician-investigators. Over the course of three years, task force members worked in small-groups, participated in conference calls, e-mail exchanges, and in-person meetings to develop the curriculum. A workshop based on the materials and how they might be used in training colleagues to teach with them was proposed and accepted for presentation at the 2008 SGIM national meeting.
The task force selected a train-the-trainer model since the goal was to provide materials and teaching strategies to SGIM members that they could use in their home institutions to increase the number of faculty members prepared to teach about health disparities at the bedside, in small group seminars, and through community-based projects.9,10
Further, as our aim was to develop a model that would be used to train individuals who would later train others, the active learning experience incorporated into this model is critical for developing teaching and improving facilitation skills.11,12
The curriculum as represented in the Train-the-Trainer Guide: Health Disparities Education Guide (2008) is a comprehensive curriculum, consisting of five modules, designed to facilitate developing, implementing and evaluating health disparities education. All participating Task Force members presented topics for inclusion in the curriculum; however considerations were only given to those topics that gave evidence of academic rigor, as evidenced by implementation and evaluation at another institution. These items were then discussed during a retreat and subsequent conference calls to determine the final content included in the curriculum.
Target Audience and Facilitator Skills
We anticipated that this curriculum would be applicable to a variety of health care providers, including physicians, nurses, dentists, and allied health professionals, who are responsible for teaching students in the various health professions. While the materials provide information, which is useful for a variety of learners who have a desire or responsibility to educate others, individuals with limited teaching experience or health disparities knowledge may need additional training to feel comfortable teaching a topic as multi-factorial and complex as health disparities. Although these modules can be used by individuals with varied experienced, optimally those teaching these modules should have prior training or experience employing active learning modalities (e.g., small group discussions, role-plays, and experiential activities). Additionally, we recommend that teachers have experience facilitating discussions on multicultural issues in health care as discussions about cultural difference, race, bias, and disparities can be emotionally charged and often raise complex ethical questions. It is also important to consider the learning environment in which these modules are presented (e.g. specialty, institution, practice, etc.), and allow for appropriate implementation.
The task force aimed to develop a health disparities curriculum to assist faculty who have an understanding of and a commitment to eliminating inequities in health care quality and racial and ethnic health disparities regardless of their level of expertise and knowledge in the area of health disparities.13
We encourage faculty to become familiar with the literature on the causes and scope of health disparities and disparities reduction. Faculty should also be encouraged to become effective facilitators able to lead discussions about health disparities in various settings and teach participants about ways to reduce disparities. Therefore, the task force recommended that faculty teaching health disparities curricula should meet the following learning objectives:
- Understand attitudes such as mistrust, subconscious bias and stereotyping that practitioners and/or patients may bring to the clinical encounter
- Attain knowledge of the existence and magnitude of health disparities, including the multi-factorial etiologies of and the multiple solutions required to eliminate them
- Acquire the skills to effectively communicate and negotiate across cultures, including trust-building and the use of key tools to improve cross-cultural communication
The SGIM Health Disparities Curriculum, which was distributed as a handout for the Disparities Precourse incorporated five modules spanning the various dimensions of health disparities in medical education: Disparities Foundations, Teaching Disparities in the Clinical Setting, Disparities Beyond the Clinical Setting, Teaching About Disparities Through Community Involvement, and Curriculum Evaluation. Each of these modules is briefly described below. The curricular modules can be used individually or collectively and can be delivered over a four-hour time span if run consecutively. Further detail on each module can be found in Table . The modules have been designed to use active, rather than passive, learning styles. Therefore, the majority of activities include participant discussion and interaction.14,15
The curriculum purposely incorporates various educational approaches, including experiential activities, didactic lectures, case presentations, and small group discussions.
The Disparities Task Force presented these modules as one of 14 pre-courses offered at the SGIM Annual Meeting in April 2008 in Philadelphia, PA. Evaluations were completed by 30 of the 32 participants as part of the SGIM annual meeting process and specifically focused on content, delivery and usability of the course materials (See Table ). Those participating in the pre-course were primarily clinical educators and described themselves as having some prior knowledge of the subject, albeit not experts. According to these evaluations, attendees found the content and the novel tools meaningful to their future work.
Disparities Precourse Evaluation Results