Enhancing existing medical school curricula with an innovative healthcare disparities curriculum

Abstract

Background
Effective healthcare disparities curricula seek to train physicians who are well equipped to address the health needs of an increasingly diverse society. Current literature on healthcare disparities curricula and implementation focuses on courses created independent of existing educational materials. Our aim was to develop and implement a novel resource-conserving healthcare disparities curriculum to enhance existing medical school lectures without the need for additional lectures.

Methods
This non-randomized intervention was conducted at the University of California Los Angeles. The curriculum was offered to all first-year medical students in the class of 2021 (n=188). With institutional approval, a new healthcare disparities curriculum was created based on the Society of General Internal Medicine’s core learning objectives for effective healthcare disparities curricula (J General Internal Med 25:S160–163, 2010). Implementation of the curriculum made use of “teachable moments” within existing medical school lectures. Teachable moments were broad lecture topics identified by the research team as suitable for introducing relevant healthcare disparities content. The new lecture-enhancing healthcare disparities curriculum was delivered with the related lecture via integrated PDF documents uploaded to an online learning management system. Students were encouraged to complete pre- and post- course assessments to examine changes in disparities knowledge and self-rated confidence in addressing disparities. Matched χ2 tests were used for statistical analysis.

Results
Participating students (n=92) completed both pre- and post-course assessments and were retrospectively stratified, based on self-reported use of the new lecture enhancing curriculum, into the “high utilizer” group (use of materials “sometimes” or “very often,” n=52) and the comparison “low utilizer” group (use of the materials “rarely” or “very rarely,” n=40). Students who self-identified as underrepresented racial and ethnic minorities in medicine were more likely to utilize the material (41% of the high utilizers vs. 17% of the low utilizer group, p<.01). Post-course knowledge assessment scores and self-reported confidence in addressing healthcare disparities improved only in the high utilizer group.

Conclusions
Integrating new guideline based curricula content simultaneously into pre-existing lectures by identifying and harnessing teachable moments may be an effective and resource-conserving strategy for enhancing healthcare disparities education among first year medical students.

