The SEQUINS scholars program: a longitudinal curriculum to advance brain health equity education among early career trainees

Abstract

Purpose:

Persistent disparities in neurological health outcomes and healthcare access represents an urgent need to equip future neurologists with the skills to address health inequities. Existing medical education efforts often lack the necessary depth and experiential learning required to effect systemic change. We describe the design, implementation, and evaluation plan for the national, longitudinal SEQUINS Scholars Program, an educational initiative for early-career trainees designed to cultivate health equity knowledge and advocacy skills.

Program Design and Evaluation:

The one-year virtual curriculum is guided by Kolb’s Experiential Learning Theory and emphasizes health equity principles, implicit bias recognition, and community engagement. Key components include seven bi-monthly expert lectures and a capstone project in community engagement, advocacy, or quality improvement at the scholar’s home institution. The program’s evaluation uses a mixed methods approach, combining pre- and post-program self-report surveys to assess changes in knowledge and self-efficacy (with 12-month follow-up), and qualitative focus groups and interviews to explore long-term behavioral change and perceived impact.

Implications:

The SEQUINS Scholars Program represents a novel, action-oriented model that moves beyond didactic teaching to foster health advocacy and quality improvement skills, specifically in the context of neurological care. By documenting and disseminating the program’s outcomes, the long-term goal is to advocate for the formal integration of health equity competencies into medical school and neurological training.

Introduction

A growing body of evidence reveals profound and persistent disparities in neurological health and healthcare delivery [1]. Across numerous studies, inequities have been documented in access to neurologic care, healthcare utilization, and clinical outcomes [1]. Medical education is beginning to respond to these disparities with many U.S. medical schools introducing health equity curricula addressing social drivers of health (SDOH) such as access to care, housing instability, and structural racism [2]. However, most existing initiatives remain limited to small-scale, elective, and classroom-based teaching. While traditional approaches may restrict experiential learning and systems growth [3]., the SEQUINS Scholars curriculum bridges these gaps by shifting from the classroom to longitudinal, community-engaged practice.

The transition from theoretical to experiential learning is a critical prerequisite for the individual-level change required to address multifaceted disparities. The Institute of Medicine has emphasized that mitigating bias requires educating healthcare providers about health inequities and enhancing cross-cultural communication to promote equitable clinical interactions [4]. Empirical evidence supports this approach: increasing providers’ awareness of implicit bias can improve treatment behaviors and reduce disparities in care [5]. Importantly, these educational interventions are most impactful when introduced early, such as during medical training, when professional attitudes and practice patterns are being formed.

Within neurology, these educational gaps are even more pronounced. Formal health equity education is rarely incorporated into neurology residency programs, and understanding health equity is not a core competency required by the American Board of Psychiatry and Neurology (ABPN) [6,7]. As a result, many trainees complete their training without adequate preparation to recognize or address inequities in neurologic care. Yet, evidence demonstrates that when trainees participate in structured health equity curricula, their knowledge and confidence (e.g. self-efficacy) in working with underserved populations increase significantly [2,8]. Moreover, they are empowered to advocate for greater preparation to address racism and bias in clinical practice [9].

To bridge this educational gap, we developed a health equity curriculum to equip neurology residents and medical students with knowledge, skills, and advocacy tools necessary to promote equity in neurological care. The curriculum integrates experiential learning, hands-on advocacy, and community engagement, culminating in a required Capstone project that reinforces continuity, and supports a longitudinal learning process. Together, these components address key limitations of existing curricula. This goal of this structured, experiential curriculum, SEQUINS[10] Scholars, is to prepare the next generation of neurologist leaders to establish an equity-focused healthcare system.

Program framework and curriculum design

The SEQUINS Scholars program is a one-year, virtual, single cohort prospective mixed methods pilot. The program will take place virtually and run under the umbrella of the Society for Equity Neuroscience (SEQUINS).

Theoretical foundation

Curriculum development and theory are guided by the Kolb’s Experiential Learning Theory (ELT) framework [11], (Fig. 1) which postulates that effective learning is ideally achieved by progressing through a cycle of four stages (having an experience, reflecting on the experience, learning from the experience, and trying out what you have learned). Guided by this theory, our trainees will be best prepared to process any implicit biases, isolate health equity problems that motivate them, and craft equity-focused solutions into their personal projects.

