Effectiveness of a social justice curriculum intervention on cultural competency among internal medicine residents

Abstract

There is a nationwide need to include social justice topics in medical education to reduce health disparities of culturally diverse patients. Cultural competence and humility act as a link between historically marginalized racial and ethnic groups and social justice to foster health equity among patients. We implemented a Social Justice in Medicine curriculum in the Internal Medicine residency program to prepare cultural competencies for social justice among residents. We sought to investigate the impact of curriculum implementation on residents’ cultural competency. The social justice in medicine included a variety of educational strategies including online curriculum modules, immersive clinical experiences in continuity clinics, community engagement, a lecture series (Social Determinants of Health, social injustices, resident activism, etc.), and the use of reflective practices (bias assessments, group discussions). We conducted a pre-post quasi-experimental study (July 2023–June 2024) to evaluate the effect of implementation of an educational intervention on competency as measured by the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals—Revised, a 25-item four-point Likert scale. This instrument assesses cultural awareness, knowledge, skill, encounters, and desire. The effect size was summarized with mean difference (MD) and 95% confidence interval (CI). A total of 40 residents participated in the study. Overall 11.7% relative improvement in cultural competency was observed following the intervention (MD = 7.7; 95% CI: 4.72–10.68, p < 0.001). The intervention improved all the domains of competency including awareness (MD = 0.93; 95% CI: −0.02–1.87, p = 0.05), knowledge (MD = 2.20; 95% CI: 1.33–3.07, p < 0.001), skill (MD = 1.90; 95% CI: 1.12–2.68, p < 0.001), encounters (MD = 1.10; 95% CI: 0.23–1.97, p = 0.014), and desire (MD = 1.58; 95% CI: 0.80–2.35, p < 0.001). The implementation of social justice in the medicine curriculum improved the cultural competencies among internal medicine residents in our study. Future longitudinal studies are required to investigate challenges, barriers, and modes of implementation strategies in a larger setting.

Keywords

social justice medical education healthy equity cultural competence

Get full access to this article

View all access options for this article.

References

ABIM Foundation, ACP-ASIM Foundation and European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med 2002; 136(3): 243.

Schiff

Rieth

. Projects in medical education: “social Justice in Medicine” a rationale for an elective program as part of the medical education curriculum at John A. Burns School of Medicine. Hawaii J Med Public Health 2012; 71(4 suppl 1): 64–67.

Beach

Price

Gary

, et al. Cultural competence: a systematic review of health care provider educational interventions. Med Care 2005; 43(4): 356–373.

Betancourt

Green

. Commentary. Linking cultural competence training to improved health outcomes: perspectives from the field. Acad Med 2010; 85(4): 583–585.

IAPCC-R. About the IAPCC-R, https://transculturalcare.net/iapcc-r/ (accessed 9 October 2023).

Caring for Underserved Communities, Warren Alpert Medical School. https://education.med.brown.edu/scholarly-concentrations-program/caring-underserved-communities (accessed 9 October 2023).

Resources for Racial and Social Justice, Harvard Medical School. https://hms.harvard.edu/about-hms/campus-culture/diversity-inclusion/resources-racial-social-justice (accessed 9 October 2023).

Diversity and Health Equity Curricular Requirements and Opportunities, University of Michigan School of Medicine. https://medicine.umich.edu/medschool/education/md-program/curriculum/diversity-health-equity (accessed 9 October 2023).

Race and Social Justice, University of New Mexico. https://ascas.unm.edu/academics/department/race-social-justice.html (accessed 9 October 2023).

10.

Vermont Medicine Magazine, Fostering Socially Conscious Clinicians. http://www.med.uvm.edu/vtmedicine/summer_2021/fostering_socially-conscious_clinicians (accessed 9 October 2023).

11.

Social Justice and Health Equity Curriculum Thread. https://med.stanford.edu/md/discovery-curriculum/social-justice-and-health-equity.html (accessed 9 October 2023).

12.

Mount Sinai Students Recognized for Social Justice Program in East Harlem—Icahn School of Medicine at Mount Sinai. http://www.mssm.edu/about-us/news-and-events/mount-sinai-students-recognized-for-social-justice-program-in-east-harlem (accessed 9 October 2023).

13.

Virginia Mason Franciscan Health Social Justice Curriculum. https://www.vmfh.org/residencies-fellowships-and-training/post-graduate-residency-programs/internal-medicine-residency/social-justice-curriculum (accessed 9 October 2023).

14.

Social Justice and Health Equity Education. https://renaissance.stonybrookmedicine.edu/medicine/residency/curriculum/social_justice_health_equity (accessed 9 October 2023).

15.

Lemieux

Chaturvedi

Juarez Diaz

, et al. The time is now: student-driven implementation of social justice and anti-racism focused curricula in medical scientist training program education. FASEB Bioadv 2021; 3(6): 439–448.

16.

Ambrose

Andaya

Yamada

, et al. Social justice in medical education: strengths and challenges of a student-driven social justice curriculum. Hawaii J Med Public Health 2014; 73(8): 244–250.

17.

Coria

McKelvey

Charlton

, et al. The design of a medical school social justice curriculum. Acad Med 2013; 88(10): 1442–1449.

18.

Stafford

Sedlak

Fok

, et al. Evaluation of resident attitudes and self-reported competencies in health advocacy. BMC Med Educ 2010; 10: 82.

19.

Andrews

Jones

Tetrault

, et al. Advocacy training for residents: insights from Tulane’s Internal Medicine Residency Program. Acad Med 2019; 94(2): 204–207.