ABSTRACT
Background
Graduate medical education (GME) focuses predominantly on clinical practice, and some specialties lack effective models for in-depth health care disparities (HCD) education, even though it is required.
Objective
We describe the perspectives and feasibility data of residents, program directors, and community partners across multiple specialties at the Medical College of Wisconsin regarding a community-based HCD curriculum that integrates community outreach with discussion-based educational sessions.
Methods
In academic years 2022-2023 and 2023-2024, first-year residents from 5 and 8 specialties participated in 2 half-day community outreach sessions and 3 half-day educational sessions. Residents (n=99), program directors (n=16), and community partners (n=5) were surveyed for perceptions of and satisfaction with the curriculum. Resident responses to survey questions were aggregated into topic areas. Faculty time, community partner donations, speaker fees, and average cost per resident for food and transportation were calculated for feasibility.
Results
Residents (99 of 129, 77%) reported overall satisfaction with educational sessions (median, 8; IQR, 6-10; 66% survey participation) and outreach experiences (median, 10; IQR, 8-10; 68% survey participation). Program directors (16 of 16, 100% survey participation; median, 9; IQR, 7-10) and community partners (5 of 5, 100% survey participation; median, 10; IQR, 10-10) reported overall satisfaction with the curriculum. Program directors reported satisfaction with logistics (median, 8; IQR, 7-9) and community partners with hosting residents (median, 10; IQR, 10-10). Costs averaged $9 per resident per educational session, and $38 per resident per outreach experience. Faculty time commitment averaged 32 hours per academic year.
Conclusions
This study demonstrates that integrating community engagement into HCD education in residency is feasible and well-received by residents, program leadership, and community partners.
Visual Abstract.
Introduction
The Accreditation Council for Graduate Medical Education Common Program Requirements emphasize the importance of teaching social determinants of health (SDOH) in graduate medical education (GME) to help reduce health care disparities (HCD).1 Faculty and residents alike report that understanding communities they serve is essential to effective medical practice.2,3 However, no standardized HCD curriculum exists, and programs often struggle to sustainably connect community partnerships into SDOH curriculum.3-5
The most effective SDOH-focused curricula combine didactic and experiential learning with authentic community partnerships.6,7 Experiential community-based curricula improve health systems practice,8 resident clinical self-development skills,8 scholarly productivity during residency,9 and introduces residents to patient needs,10 facilitating active learning.11 Furthermore, effective community partnerships enhance clinical training and improve physician adaptability.12
Despite these benefits, barriers exist, including duty hour restrictions and financial constraints.12 Additionally, most published HCD curricula in GME come from primary care, leaving subspecialties with models that may not fully translate to subspecialty training.13 Even for programs committed to HCD education, developing partnerships where community organizations serve as true collaborators can be challenging.
This study describes perspectives of residents, program leaders, and community partners over 2 years of a community-engaged, multispecialty, experiential HCD GME curriculum.
KEY POINTS
What Is Known
Health care disparities (HCD)-focused curricula in primary care specialty training programs can effectively educate residents about strategies to address social determinants of health, although incorporating meaningful community engagement and community-based experiences into residency education remains unstandardized.
What Is New
A single-institution, multispecialty, community-based HCD curriculum achieved high participation and satisfaction among residents, program directors, and community partners. The curriculum was feasible to implement, requiring modest costs and an average faculty commitment of 32 hours annually.
Bottom Line
Residency program leaders could use this model to successfully incorporate community-engaged HCD education with relatively low cost and manageable faculty effort. Partnering with community organizations may be a practical strategy for programs seeking to expand disparities education.
Methods
Setting and Participants
A voluntary HCD curriculum was offered to first-year residents at the Medical College of Wisconsin (MCW) in academic years 2022-2023 (program year [PY]1) and 2023-2024 (PY2). PY1 included anesthesiology, neurology, obstetrics and gynecology, radiation oncology, and general surgery; PY2 added psychiatry, internal medicine, and diagnostic radiology. The HCD curriculum was voluntary so program directors (PDs) decided how they would encourage resident participation. The study team emailed an invitation to all eligible residents with PD approval. Residents provided consent for participation in response to the email (Table 1).
Table 1.
