Teaching about racial/ethnic health disparities: A national survey of clerkship directors in internal medicine

Background: The Institute of Medicine and the Liaison Committee on Medical Education (LCME) have both identified the importance of integrating teaching regarding health disparities into medical education. Thus far most of the limited teaching in this area occurs in the first two years of medical school. Purpose: The purpose of this study is to evaluate education in internal medicine clerkships about health disparities and understand barriers to including this content. Method: In 2005, the Clerkship Directors in Internal Medicine (CDIM) conducted their annual, confidential survey. The authors asked about clerkship content addressing ethnic/racial health disparities, means for implementing curricula, and barriers to covering disparities content. For each, there were yes/no statements, multiple-choice questions, and free text responses. Results: The survey response rate was 81% (88/109). Forty-one percent indicated that they cover ethnic/racial health disparities in their clerkship. Of these 36 respondents, 50% covered prevalence of disease. Fewer clerkships addressed differences in presentation of disease (33%), health outcomes (24%), and quality of care (19%). Barriers to including health disparities content: limited time in the curriculum (34%), clerkship director lack of expertise (12%), concerns regarding sensitive material (11%), and the opinion that evidence remains controversial (7%). Sixty-one percent of all respondents did feel that the "internal medicine clerk-ship should explicitly address ethnic/racial differences in common medical illnesses"; there was no correlation between clerkship director gender or age and response to this question (chi-square and Mann-Whitney U, respectively; p >.05). Conclusions: Although most internal medicine clerkships do not currently have explicit content about racial/ethnic health disparities, many regard this as essential content. National organizations, such as CDIM, can take leadership through modification of published guides on curriculum objectives and creating opportunities for dissemination of appropriate curriculum.