The Role That Graduate Medical Education Must Play in Ensuring Health Equity and Eliminating Health Care Disparities

Abstract

Despite the 2002 Institute of Medicine report that described the moral and financial impact of health care disparities and the need to address them, it is evident that health care disparities persist. Recommendations for addressing disparities include collecting and reporting data on patient race and ethnicity, supporting language interpretation services, increasing awareness of health care disparities through education, requiring cultural competency training for all health care professionals, and increasing diversity among those delivering health care. The Accreditation Council on Graduate Medical Education places strong emphasis on graduate medical education's role in eliminating health care disparities by asking medical educators to objectively evaluate and report on their trainees' ability to practice patient-centered, culturally competent care. Moreover, one of the objectives of the Accreditation Council on Graduate Medical Education Clinical Learning Environment Review visits as part of the Next Accreditation System is to identify how sponsoring institutions engage residents and fellows in the use of data to improve systems of care, reduce health care disparities, and improve patient outcomes. Residency and fellowship programs should ensure the delivery of meaningful curricula on cultural competency and health care disparities, for which there are numerous resources, and ensure resident assessment of culturally competent care. Moreover, training programs and institutional leadership need to collaborate on ensuring data collection on patient satisfaction, outcomes, and quality measures that are broken down by patient race, cultural identification, and language. A diverse physician workforce is another strategy for mitigating health care disparities, and using strategies to enhance faculty diversity should also be a priority of graduate medical education. Transparent data about institutional diversity efforts should be provided to interested medical students, residents, and faculty. Graduate medical education has a clear charge to ensure a generation of physicians who are firmly grounded in the principles of practicing culturally competent care and committed to the reduction of health care disparities.

Achieving Equity in an Evolving Healthcare System: Opportunities and Challenges

“…Maldonado and colleagues report that despite comprising nearly 40% of the total population in the United States, racial and ethnic minorities represent only 12.3% of the nation's physician workforce. 55 Unfortunately, this disparity of underrepresented minorities holds true for most of the clinical health professions workforces (i.e., pharmacy, dentistry).…”

Can a Strategic Pipeline Initiative Increase the Number of Women and Underrepresented Minorities in Orthopaedic Surgery?

“…Healthcare disparities have become a recent focus of literature in the United States [ 2 , 4 , 8 , 9 , 11 , 12 ]. The preparation of a physician workforce that mirrors the gender, racial, and ethnic makeup of the population is an important step toward eliminating these disparities [ 7 ]. The current composition of the physician workforce in the United States has failed to reflect the changes seen in its population.…”

Toward diversity-responsive medical education: taking an intersectionality-based approach to a curriculum evaluation

“…As awareness about the relationship between socio-cultural factors that underlie a patient’s health beliefs and practices and their health outcomes is growing, so is the need for physicians that are competent to provide adequate care to patients of different cultures and backgrounds (Rapp 2006 ; Napier et al 2014 ). Research into this topic suggests that preparing physicians to meet the needs of a diverse population can enhance the quality of patient–doctor interactions, improve health outcomes of marginalized or minority demographics, and reduce health disparities between groups (Dogra et al 2009 ; Awosogba et al 2013 ; Maldonado et al 2014 ). Medical education is considered an important terminal through which culturally competent and diversity-sensitive practices can be integrated into the health care system (Verdonk et al 2009 ; Napier et al 2014 ; Betancourt 2003 ).…”