POSITION PAPER
Recommendations for Teaching about Racial and Ethnic Disparities in Health and Health Care
Wally R. Smith, MD;
Joseph R. Betancourt, MD, MPH;
Matthew K. Wynia, MD, MPH;
Jada Bussey-Jones, MD;
Valerie E. Stone, MD, MPH;
Christopher O. Phillips, MD, MPH;
Alicia Fernandez, MD;
Elizabeth Jacobs, MD, MPP; and
Jacqueline Bowles, MD, MSCE
6 November 2007 | Volume 147 Issue 9 | Pages 654-665
Racial and ethnic minorities often receive lower-quality health care than white patients, even when socioeconomic status, education, access, and other factors are used as controls. To address these pervasive disparities, health care professionals should learn more about them and the roles they can play in eliminating them, but few curricula are focused on understanding and addressing racial and ethnic health disparities, and well-accepted guidelines on what and how to teach in this complex area are lacking.
The Society of General Internal Medicine Health Disparities Task Force used a review and consensus process to develop specific recommendations and guidelines for curricula focusing on health disparities. Learning objectives, content, methods for teaching, and useful resources are provided. Although the guidelines were developed primarily for teaching medical students, residents, and practitioners in primary care, the Task Force's general recommendations can apply to learners in any specialty.
The Task Force recommends that a curricula address 3 areas of racial and ethnic health disparities and focus on the following specific learning objectives:1) examining and understanding attitudes, such as mistrust, subconscious bias, and stereotyping, which practitioners and patients may bring to clinical encounters; 2) gaining knowledge of the existence and magnitude of health disparities, including the multifactorial causes of health disparities and the many solutions required to diminish or eliminate them; and 3) acquiring the skills to effectively communicate and negotiate across cultures, languages, and literacy levels, including the use of key tools to improve communication. The broad goal of a curriculum on disparities should be for learners to develop a commitment to eliminating inequities in health care quality by understanding and assuming their professional role in addressing this pressing health care crisis.
Author and Article Information
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From Virginia Commonwealth University, Richmond, Virginia; Massachusetts General Hospital, Boston, Massachusetts; The Institute for Ethics at the American Medical Association and Stroger Hospital of Cook County & Rush University Medical Center, Chicago, Illinois; Emory University School of Medicine, Atlanta, Georgia; The Cleveland Clinic Foundation, Cleveland, Ohio; San Francisco General Hospital, San Francisco, California; and Sepulveda Ambulatory Care Center, North Hills, California.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Wally R. Smith, MD, Division of Quality Health Care, Medical Director, Center on Health Disparities, Virginia Commonwealth University, Box 980306, 1200 East Broad Street, Room W10W-402, Richmond, VA 23298-0306.
Current Author Addresses: Dr. Smith: Division of Quality Health Care, Center on Health Disparities, Virginia Commonwealth University, Box 980306, 1200 East Broad Street, Room W10W-402, Richmond, VA 23298.
Dr. Betancourt: Massachusetts General Hospital, 50 Staniford Street, Suite 942, Boston, MA 02114.
Dr. Wynia: The Institute for Ethics at the American Medical Association, 515 North State Street, Chicago, IL 60610.
Dr. Bussey-Jones: Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA 30303.
Dr. Stone: General Medicine Unit, Massachusetts General Hospital, Bulfinch 130, 55 Fruit Street, Boston, MA 02114.
Dr. Phillips: Health Services Research Section of Hospital Medicine, E13, Department of General Internal Medicine, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Dr. Fernandez: San Francisco General Hospital, Primary Care Research Center, Ward 95, 995 Potrero Avenue, San Francisco, California 94110.
Dr. Jacobs: Collaborative Research Unit, Stroger Hospital of Cook County & Rush University Medical Center, 1900 West Polk Street, 16th Floor, Chicago, IL 60612.
Dr. Bowles: Sepulveda Ambulatory Care Center, 16111 Plummer Street (00PG), North Hills, CA 91343.
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