Educational Session and Outreach Participation in Both Program Years (2022-2023 and 2023-2024) of Health Care Disparity Curriculum
| Program Year 1 Specialty | No. Eligiblea | Nb | Educational Session Survey Participation Rate, %c | Outreach Survey Participation Rate, %d |
|---|---|---|---|---|
| Anesthesiology | 19 | 15 | 91 | 100 |
| Neurology | 6 | 1 | 100 | 100 |
| Obstetrics and gynecology | 8 | 3 | 25 | 0 |
| Radiation oncology | 2 | 2 | 100 | 100 |
| Surgery | 18 | 18 | 83 | 100 |
| Program Year 2 Specialty | No. Eligiblea | Nb | Educational Session Survey Participation Rate, %c | Outreach Survey Participation Rate, %d |
|---|---|---|---|---|
| Anesthesiology | 19 | 18 | 78 | 100 |
| Diagnostic radiology | 7 | 2 | 50 | 50 |
| Internal medicine | 10 | 9 | 14 | 50 |
| Neurology | 6 | 2 | 57 | 50 |
| Obstetrics and gynecology | 5 | 5 | 63 | 50 |
| Psychiatry | 8 | 3 | 52 | 50 |
| Radiation oncology | 2 | 2 | 64 | 75 |
| Surgery | 19 | 19 | 87 | 50 |
a Number eligible represents all residents that were enrolled in their respective programs.
b N represents number of residents who completed at least one survey, therefore enrolled in the program.
c Participation rates calculated include those who attended in person or watched recordings and completed a survey.
d Participation rates calculated include those who completed a survey participation in outreach.
PDs and delegates (associate PDs, interim PDs, and core faculty members delegated to represent the PD) and community partners completed end-of-year surveys about their experience. PDs were informed about all curricular components and had access to recorded educational sessions but did not typically attend all sessions or outreach. During the early project phase, PDs identified a need for HCD curriculum involving community engagement and several directors and associate directors joined the planning team. Buy-in was further developed through meetings with the research team and a one-page document describing the curriculum provided. After PY1, feasibility and outcome data were shared to recruit additional programs for PY2.
Interventions
Curriculum Design:
The curriculum was developed iteratively using Backwards Design by an interdisciplinary team, including community-engaged researchers, education-focused PhD researchers, clinicians from multiple subspecialties, community partner organization representatives, and one resident.14 The curriculum included 2 half days of community outreach and 3 half days of discussion-based educational sessions annually (Table 2). The study team used post-session surveys to refine the curriculum. AMEE Guide No. 87 was used as a guide in development of the post-session surveys when appropriate.15 Educational sessions were scheduled to maximize resident availability across all programs. Residents unable to attend in-person educational sessions received a recording to watch asynchronously (Table 1). Asynchronous participants averaged 16% in PY1 and 35% in PY2.
Table 2.
Educational Session Course Offerings for Participants in Program Years 1 (2022-2023) and 2 (2023-2024) of Health Care Disparity Curriculum
| Didactic Course | Program Year 1 | Program Year 2 |
|---|---|---|
| The Historical Context of Health Disparities in Milwaukee—Lecture with facilitated discussion focused on specific historical context for health disparities in Milwaukee | x | x |
| Trauma Informed Care Workshop—Workshop explored methods of how physicians in non-primary care fields can address patient care through understanding trauma and psychosocial needs | x | x |
| Fireside Chat With Community Health Leaders—Facilitated discussion held through 3 Milwaukee community leaders working to bridge the gaps between health care needs and the unhoused | x | |
| Understanding Microaggressions: My Role in Improving Health Inequities—Lecture with examples of microaggressions, how to spot them, and how to effectively address them in the workplace | x | |
| Journaling Time—Time to reflect on learning objectives and write | x | x |
| Going to the Next Level: How Will You Evolve Your Practice in Health Care?—Facilitated discussion to process emotions from outreach experiences and the new historical context they have attained | x | |
| The Refugee Experience Simulation—Workshop simulation experience of a typical refugee in America, and a facilitated discussion of the experience | x | |
| Build a Healthy Culture of Respect and Trust—Lecture on how to build a respectful and empathetic environment | x | x |
| Historical Context of United Community Center and Cultural Connections With Our Hispanic and Latino Communities—Introduction to a community center that primarily serves the Hispanic community of Milwaukee, discussing its roots and services | x | |
| Panel Discussion: Cultural Competence and Holistic Care in Medicine—Panel provided historical context of Indigenous and Hmong populations of Milwaukee | x | |
| Health Care Inequities and Our Future: A Small Group Discussion—Workshop using a nominal group technique style small-group discussion focused on health care inequities within Milwaukee and how they may change their practice as physicians | x | x |
| Introduction to the 414Life Initiative—Introduction to the 414Life Initiative through the City of Milwaukee and Froedtert Hospital | x |
Community Outreach:
Two nonprofit organizations partnered in curriculum planning and outreach: StreetLife Communities and Ascension All Saints Family Health Center Community Garden. Partners received compensatory donations. Residents participated in one half-day outreach with each organization. Community partners who led or co-led outreach experiences with residents were asked to complete end-of-year surveys.
