Abstract
Background:
Crittenton’s 2016 CHNA identified 3 main priorities: (1) obesity/overweight/nutrition/diabetes, (2) mental health, and (3) access to care. Collaborative partnerships are effective in achieving communitywide behavior change and improving population-level outcomes. Curricula that increase resident knowledge about health disparities are an effective strategy for improving understanding about health disparities. Diabetes self-management and education are critical elements of care for people with diabetes and improve patient outcomes.
Methods:
We designed an educational curriculum to increase resident awareness of heath disparities and the hospital’s CHNA/current priority areas, address disparities in diabetes care, and increase referrals for diabetes self-management education (DSME). The family medicine, internal medicine, and transitional year residency programs committed to faculty and resident participation. Educational intervention I included 4 didactic sessions covering health disparities, CHNA, services provided by the hospital’s Diabetes Center/DSME, and resources available through the local chapter of the American Diabetes Association. Pre- and post-didactics session surveys were administered to residents. Educational intervention II was a problem-based learning (PBL) case on health disparities, CHNA, and DSME. Residents completed evaluations of the PBL activity. Data were collected on the number of patient appointments for DSME for periods before the didactics, following the didactics, and following the PBL case.
Results:
More than 90% of residents accurately defined health disparities over 2 years (2015/2016), although there was a slight decrease in 2016. The percentage of residents who knew how to access the CHNA slightly increased in 2016. In the pre- vs post-didactics survey results, no significant differences were found in diabetes practice patterns or knowledge about DSME. The low response rate on the post-didactics survey limits the ability to make statistical inferences. Comparing the effectiveness of didactics to PBL, the PBL had a higher mean but not at a statistically significant level (PBL mean = 3.83; didactics mean = 3.78; P = 0.4). Pre- and post-didactics data show no effect on DSME appointments for patients referred by residents and program faculty. Following the PBL, the rate of DSME appointments nearly doubled.
Conclusion:
Residents arrive at their programs with a good understanding of health disparities, although they may not recognize the disparities that exist in the hospital community in which they practice. Lectures are ineffective in enhancing understanding of community programs/priorities and for applying knowledge. PBL is an effective instructional method for teaching and learning about local health disparities, CHNAs, and DSME.
PROJECT MANAGEMENT PLAN – Health Disparities Educational Initiative for Residents at Crittenton.
| Vision Statement | This project builds on residents’ existing knowledge of health disparities, meaningfully rectifies gaps in resident education about the CHNA and diabetes disparities/services, and triggers resident-driven community interventions and educational initiatives to help reduce healthcare disparities. |
| Team Objectives | The primary objectives of this project were to educate residents on how disparities manifest in the hospital community and how hospital and community resources can be used to address disparities. We planned to raise resident awareness of healthcare disparities in the community in a sustainable way through meaningful participation in educational initiatives, community health, and quality improvement projects. We began with a baseline assessment of resident knowledge about health disparities, the hospital’s CHNA, and diabetes treatment and services. We developed educational interventions including a problem-based learning (PBL) case focused on the hospital’s CHNA and diabetes disparities. |
| Success Factors | The most successful part of our work was the involvement of the residents in the PBL case and the sustainment of the initiative through the GME CLER Council and the Resident Task Force on Health Disparities. A resident suggested using PBL to bridge the gap in knowledge and use of the CHNA, another resident assisted in development of the case, and 9 residents served as small group preceptors for the case. We plan to use the case (or a modified version of it) at our resident orientation to highlight the CHNA and the health disparities in the local community that incoming residents are likely to encounter. We were inspired by the enthusiasm the case generated among the residents and the opportunities for using PBL for other topics. |
| Barriers | The largest barrier was obtaining a sufficient number of responses to voluntary surveys. We worked to overcome this challenge by using results from existing surveys and adding project-related questions to a mandatory survey. Another barrier was related to the continuity of the project because of changes in personnel. |
| Lessons Learned | The single most important piece of advice to provide another team embarking on a similar initiative is to get resident buy-in and keep them involved in the planning and execution of project activities. Also, it is a good idea to continuously think about and plan for scale, spread, replication, and sustainment of the initiative during all phases of the project, including at the outset. |