Full text

Treacy‑Abarcaetal. BMC Medical Education (2021) 21:613
https://doi.org/10.1186/s12909‑021‑03034‑7
RESEARCH ARTICLE
Enhancing existing medical school curricula
withaninnovative healthcare disparities
curriculum
Sean Treacy‑Abarca1,2 , Marisela Aguilar1,2, Stefanie D. Vassar3,4, Estebes Hernandez1,5, Neveen S. El‑Farra1,5 and
Arleen F. Brown3,4,6*
Abstract
Background: Effective healthcare disparities curricula seek to train physicians who are well equipped to address
the health needs of an increasingly diverse society. Current literature on healthcare disparities curricula and imple‑
mentation focuses on courses created independent of existing educational materials. Our aim was to develop and
implement a novel resource‑conserving healthcare disparities curriculum to enhance existing medical school lectures
without the need for additional lectures.
Methods: This non‑randomized intervention was conducted at the University of California Los Angeles. The cur‑
riculum was offered to all first‑year medical students in the class of 2021 (n=188). With institutional approval, a new
healthcare disparities curriculum was created based on the Society of General Internal Medicine’s core learning
objectives for effective healthcare disparities curricula (J General Internal Med 25:S160–163, 2010). Implementation of
the curriculum made use of “teachable moments” within existing medical school lectures. Teachable moments were
broad lecture topics identified by the research team as suitable for introducing relevant healthcare disparities content.
The new lecture‑enhancing healthcare disparities curriculum was delivered with the related lecture via integrated
PDF documents uploaded to an online learning management system. Students were encouraged to complete pre‑
and post‑ course assessments to examine changes in disparities knowledge and self‑rated confidence in addressing
disparities. Matched χ2 tests were used for statistical analysis.
Results: Participating students (n=92) completed both pre‑ and post‑course assessments and were retrospectively
stratified, based on self‑reported use of the new lecture enhancing curriculum, into the “high utilizer” group (use of
materials “sometimes” or “very often,” n=52) and the comparison “low utilizer” group (use of the materials “rarely” or
“very rarely,” n=40). Students who self‑identified as underrepresented racial and ethnic minorities in medicine were
more likely to utilize the material (41% of the high utilizers vs. 17% of the low utilizer group, p<.01). Post‑course knowl‑
edge assessment scores and self‑reported confidence in addressing healthcare disparities improved only in the high
utilizer group.
Conclusions: Integrating new guideline based curricula content simultaneously into pre‑existing lectures by
identifying and harnessing teachable moments may be an effective and resource‑conserving strategy for enhancing
healthcare disparities education among first year medical students.
© The Author(s) 2021. Open Access This ar ticle is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or
other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line
to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this
licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco
mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Open Access
*Correspondence: abrown@mednet.ucla.edu
6 UCLA Division General Internal Medicine and Health Services Research,
911 Broxton Plaza, Room 205, CA 90024 Los Angeles, USA
Full list of author information is available at the end of the article
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Page 2 of 7
Treacy‑Abarcaetal. BMC Medical Education (2021) 21:613
Introduction andbackground
Medical school curricula on the healthcare disparities
that disproportionately affect racial and ethnic minor-
ity patients are critical for training well rounded, cultur-
ally sensitive physicians who are equipped to address the
health needs of an increasingly diverse society. Current
medical school curricula largely lack systematic teaching
on evidenced based healthcare disparities topics. Early
exposure to healthcare disparities topics for physicians
in training is important for the goals of providing access
to high quality care to all patient populations and ensur-
ing that healthcare delivery is continuously improved.
Although many have called for systematic introduction
of healthcare disparities curricula in medical education,
there remain limited data on successful strategies for
achieving this goal [1–4]. To promote medical education
reform to better address our society’s health needs, the
Accreditation Council for Graduate Medical Education
and the Liaison Committee on Medical Education have
long advocated for effective healthcare disparities educa-
tion to improve care for underserved patient populations
[1, 2]. Healthcare disparity education has been described
as suboptimal by both faculty and students despite avail-
able guidelines and the evidence of benefits for medical
institutions that such curricula provide [3–5].
Effective healthcare disparity education also has posi-
tive effects for medical schools. Explicit attention to
health disparities in the curriculum may improve recruit-
ment of underrepresented in medicine minority (URM)
students (those identifying racially or ethnically as Afri-
can American and/or Black, Hispanic/Latino, Native
American) [6]. Healthcare disparities curricula can
promote a sense of inclusion for URM students in their
learning environment, contributing to a diversified physi-
cian workforce that is better equipped to care for diverse
patient populations [7–9]. Additionally, healthcare dis-
parities education can more consistently portray minor-
ity populations who may not be represented among
medical school faculty, staff, or students [10, 11]. Com-
prehensive education that includes minority health in a
physician’s formative pre-clinical years improves patient