Fig. 1.

Application of kolb’s experiential learning theory to the SEQUINS scholars program.

Educator competencies and training

The curriculum is delivered by seven neurologist Course Educators who will receive training in the ELT framework to ensure high-fidelity delivery and minimize variability [11]. Educators were selected based on national recognized expertise in health equity, advocacy, community-based research, global and rural health, and implicit bias training. Beyond content expertise, educators with formal experience in trainee education was prioritized.

Content and external engagement

The evidence-based curriculum utilizes case-based discussions and reflective journaling, utilizing modules from established sources [e.g., American Academy of Neurology (AAN) Anti-racism Education Program and Advocacy Toolkit] [12]. Further, it draws on similar health equity curricula structure for comprehensive application [13–15]. The scholars will be encouraged to attend and watch free recordings of the American Medical Association National Health Equity Grand Rounds Series[16] and Prioritizing Equity Series [17]. The scholars will also have optional “Office Hours” with national health equity and advocacy leaders throughout the year where they will have an informal platform to engage and ask questions. The scholars are also encouraged to foster collaboration, peer mentorship, and socialization amongst themselves with their own “SEQUINS Scholars Socials.” Scholars will be encouraged to read Achieving Equity in Neurological Practice[18] in conjunction with the course for additional insights into neurology specialty specific health care inequities and potential solutions.

National meetings

The scholars will be encouraged to submit science and attend the AAN Annual Meeting where a tailored meeting agenda, created by the AAN Diversity, Equity, & Inclusion Committee[19], will be provided. The scholars will be encouraged to apply for AAN meeting scholarships[20] and the AAN Enhanced Resident Leadership Program[21]. The scholars also will notify their residency programs and medical schools upon acceptance into the program to accommodate and support travel and conference registration. The scholars also will receive a complimentary one-year membership to SEQUINS. They will be encouraged to submit scientific abstracts and attend the annual meeting [22]. They will also be encouraged to apply for AAN Neurology on the Hill[23] and the Palatucci Advocacy Leadership Forum[24] to learn advocacy and leadership skills.

Cohort recruitment and selection

Recruitment will occur through a call for applications (for medical students and neurology residents) distributed through academic departments and professional organizations. Selection will be made by the seven Course Educators who will prioritize diversity across geography (ensuring rural and urban representation), background (including lived experiences and underrepresented identities in medicine[25]), and training level (medical students through senior residents). Educators with a personal connection to an applicant will be removed from reviewing the applicant to maintain objectivity. The program size will be capped at twenty scholars in total: 10 neurology residents and 10 medical students.

Program implementation and requirements

Delivery and participation

The program consists of seven virtual lectures over one year. A certificate of completion requires 75% session attendance; recordings are provided for excused absences to be viewed within one week.

Capstone project

Scholars will be required to complete a project in community engagement, advocacy, or quality improvement at their home institution. They will be asked to secure a local mentor or else be paired with a SEQUINS faculty member if they are unable to identify a local mentor. The expectation will be for the scholar to submit an abstract upon completion of the one-year program with plans to be delivered as a presentation and/or formalized into a manuscript.

Evaluation and data integration

Data collection

The program employs a longitudinal mixed-methods approach.

Quantitative Measures (Scholars Evaluation):

• Instrument: An existing, published, pre- and post-program survey will be adapted (permission obtained from author) [13].

• Metrics: Assess change in knowledge, self-efficacy in health advocacy, awareness of implicit bias, comfort around health disparities, interest in global health, and cross-cultural communication confidence.

• Timing: Pre-program (Baseline), Post-program (End of Year 1), and Longitudinal Follow-Up (12 months post-program).

Qualitative Measures (Program Evaluation):

• Focus Groups: Semi-structured focus groups with scholars and Course Educators post-program to explore program impact, perceived relevance of sessions, and areas for iterative improvement.

• Interviews: Select participants will be invited for 12-month follow-up qualitative interviews to explore how training influenced leadership, clinical decision-making, and long-term engagement in equity efforts.

