Preparing Medical Students to Address Health Disparities Through Longitudinally Integrated Social Justice Curricula: A Systematic Review

Abstract

Purpose The education of health care professionals is a contributing factor to persistent health disparities. Although medical students are expected to understand racism, classism, and other social and structural drivers of health (SDH), standardization and best practices for teaching these concepts are lacking. Some medical schools are adopting social justice curricula (SJC) that prioritize health equity in teaching students to recognize SDH and preparing them to address the consequent health disparities. This systematic review sought to evaluate how these schools have integrated SJC into their core teaching; the criteria they have used to measure success and to what extent these criteria are met; and best practices in planning, implementing, and evaluating SJC. Method The authors searched 7 databases for English-language studies published between January 2000 and April 2020, reporting on longitudinally integrated SJC at U.S. medical schools intended for all students. Quantitative and qualitative outcomes were synthesized and summarized. Results Searches identified 3,137 articles, of which 11 met inclusion criteria. Results demonstrated schools use a variety of teaching methods over a wide range of didactic hours to teach SJC concepts. Surveys and objective tests indicated students in SJC are generally satisfied and demonstrated improved knowledge and skills related to understanding and mitigating SDH, although findings related to changes in attitudes were equivocal. Evaluations at graduation and in residency demonstrated students who experience SJC are more prepared than their peers to work with patients who are underserved. Best practices in SJC included addressing the hidden curriculum, considering medical mistrust, and using tools like the Racial Justice Report Card and Tool for Assessing Cultural Competence Training. Conclusions These findings indicated SJC can prepare students to better address the root causes of health disparities. Future research should consider the long-term influences of these curricula on students, patients, and the community.

The impact of a student-led anti-racism programme on medical students’ perceptions and awareness of racial bias in medicine and confidence to advocate against racism

“…A further challenge for the students in the current study related to finding time in a busy academic schedule to participate in the programme despite the student-identified necessity of the programme. This highlights the need for medical schools to formally incorporate anti-racism and social justice education into the timetable, the benefits of which have been highlighted in a recent systematic review [ 50 ]. The review demonstrated improved knowledge and skills related to understanding and tackling social injustice amongst medical students and that graduates were better prepared to work with underserved populations when they have dedicated teaching regarding the impact of social injustice on health.…”

The promise and challenges of multi-cancer early detection assays for reducing cancer disparities

“…An intentional effort to build and maintain trust and reduce the impacts of medical mistrust on patient outcomes is needed. Interventions should follow established models of community-academic engagement (20), increase diversity in the biomedical workforce (21), enhance medical school curricula (22), and improve patient-centered communication (23).…”

Development and delivery of justice, equity, diversity, inclusion, and anti-oppression concepts in entry-level health professional education: a scoping review protocol

“…11,15 A growing body of evidence, including the TRC and UNESCO calls to action, suggests JEDI training is needed to give HCPs the knowledge and skills to promote AO and health justice, and deliver culturally safe care for diverse populations to improve health outcomes. 9,10,[15][16][17] Integration of JEDI and AO concepts in health care education can have meaningful impact. For example, in medical schools where social justice is integrated into core curricula, students are more likely to learn about drivers of health disparities, recognize their own biases, and connect patients with appropriate resources.…”

“…For example, in medical schools where social justice is integrated into core curricula, students are more likely to learn about drivers of health disparities, recognize their own biases, and connect patients with appropriate resources. 16 It is necessary for all HCPs to enter practice with an understanding of the benefits of providing culturally safe care. 17 Preparing students in entry-level health care professional programs with the skills to promote JEDI concepts and dismantle oppressive systems and structures can help reduce health disparities, enhance patient satisfaction, and improve intervention compliance and effectiveness.…”

“…A growing body of evidence, including the TRC and UNESCO calls to action, suggests JEDI training is needed to give HCPs the knowledge and skills to promote AO and health justice, and deliver culturally safe care for diverse populations to improve health outcomes 9,10,15–17 . Integration of JEDI and AO concepts in health care education can have meaningful impact.…”