StreetLife Communities provides medical care and survival supplies to those unhoused, sex trafficked, and/or managing addiction. In groups of 7 or fewer, residents joined street outreach teams, distributed supplies, and observed living conditions and medical barriers faced by those served.
Ascension All Saints Family Health Center maintains a community garden located in a Milwaukee food desert, providing direct access to fresh produce. Residents worked in the garden in groups of 15 or more and learned about the organization’s history and partnership with the community.
Outcomes Measured
Residents, PDs and delegates, and community partners were surveyed on satisfaction with logistics and content each year.
Analysis of Outcomes
Resident Surveys:
Residents completed surveys after each educational session (online supplementary data Appendix 1) and outreach experience (online supplementary data Appendix 2). Descriptive statistics summarized quantitative data (Table 3). Open-ended questions were analyzed by 4 researchers using Braun and Clarke’s reflexive thematic analysis.9 Coders independently assigned codes, which were then iteratively compared 4 separate times and finalized through inductive discussion into topics (Table 4).
Table 3.
Resident Survey Results for Educational Session and Outreach Experiences for Both Program Years (2022-2023 and 2023-2024) of Health Care Disparity Curriculum (N=99)
| Educational Session Survey Questions | Median | Mode | IQR |
|---|---|---|---|
| This lecture material/session met the stated objectives.a | 7 | 7 | 6-7 |
| The presenter/presentation was effective.a | 7 | 7 | 6-7 |
| The presenter/presentation was engaging.a | 7 | 7 | 6-7 |
| The pacing of this session/workshop was appropriate.a | 7 | 7 | 5-7 |
| The materials complemented the session/workshop.a | 7 | 7 | 5-7 |
| This session/workshop helped me to think about the world in a different way.a | 6 | 7 | 5-7 |
| This educational experience will change the way that I approach my patients.a | 6 | 7 | 5-7 |
| This educational experience will affect the way that I approach people outside of the hospital.a | 6 | 7 | 5-7 |
| This educational experience should be offered to future trainees.a | 7 | 7 | 5-7 |
| Please rate your overall learning experience with the session/workshop.a | 8 | 10 | 6-10 |
| Please rate your overall satisfaction with the session/workshop.b | 8 | 10 | 6-10 |
| Outreach Survey Questions | |||
| 1. Bonding: I feel closer to my co-residents after this community outreach experience.a | 7 | 7 | 6-7 |
| 2. Confidence: As a result of the community outreach experience, I feel more confident in my ability to care for members of Medical College of Wisconsin’s community.a | 6 | 7 | 5-7 |
| 3. Perspective: The community outreach experience gave me a better sense of the challenges our community faces.a | 7 | 7 | 7-7 |
| 4. Goals: The community outreach experience helped me to set professional and personal goals beyond simply “getting through” residency.a | 7 | 7 | 6-7 |
| 5. Overall, I feel that being able to participate in community outreach is a valuable part of residency.a | 7 | 7 | 7-7 |
| 6. Being able to participate in community outreach as part of my residency makes me feel individually valued by my residency program and Medical College of Wisconsin.a | 7 | 7 | 6-7 |
| 7. On a scale of 1 (low) to 10 (high), please rate your overall learning experience with the outreach experience.b | 9 | 10 | 8-10 |
| 8. On a scale of 1 (low) to 10 (high), please rate your overall satisfaction with the outreach experience.b | 10 | 10 | 8-10 |
a Rated on a 7-point scale (1=strongly disagree, 7=strongly agree).
b Rated on a 10-point scale (1=low, 10=high).