outcomes [12–14]. However, vague or open-ended
healthcare disparities curricula may impede non-URM
students’ learning and comfort related to healthcare dis-
parities [15]. us, both URM and non-URM students
benefit from healthcare disparities curricula delivered
with well-defined learning objectives.
e Society of General Internal Medicine (SGIM)
Health Equity Commission, formerly the Disparities
Task Force (DTF), proposed an approach for improving
health disparities education in medicine by providing
institutional stakeholders with well-defined learning
objectives for effective healthcare disparities curricula
[16]. ese core objectives include:
1. Understand attitudes such as mistrust, subcon-
scious bias and stereotyping that practitioners and/or
patients may bring to the clinical encounter.
2. Attain knowledge of the existence and magnitude of
health disparities, including the multi-factorial etiol-
ogies of and the multiple solutions required to elimi-
nate them.
3. Acquire the skills to effectively communicate and
negotiate across cultures, including trust-building
and the use of key tools to improve cross-cultural
communication [16].
Vela et al. used Health Equity Commission learn-
ing objectives to implement and evaluate a week-long
course including lectures, small groups, clinic visits and
poster presentations for incoming medical students [13,
17] is robust curriculum improved students’ knowl-
edge and comfort with healthcare disparities. e study
relied on trained, dedicated instructors, a workforce that
may not be available at all institutions. In contrast, sin-
gle standalone lectures and elective courses on healthcare
disparities delivered alongside existing medical lectures
have not been shown to be effective; instead, studies sug-
gest that there may be benefit to diffusing these elements
throughout medical school curricula [18–21]. No studies
have examined whether the content of existing medical
school lectures can provide “teachable moments,” i.e., the
necessary context and opportunity to longitudinally inte-
grate healthcare disparities teaching. Further, few studies
have examined demographic differences in level of inter-
est in disparities curriculum among medical students.
Broadly, our aim was to introduce a new implemen-
tation strategy to integrate guideline-based health-
care disparities content into an existing medical
education curriculum. An important goal of this project
was to address the societal need for physicians who are
well equipped to address healthcare disparities in their
direct service to patients and in their efforts to improve
healthcare systems. To address this gap, we developed,
implemented, and evaluated an innovative healthcare
disparities curriculum and implementation strategy built
upon SGIM Health Equity Commission learning objec-
tives [7, 13]. rough this work, we sought to enhance
Keywords: Healthcare disparities, Medical education, Minority health
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Page 3 of 7
Treacy‑Abarcaetal. BMC Medical Education (2021) 21:613
existing lecture materials in a resource conserving and
sustainable manner through simultaneous delivery of
new content that capitalized on teachable moments.
We sought to evaluate our curriculum’s effectiveness in
teaching healthcare disparities without introducing more
lecture time or requiring additional lecturers.
Methods
Setting andparticipants
All entering first-year medical students at the University
of California, Los Angeles David Geffen School of Medi-
cine (DGSOM) (n=188) in the class of 2021 were pro-
vided access to the new curriculum during the 8-week
introductory course, “Block 1.” Use of the curriculum
was encouraged, but course exams did not include this
content, which allowed us to gauge organic interest in
the material and characteristics of the students who
participated.
Program description
After an initial assessment, research team of students
and institutional leaders, identified the need for a cost
conserving, effective healthcare disparities curriculum.
A wider group of institutional stake holders were briefed
and approved the implementation of an institution-wide
non-randomized intervention. Study research associ-
ates (second and third year medical students) were then
recruited and trained to assist in the development of
the new healthcare disparities curriculum. Training of
research associates consisted of three in-person training
sessions provided by institutional stakeholders to ensure
an understanding of the SGIM Health Equity Commis-
sion’s learning objectives.
e trained research team then evaluated all lec-
tures within the 8-week “Block 1” introductory course
for the presence of teachable moments to integrate
health disparities topics that were selected based on the
SGIM Health Equity Commission’s learning objectives.
Teachable moments were defined as opportunities within
existing lectures where broad topics could be used to
introduce specific healthcare disparities learning objec-
tives. As an example, in a preexisting immunology lec-
ture that addressed the biological mechanisms of asthma,
the lecture was enhanced with content on racial and eth-
nic healthcare disparities in asthma prevalence, morbid-
ity, mortality and environmental exposures. Topics were
introduced using a template based on SGIM guidelines
for healthcare disparities content. Research associates
applied the template to the teachable moments identified
for assigned topics then determined whether there were
two or more available peer-reviewed research studies on
the topic to support health equity enhancement of the
curriculum.
Not all lectures had teachable moments. Within the
8-week course there were six weeks of lectures that were
amendable to enhancement. Lecture-enhancing health-
care disparity teaching materials were developed for 26
lectures of 43 total lectures given during the six-week
period. e amount of content provided based on the