Process Measures (Feasibility):

• Session attendance (75% required for certificate of completion)

• Capstone project progress (title submission, progress report, final report)

• Project dissemination metrics (abstracts, manuscripts, institutional tools)

Mixed methods integration strategy

The study will utilize an explanatory sequential integration, with a combination inductive-deductive analysis qualitative approach [26]. Focus group and interview transcripts will be analyzed using applied thematic analysis to identify key themes related to program impact, curriculum effectiveness, and barriers/facilitators to implementation. In addition to inductive coding to capture emergent themes, a deductive coding approach[27] will be applied using the Kolb’s Experiential Learning Theory framework as a guiding structure. This framework will inform the development of an initial codebook, allowing data to be systematically examined according to cognitive domains (e.g., knowledge, comprehension, application, analysis, synthesis, and evaluation) to assess learning outcomes and the depth of participant engagement with the curriculum. Qualitative findings will be used to contextualize and explain the “why” behind quantitative score shifts in self-efficacy or knowledge. For example, focus group themes regarding barriers to advocacy will inform the interpretation of survey scores related to comfort with health disparities.

Paired t tests or repeated measures ANOVA will be used to compare pre- and post-program survey scores and assess sustained knowledge and self-efficacy at 12-month follow-up (Table 1).

Table 1.

Evaluation plan, a mixed-methods approach combining quantitative self-report measures and qualitative exploration.

Component	Method/Instrument	Metrics	Timing
Qualitative Measures (Program Evaluation)	Focus Groups: Semi-structured discussions between Scholars and Course Directors Interviews: Individual qualitative interviews with select participants	Explore perceived program impact, relevance of sessions, and areas for iterative improvement Explore perceived program impact, relevance of sessions, and areas for iterative improvement	- Post-program - Longitudinal Follow-Up
Quantitative Measures (Scholars Evaluation)	Pre- and post-program survey	Change in knowledge, self-efficacy in health advocacy, awareness of implicit bias, comfort discussing health disparities, interest in global health, cross-cultural communication confidence	- Pre-program (Baseline) - Post-program - Longitudinal Follow-Up

Outcomes and evaluation

Academic outputs and tracking

For measurable results, academic productivity will be systematically tracked via annual scholar surveys and NIH RePORTER monitoring [28].

• Tracking the number of abstracts accepted at national conferences

• Documenting manuscript submissions and acceptances to peer-reviewed journals

• Documenting leadership roles assumed by graduates

Success will be attributed to the program through “Acknowledgement” sections in publications and unique tracking IDs in our internal database. This language will be made available to the Scholars for use in academic products related to their training.

Educational outreach and scalability

Dissemination efforts focus on the diffusion of the SEQUINS curriculum through both open-access and formal institutional channels.

• Development of an open-access toolkit (facilitator guides, slides, reflection prompts) on the SEQUINS website for replication

• Submission of materials to the AAN Axon Registry[29] and Society of Neurology Chairs’ Graduate Medical Education (GME) committees

• Engagement with GME leadership networks to advocate for curriculum adoption

• Dissemination at local medical schools as structured curricula for practice

Alumni network and long-term sustainability

The establishment of a national alumni network will serve to foster a community of practice, collaboration and mentorship. The network will facilitate quarterly virtual Grand Rounds, peer mentorship pairings, and encourage multi-site research projects. Participation will be measured through annual surveys, attendance rates at virtual events, and the adoption of curriculum elements at home institutions. By creating a continuum of engagement, alumni remain active by serving as mentors for the SEQUINS Associates Program.

The sequins associate scholars track: pipeline development

The Associate Track functions as a strategic “waiting room” to nurture talent and maintain a robust applicant pool. Eligible applicants to the SEQUINS Scholars who are not selected to join the program each year will be invited to participate in the SEQUINS Associate Scholars Program. A comparison of key features of the SEQUINS Associate Scholars Program vs. SEQUINS Scholars Program can be found in Table 2. The goal of the SEQUINS Associate Scholars Program is to retain and engage the broader pool of eligible applicants through a few lower intensity educational opportunities to enhance their knowledge and nurture their continued interest with the expectation that they will reapply to the SEQUINS Scholars Program better prepared in the future.

Table 2.

Program tracks and their corresponding features.

