Introducing Health Equity Curriculum: Challenges and Opportunities

Abstract

A mandatory course series covering the topics of health equity, social determinants of health, philosophy of disease, and physician advocacy for patients was implemented in 2023. Post-course evaluations indicated that the course was an overall success, yet the M2 class had a uniquely negative reaction to the course.

There has been a recent push in medical education to integrate a focus on health equity into medical education curricula [1, 2]. In a 2018 position paper, the American College of Physicians “recommends that social determinants of health and the underlying individual, community, and systemic issues related to health inequities be integrated into medical education at all levels” [3]. Seeking to amend a curricular gap in this area, Western Michigan University Homer Stryker M.D. School of Medicine (WMed) implemented a new course series, Disease, Disparities, and Justice (DDJ). The course series’ goal is to instill medical students with foundational tools to help achieve optimal health outcomes for all their patients throughout their careers. This paper describes our experience implementing this health equity-focused course sequence.

The DDJ course sequence replaced the Medical Education (MEDU) course sequence, which provided opportunities for career exploration and exploration of topics within medicine and medical education research at different events throughout the academic year. Developed by faculty content experts, DDJ aims to educate students on theories of disease, health disparities, social determinants of health, and the implications they have for how society arranges health care resources (Fig. 1). WMed implemented course one, “What Is Disease?,” (DDJ1) in the fall of 2023. All M1s and M2s were enrolled in the course, while M3s and M4s had the option to either continue with MEDU or enroll in DDJ1. 46 of 84 M3s and 51 of 84 M4s enrolled in DDJ1, which was asynchronous. Student assessments within the course include pass/fail formative assessments to unlock the next unit in the course, as well as a pass/fail summative quiz with a 90% pass threshold. All enrolled students passed the course.

Fig. 1.

Course title and learning objectives for each course in the Disease, Disparities, and Justice Course Sequence

279 students completed a post-course evaluation with a 97% response rate. Three main themes comprised the narrative student feedback: (1) logistical and technical suggestions; (2) positive responses to the course content; and (3) negative responses to the replacement of MEDU with the DDJ course sequence. Positive comments about course content and narrative responses that provided technical, logistical, or organizational feedback for the asynchronous, online course occurred throughout all surveyed classes. These comments indicated that students liked the course content, with one writing that they “thought the content was interesting and enjoyed thinking more critically about the definitions of disease.” Another wrote that the course was “a great dive into the different frameworks of understanding medicine and healthcare,” while yet another indicated that the course content helped them “reflect on my own perceptions of illness and healthcare.” Overall, 68% of M1s, 67% of M3s, and 73% of M4s were explicitly positive about the course.

Notably, negative responses to DDJ1 replacing the MEDU course sequence occurred only in M2 responses. 44% of M2 responses were negative in sentiment and indicated that the course itself was not valuable to practice as a physician. This is notable, as only 9% of M1, 3% of M3, and 2% of M4 comments were negative. M1, M3, and M4 classes found the content and format (asynchronous and virtual) helpful and enjoyable. However, 32% of responses from the M2 class explicitly requested the return of MEDU in lieu of the DDJ course. In the MEDU course sequence, students earned credits by attending MEDU-approved events throughout the term. By hosting MEDU events and getting involved in MEDU-affiliated interest groups, students could bolster their curriculum vitae in preparation for residency applications. M3 and M4 students preferred the content, organization, and time commitment of DDJ1 compared to MEDU, possibly due to the asynchronous aspect of the course and their clinical rotation schedules. One M3 wrote that DDJ was a “great alternative to medu meetings and videos. Loved the interactive experiences,” while an M4 student wrote that they “would choose to do this course again as an alternative to MEDU or just in general.”

Schools interested in implementing a similar course or course sequence should take care to consider how and when the curricular change is implemented. Students in the clinical portion of their medical education found DDJ1 to be useful for thinking about interactions with their patients, indicating that the clinical portion of UME is a good time to implement such a course. However, second year students did not share this positive assessment, primarily for reasons related to how the curriculum fits into their broader goals and interests as medical students. As other medical schools introduce similar curricula, they should consider both the appropriateness of the content and how that content will fit with different cohorts’ broader educational activities.

Declarations

Ethical Approval

This work was determined to not be human research. All data were collected and analyzed in accordance with applicable regulations.

Competing Interests

The authors declare no competing interests.