Medical School Curriculum Evaluation to Improve Health Equity Education

Abstract

Following the birth of Black Lives Matter, USA medical students advocated for greater commitment to health equity from their schools. In response to such concerns, in 2015, the Yale School of Medicine formed a committee for diversity, inclusion, and social justice and a committee on lesbian, gay, bisexual, transgender, queer, questioning, and intersex affairs. Based on their efforts, our Educational Policy and Curriculum Committee commissioned a student-faculty-led task force to survey the curriculum and make recommendations toward the creation of a health equity curriculum. We conducted a national review of reforms in medical schools’ health equity curricula and reviewed health equity content throughout ours. We then interviewed course directors to assess their perception of the state of health equity education and conducted student focus groups to assess their awareness of structural competency and the efficacy of the existing curriculum. We identified three themes that needed high-quality coverage. The first theme was a critical understanding of difference along various axes of oppression including but not limited to race, class, gender, sexuality, disability, and culture. The second theme was a focus on the impact of difference on the physician-patient relationship, and the third theme was the impact of social structures on health and healthcare. We designed best practices for incorporating health equity into the curriculum, and a plan for a health equity thread spanning all its core components. We identified that classroom teaching is not sufficient, and recommended a required experiential learning practicum responsive to community needs. Lastly, we made recommendations regarding faculty and housestaff health equity education given the critical role they play in undergraduate medical education.