Table 4.
Thematic Analysis of Open Questions on Educational Session and Community Outreach Surveys Offered to Residents After Each Learning Experience in Both Program Years (2022-2023 and 2023-2024) of Health Care Disparity Curriculum (N=99)
| Educational Session Survey Question | Topic | Theme Meaning | Frequency | Resident Quotes |
|---|---|---|---|---|
| What was your favorite thing about this experience? | Socialization | Having discussions and interactions with peers during curriculum was important to residents. | 93 | “I liked that people could share experiences they’ve had with patients. It helped me fill in gaps in experiences that I may not have had.” |
| Growth-centered curriculum | Residents found appreciation of the gravity or importance of material taught, which led to new ideas or deeper understanding of how to serve their community. | 84 | “This was a very thought-provoking lecture, and really helped put into context how unfair or unjust people can be (even unintentionally). This session is VERY important as future physicians!” | |
| Connection with presenter | Having authentic connection or strong engagement with the presenter was important to engagement. | 75 | “The speaker was awesome—people need to hear his stories and experiences. His are not unique. People say things without thinking of implications all the time...” | |
| Cultural awareness | Residents found a deeper understanding of cultures and cultural backgrounds with importance placed on learning about racial disparities, barriers to health care, segregation, and racism. | 52 | “It was very insightful learning about the Hispanic/Latino community and how their culture impacts how they receive health care. It was also interesting seeing similarities with my own Nigerian culture.” | |
| Historical and clinical connections | Content provided much needed historical context of Milwaukee and the community, which led to clinical connections for how to best serve their patients. | 47 | “It was incredibly insightful. I didn’t know anything about the history of Milwaukee and am very glad that I was given the opportunity to learn, to better understand the community.” | |
| What would you change about this experience? | Logistical disruptions | Residents stressed the importance of pacing, structure, proximity, and room and/or technology. | 71 | “I think the room we were in limited the dialogue; possibly smaller groups would help.” |
| Active learning and takeaways | A need for more engaging curriculum with visual aids, practical examples, and tangible actions they can use in the future. | 62 | “Maybe more practical examples and less generalized info.” “Visual aids to accompany the discussion with statistics/numbers to cater to different learning styles.” |
|
| Advanced health disparity education | There was a need for more focus on topics not learned prior to residency that emphasized community partner involvement and discussions about culture and/or cultural differences. | 30 | “I wish we could’ve also had medical professionals from clinics treating primarily these populations to understand how they approach treating them.” | |
| Seriousness | Residents specified the Refugee Simulation felt too gamified and emphasized the importance of seriousness of topics learned. | 6 | “I appreciate the intent of the simulation and agree there’s value in making people uncomfortable to think about the experiences of others. That being said, when ‘gamifying’ the refugee experience a lot is lost in translation.” |
| Community Outreach Survey Question | Topic | Theme Meaning | Frequency | Resident Quotes |
|---|---|---|---|---|
| What was your favorite thing about this experience? | Growth in understanding community partners | Residents grew in their understanding of the community and/or community needs through outreach. | 32 | “All of it. The people we met were incredible. Seeing the harsh realities of what poverty really looks like, learning about current legislation, hearing about addiction in these communities, just remembering to humanize those who experience homelessness. This was such a valuable experience. It is something I will carry with me forever.” |
| Community engagement | Working with or for the community was important to the experience for residents. | 27 | “Great to get out into the community and actually engage with the community.” | |
| Social interaction | Residents expressed value in working alongside peers. | 26 | “Getting to hang out with my co-residents in a setting outside of the hospital while learning more about the people in our city.” | |
| Learning historical context for the health care system | Residents describe learning the history of Milwaukee and making connections from the outreach experience with how community navigate health care. | 19 | “Getting to meet people in Milwaukee and understanding their experiences and how it relates to health.” | |
| What would you change about this experience? | More time | Residents wanted the experience to be longer than a half day. | 21 | “Absolutely no changes, outside of perhaps allowing us to stay for longer. This experience was phenomenal.” |
| Environmental/activity logistics | Residents felt there was a need for more preparation for engaging in activities of community service (clothes to wear, physical labor expectations, how time will be managed, etc). | 16 | “It would have been nice to get more information upfront/before the experience to be prepared, know what to wear, that food would not be provided, etc.” | |
| Community partner context and interactions | Seeing/hearing the mission statement, setup for work, and future ways to get involved were important to residents and residents would like to see this more elevated. | 12 | “It would have been nice to interact individually with other community members to better understand the impact that this organization has had on their life, and also better understand the food insecurity in the local area…” | |
| Institutional support | Residents wanted to see more representation and involvement from our institution. | 4 | “I’m not sure, I think MCW [Medical College of Wisconsin] may be able to collect food donations to aid in delivering goods as well.” | |
| Future opportunity | Some residents felt this inspired them for future opportunities for our program to expand. | 3 | “I think a little intro session regarding the opioid epidemic or Milwaukee history regarding opioids/trafficking could add to the experience but not vital to the experience.” |
Program Director Surveys:
PDs and delegates completed end-of-year Likert scale surveys (online supplementary data Appendix 3) measuring perceptions of HCD curriculum effectiveness and feasibility (Table 5).