Program Track	Eligibility	Admission	Slots	Duration	Activities	Recognition	Miscellaneous
SEQUINS Scholars Program	Medical students, Neurology residents	Formal application, Review Panel Selection	20	1 year	Bi-monthly lectures about neurological disparities research from leading experts, are exposed to role models to foster their career development and are assigned local mentors to help them complete a capstone project	Certificate of completion	Complimentary SEQUINS membership during time of scholarship Complimentary SEQUINS annual meeting registration during time of scholarship Required virtual attendance at SEQUINS annual meeting Required attendance at AAN to network with other scholars (contingent on availability of funding)
SEQUINS Associate Scholars Program	Medical students, Neurology residents	Formal application, Review Panel Selection	Indefinite	1 year	4 virtual lectures per year	Certificate of participation	Complimentary SEQUINS annual meeting registration during time of scholarship

Discussion

The SEQUINS Scholars program represents a novel and important step in addressing the systemic educational gap surrounding health equity within medical training. By establishing a longitudinal curriculum evaluated through a mixed-methods approach, this program is designed not only to enhance trainees’ knowledge of health equity, but also to foster the essential skills needed for effective health advocacy and community engagement. This structured, action-oriented methodology moves beyond the passive, often didactic, approaches commonly found in medical education by requiring scholars to complete a capstone project at their home institutions. The program’s national reach and expert faculty are directly linked to our evaluative framework. For instance, the geographic diversity of participants allows for the measurement of dissemination of best practices across multiple academic centers. By utilizing a mixed-methods evaluation, we move beyond immediate knowledge acquisition to assess sustained behavioral change and skill development anchored by the required capstone project. While we acknowledge the limitations of self-report surveys, the triangulation of quantitative metrics with qualitative focus groups and interviews serves to mitigate social desirability bias [30].

Equity is a key dimension of quality as defined by the Institute of Medicine[31], and Quality Improvement (QI) methodologies have significant potential to address health care disparities. However, equity is often overlooked in QI initiatives[32–36]. As QI is taught among medical schools and residencies, it is important to ensure that trainees are learning how QI methodologies can be used to improve health equity. Through the SEQUINS Scholars program, trainees are introduced to strategies to ensure that QI projects serve to advance health equity [33,34]. The focus on both clinical bias recognition and systemic advocacy, makes the SEQUINS Scholars model uniquely positioned to prepare the next generation of neurologists to lead change towards equitable care in research and practice.

The curriculum benefits from several key strengths. Its national reach ensures diversity in participant geography and background, facilitating the dissemination of best practices across numerous academic medical centers simultaneously. Furthermore, the inclusion of dedicated, expert faculty provides high-quality content and mentorship across critical domains such as rural health, quality improvement, and implicit bias. The longitudinal nature of the program, anchored by the required capstone project and supported by mixed-methods evaluation, offers a mechanism to assess sustained behavioral change and skill development, not just immediate knowledge acquisition. The SEQUINS model aligns with emerging national movements in GME toward competency-based training. The requirement for scholars to complete a capstone project at their home institutions mirrors the GME shift toward experiential, project-based competency assessment [37,38]. Additionally, beyond immediate self-efficacy, the program is designed to measure long-term career impacts, including health equity-focused scholarly output and leadership roles.

This program also has several limitations that must be acknowledged. Like many educational interventions, the reliance on self-report surveys for quantitative measures introduces the potential for social desirability bias[39], though this is partially mitigated by the triangulation with qualitative data from focus groups and interviews. Finally, the virtual-only format, while necessary for national accessibility, may limit certain in-person networking and community engagement opportunities. However, in person presence at multiple national conferences with equity-focused sessions will allow for networking.

Looking toward future directions, our findings will inform the scalability and replicability of the SEQUINS Scholars model. We plan to iteratively refine the program in future cohorts, integrating feedback to refine the curriculum. This process will be guided by a framework which emphasizes experiential learning and community-based projects, is highly adaptable, and can be replicated by other medical specialties seeking to enhance their health equity training.

Conclusion

Ultimately, the SEQUINS Scholars program aims to demonstrate a scalable and effective model for cultivating the next generation of neurologists as equity leaders. Our long-term goal is to leverage these robust outcomes to advocate for the formal integration of specific health equity competencies, including clinical bias recognition and the application of equity-focused QI strategies, into existing neurology ACGME milestones. Success will be measured by the program’s ability to inform future scalability and the eventual adoption of its curriculum elements into the foundational training requirements of the specialty. By demonstrating a scalable, effective model for cultivating advocates and leaders, the SEQUINS Scholars program aims to leave a legacy that raises the standard of care and professional identity for neurologists.