Early impact of a Health Equity, Diversity, and Inclusion curricula on resident knowledge, attitudes and skill in cross-cultural care

Background: Graduate medical education (GME) programs that provide targeted training on the care of disadvantaged populations may result in improved cross-cultural care and decreased health disparities and patient discrimination in the health care system. In 2018, the ACGME highlighted lack of formal education on knowledge and strategies to address health disparities as a national priority need. Currently, many residents do not receive training on structural competencies and biases that contribute to poor health, nor are they equipped with skills to advocate for patients who disproportionately experience inequity from structural and social determinants of health (SDOH). Objective: To examine change in resident knowledge, attitudes and preparedness in management and care of diverse populations after delivery of modules within a Health Equity, Diversity and Inclusion (HEDI) resident curriculum. Design: The HEDI curriculum at Cohen Children’s Medical Center was developed to expand resident training to include sessions on: implicit bias, use of interpreters, health literacy, health disparities, community engagement, LGBTQ health, mistrust, racism, SDOH, cultural and structural competency. Prior to initiation of the curriculum, residents completed the validated Cross-Cultural Care Survey (CCCS). Each month, trainees engage in interactive workshops and case-based simulations. Before and after each session, residents complete a survey to assess their knowledge, skill, and attitudes related to that particular session. Descriptive analyses and Fisher’s Exact Test was used to assess for bivariate associations. Results: Of the 49 residents who completed the CCCS, 67% felt unprepared to deliver cross-cultural care. Approximately 18% identified lack of experience and 30% reported inadequate training as barriers to delivering cross-cultural care. Attendance of at least 1 HEDI session was associated with a decrease in residents’ personal feeling of helplessness when caring for patients of different cultures (p<0.025) and their own dismissive attitudes as a problem in the delivery of cross-cultural care (p<0.05). Conclusion: Early results from the HEDI curriculum demonstrate improvement in preparedness and attitudes in providing better cross-cultural care among residents. Further research is warranted to examine whether the curricular elements provide a long-term, sustained impact on resident knowledge, skills, and attitudes, which are necessary to combat and eliminate health disparities.