Table 5.
Satisfaction Surveys Offered to Program Directors and Affiliates (N=16) and Community Partners (N=5) After Each Program Year (2022-2023 and 2023-2024) of Health Care Disparity Curriculum
| Program Director Survey Questions | Median | Mode | IQR |
|---|---|---|---|
| 1. Community engagement and education on health care disparities and implicit bias are important components of my program’s resident training curriculum.a | 7 | 7 | 7-7 |
| 2. As a result of their community outreach/disparities curriculum, I feel more confident in my trainees’ ability to care for members of Medical College of Wisconsin’s community.a | 6 | 7 | 6.5-7 |
| 3. The community outreach experience/disparities curriculum gives trainees a better sense of the challenges our patients face.a | 7 | 7 | 5-7 |
| 4. The community outreach experience/disparities curriculum will help our trainees to set professional and personal goals beyond simply “getting through” residency.a | 7 | 7 | 5-7 |
| 5. Scheduling nonclinical time for my trainees to participate in community outreach and health care disparities didactics was feasible.a | 6 | 7 | 6-6.5 |
| 6. Please rate your overall satisfaction with the community outreach and health care disparities/implicit bias curriculum.b | 9 | 10 | 7-10 |
| 7. Please rate your overall satisfaction with the logistics of the curriculum (feasibility of scheduling, communication with the project team, etc).b | 8 | 8 | 7-9 |
| Community Partner Survey Questions | |||
| 1. As an organization, we feel valued by the Medical College of Wisconsin and its resident training programs.a | 7 | 7 | 7-7 |
| 2. We believe that the trainees’ community outreach experience with our organization will improve their ability to care for members of our community in the future.a | 7 | 7 | 7-7 |
| 3. We believe that the trainees’ community outreach experience with our organization will give them a better sense of the challenges our community faces.a | 7 | 7 | 7-7 |
| 4. The trainee group and their faculty representatives were respectful of our organization and of the members of our community.a | 7 | 7 | 7-7 |
| 5. Please rate the quality of communication between the study team and your organization.a | 7 | 7 | 7-7 |
| 6. Please rate your overall experience hosting our Medical College of Wisconsin trainees.b | 10 | 10 | 10-10 |
| 7. Please rate your overall satisfaction with the curriculum project.b | 10 | 10 | 10-10 |
a Rated on a 7-point scale (1=strongly disagree, 7=strongly agree).
b Rated on a 10-point scale (1=low, 10=high).
Community Partner Surveys:
Community partners completed end-of-year Likert scale surveys (online supplementary data Appendix 4) measuring perceptions of partnership and curricular effectiveness (Table 5).
Feasibility:
The study team collected data of time requirements per faculty, cost of speakers, food, transportation, and venues for educational and outreach sessions, and donations provided to community partners.
MCW Institutional Review Board approved this study for expedited review (PRO00043861).
