Crittenton Hospital Medical Center/Wayne State University, Rochester Hills, MI
Health Disparities Educational Initiative for Residents at Crittenton Hospital Medical Center

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.