Results
Participation
Thirty-nine residents enrolled in PY1 and 60 in PY2 (99 of 129, 77% participation in study), with higher overall survey participation rates in PY1 (Table 1). In total, 129 residents were enrolled in the 8 specialty programs over the 2 years, and 99 of those residents volunteered to engage in the curriculum. Seven PDs and delegates in PY1 and 9 in PY2 (16 of 16, 100% participation in study) and 2 community partner representatives in PY1 and 3 in PY2 (5 of 5, 100% participation in study) completed end-of-year surveys.
Resident Surveys
Educational Session Surveys:
Table 3 outlines descriptive statistics for resident responses to Likert scale questions for educational sessions in PY1 and PY2. Measured on Likert scale 1 (low) to 10 (high), residents reported their overall learning experience (median, 8; IQR, 6-10) and satisfaction with educational sessions (median, 8; IQR, 6-10). Measured on Likert scale 1 (strongly disagree) to 7 (strongly agree), residents reported educational sessions helped them to think differently about the world (median, 6; IQR, 5-7), their patient approach (median, 6; IQR, 5-7), and how they will approach people beyond the hospital (median, 6; IQR, 5-7; Table 3).
We identified 5 topics from resident data as favored experiences for educational sessions, including: socialization (frequency=93), growth-centered curriculum (84), connection with presenter (75), cultural awareness (52), and historical and clinical connections (47), and 4 areas for improvement, including: logistical disruptions (71), active learning and takeaways (62), advanced HCD education (30), and seriousness (6; Table 4).
Outreach Surveys:
Table 3 also presents outreach survey results. Residents rated their learning experience (median, 9; IQR, 8-10) and participation in community outreach (median, 10; IQR, 8-10) on Likert scales of 1 (low) to 10 (high). Measured on Likert scale 1 (strongly disagree) to 7 (strongly agree), residents reported they felt closer to their co-residents (median, 7; IQR, 6-7), valued community outreach (median, 7; IQR, 7-7), and felt valued by their residency program and institution because of their ability to participate in community outreach (median, 7; IQR, 6-7). Residents reported increased confidence in caring for community members (median, 6; IQR, 5-7), better understanding of their patients’ challenges (median, 7; IQR, 7-7), and motivation to set professional and personal goals beyond simply getting through residency (median, 7; IQR, 6-7).
Residents’ favorite aspects of the experience included: growth in understanding community partners (frequency=32), community engagement (27), social interaction (26), and learning historical context for the health care system (19). Topics for suggested improvement included: desire for more time (21), environmental/activity logistics (16), community partner context and interactions (12), institutional support (4), and future opportunity (3). However, most suggested improvement responses stated “nothing” or were blank (67). The most frequent response when residents were asked what they would change about the program was that they wanted it to last longer (21; Table 4). Agendas and learning objectives for educational sessions and outreach experiences are listed in the online supplementary data Appendix 5.
Program Director Surveys
Measured on Likert scale 1 (strongly disagree) to 7 (strongly agree), PDs and delegates, across both academic years (PY1 n=7; PY2 n=9), valued HCD/SDOH education (median, 7; IQR, 7-7) and reported increased confidence in residents’ ability to care for community members (median, 7; IQR, 6.5-7), understand patient challenges (median, 7; IQR, 5-7), and set professional goals beyond simply getting through residency (median, 7; IQR, 5-7). Measured on Likert scale 1 (low) to 10 (high), they report satisfaction with content (median, 9; IQR, 7-10) and logistics (median, 8; IQR, 7-9).
Community Partner Surveys
Measured on Likert scale 1 (strongly disagree) to 7 (strongly agree), community partners, across both years (PY1 n=2; PY2 n=3), reported they felt valued (median, 7; IQR, 7-7), the outreach experience improves residents’ future ability to care for community members (median, 7; IQR, 7-7), residents better understand challenges faced by our community (median, 7; IQR, 7-7), and faculty and representatives were respectful of community partners and members (median, 7; IQR, 7-7). Measured on Likert scale 1 (low) to 10 (high), community partners rated the overall experience of hosting residents (median, 10; IQR, 10-10) and project curriculum satisfaction (median, 10; IQR, 10-10).
Feasibility Data
Curriculum development and maintenance occurred through monthly hour-long meetings. Including delivery of educational sessions and outreach, total annual per faculty time was 32 hours. Costs included community partner donations, community speaker honorariums, resident meals, and transportation to outreach. Community partner compensation totaled $12,566 to pay for donations and speaking time. Food averaged $9 per resident per educational session, and buses to and from each outreach experience averaged $38 per resident.
Discussion
Residents, PDs, and community partners expressed satisfaction with the educational sessions and outreach experience, indicating this curriculum models a feasible approach for community-partnered GME. As a novel strategy, the curriculum incorporated community partner feedback to ensure it was meaningfully co-constructed, promoting programmatic longevity and mutually beneficial community partnerships.12,13 Preliminary success across specialties underrepresented in community engagement literature suggests applicability for HCD as a core residency training component.
Formal HCD curriculum is known to improve resident self-assessment and confidence in HCD knowledge,2,12,16 preparing physicians to effectively practice in diverse settings and communities after residency.12 Our findings confirm prior evidence that experiential community-based learning is effective in achieving the above aims,8,10,11 as our participants reported that outreach increased their confidence in caring for patients and understanding the challenges they face. Training programs must acknowledge their roles in eliminating HCD via curriculum, starting with providing residents a historical understanding of their patients through meaningful curricula and attitudes toward working in underserved areas.17,18 PD and community partner data similarly supported the perspective that this curriculum equipped residents to better address SDOH in the future.
The curriculum’s grounding in community outreach also facilitated resident socialization and bonding during sessions.19 Residents stressed the value of being together and discussing important issues with co-residents, including residents from other subspecialties. This feedback suggests that this study fills a gap in current literature, where curricula typically involve single programs. By having multiple subspecialties participating and learning together, the experience was enhanced.
Although PDs and delegates reported that scheduling nonclinical time for resident community outreach and educational sessions was feasible, clinical demands, night shifts, competing educational requirements, and vacation/sick days sometimes prevented attendance. This suggests that PDs value the curriculum, but logistical barriers persist, particularly when coordinating multiple specialties.
Although these results are promising, this study is limited to one institution practicing in a Midwest metropolitan population across 8 clinical specialties and 2 community partner organizations. Additionally, participation was voluntary, introducing selection bias, as residents and PDs who already valued community outreach were more likely to participate. Study outcomes were self-reported, potentially introducing social desirability bias. If participation had been required, feedback may be more transferable. A robust thematic analysis technique was used to categorize topics from resident responses; however, the richness is limited as data were open-ended survey responses. Data from interviews or focus groups would have been richer and improved the qualitative findings. Finally, although Likert scales were employed to combat survey fatigue and anchored personal opinion of satisfaction as low (1) to high (10), the researchers recognize this strategy introduces subjectivity in participant responses.
Building on our success in fostering community-centered learning, we aim to expand participation beyond first-year residents to other sectors of health care professional education. We would also like to collect more data around sustainability and what long-term partnership value curriculum like this brings to community partners. The curriculum continues within the department of anesthesiology, and the researchers are working with other specialties to determine how to continue the curriculum beyond the pilot period despite aforementioned logistical barriers, as well as newer challenges created by institutional interpretations of Executive Order 14151, which calls for termination of equity-focused programs.20 Our goal is to ensure curricular refinement for sustainable integration into crowded residency schedules via multi-department partnerships.
Conclusions
This study demonstrates that integrating community engagement into HCD education in residency is feasible and well-received by residents, program leadership, and community partners. Resident participants reported satisfaction with the curriculum on a variety of metrics, including improved confidence in understanding SDOH and caring for future patients, along with well-being-related metrics such as social connection.
Supplementary Material
Acknowledgments
The authors would like to acknowledge the contributions of Surgery Resident Christina Georgeades, MD, as an acting consultant to curriculum design. Additionally, the authors would like to acknowledge the significant partnerships and contributions of StreetLife Communities and All Saints Community Garden, as the curriculum created would not have been possible without their guidance, feedback, and outreach experiences.
Author Notes
Funding: Support was provided for this study through the Advancing a Healthier Wisconsin Endowment within the Medical College of Wisconsin.
Conflict of interest: The authors declare they have no competing interests.
Disclosure: AI was not used in writing this article.
Editor’s Note
The online supplementary data contains the surveys used in the study and the multispecialty health care disparities curriculum learning objectives and agendas.
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