three SGIM learning objectives varied on a week to week
basis, but 213 topics were introduced of which 15.5%
related to objective 1, 54.5% related to objective 2, and
30% related to objective 3 (Table1).
e curriculum was made easily accessible through the
online learning management system, Gryphon, which
contained all medical school course materials. Block 1
course chairs announced the importance of the new lec-
ture-enhancing healthcare disparities materials and how
to access them. All students were encouraged to study the
materials and participate in the curriculum evaluation.
Students were informed that participation was voluntary.
e new healthcare disparities content was provided to
students on Gryphon as PDFs (Supplementary Fig. 1).
No changes to students’ schedule or lectures were made.
Individual involvement of lecturers in the curriculum
varied, but all referenced the availability of the material.
Table 1 Curriculum content stratified by week and core content
Lectures Lectures Enhanced Topic Totals Learning Objective 1 Learning Objective 2 Learning
Objective 3
Mistrust, bias and Stereotyping Existence and
Magnitude of Health
Disparity
Communication
Across Cultures
Week 2 10 6 31 7 (23%) 14 (45%) 10 (32%)
Week 3 9 2 19 4 (21%) 9 (47%) 6 (32%)
Week 4 10 7 73 7 (9.6%) 44 (60%) 22 (30%)
Week 5 6 4 37 3 (8%) 25 (66%) 9 (24%)
Week 6 8 7 53 12 (23%) 24 (45%) 17 (32%)
Total 43 26 (60%) 213 33 (15.5%) 116 (54.5%) 64 (30%)
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Page 4 of 7
Treacy‑Abarcaetal. BMC Medical Education (2021) 21:613
Research design
e study was granted a “Category 1” exemption for
research on the effectiveness of or the comparison among
instructional techniques by the UCLA Institutional
Review Board. Major aims of our project were to exam-
ine the feasibility of utilizing teachable moments, under-
stand the effectiveness of our implementation strategy
in teaching healthcare disparities topics, and gauge stu-
dent interested in the curricular content. We conducted
a non-randomized intervention, comparing participants
who reported use of the material to those who did not
using a difference in differences approach. Given the
exploratory nature of the project and the institutional
stakeholders’ desire to ensure that all interested students
had access to the disparities curriculum, we decided to
forgo traditional randomization and evaluated the inno-
vative curriculum and implementation strategy using a
non-randomized study design.
All students in the DGSOM in the class of 2021
(n=188) were given access to the lecture-enhancing
materials; a subset of students (n=92) completed pre-
and post- course assessments (Supplementary File 1). We
measured students knowledge of healthcare disparities
with 16 true/false knowledge-based questions and exam-
ined their self-reported confidence levels in addressing
healthcare disparities in clinical settings with seven Lik-
ert scale questions. ese evaluation questionnaires were
developed by the lead authors based on past literature
using similar approaches. Such evaluation approaches
are have been effective in assessing healthcare disparities
curricula [13]. At the end of the 8-week course, students
were asked the same questions, but randomly ordered.
Students were tested only on topics and content taught
in new healthcare disparities curriculum. Students self-
reported their use of the new learning materials which
was then used to accomplish our goal of understanding
organic interest in learning about healthcare disparities
and to create comparison groups.
Among the 92 students who completed the assess-
ments, we compared those who reported use of the
disparities material “sometimes” to “very often” on the
post-course assessments (“utilized materials”) to the 40
students who reported that they used the lecture enhanc-
ing material “rarely” or “very rarely” (“did not utilize the
material” n=40). e former were considered to have
been fully exposed to the innovative curriculum and
implementation strategy. e remaining students were
considered the comparison group. e 96 students who
did not were not included in analysis of the curriculum,
and we do not know the extent to which they used the
disparities curriculum material. McNemar’s matched χ2
test was utilized to compare performance on individual
knowledge questions for the “utilized material” group
versus the “did not utilize the material” group. We also
compared aggregated scores for the two groups using two
sample t-test. Statistical analysis utilized predetermined
cut-offs for statistical relevance at p<.05. All analysis was
conducted using STATA version 16.0 (StataCorp, College
Station, Texas).
Results
e participants consisted of 30% URM students and
70% non-URM or other race (Table2). Students who
self-identified as URM were more likely to have utilized
the healthcare disparities material (41% of the high uti-
lizer group compared to 17% of the low utilizer group,
p<.01), while Asian students did not differ in utilization
of the curriculum (40% versus 37%, p<.215), and White
students were more likely to not use the material (46%
versus 15%, p<.001) (Supplementary Table1).
Individual performance on the 16-knowledge based
true/false questions (Supplementary Table 2) and
responses on confidence based Likert questions was used
to generate composite scores for high compared to low
utilizers (Table2). No statistically significant differences
were found between the two groups in the pre-curricu-
lum knowledge. e average composite post-curriculum
knowledge score for the high utilizer group was 79.9%,
compared to 70% in the low utilizer group (p<.001)
(Table2). Composite post-course knowledge scores for
the high utilizer group improved by 10.8% from a base-
line of 69.1%. Pre-course knowledge scores for the com-
parison group did not improve. e high utilizer group
had higher self-reported confidence (“good” or “very
good/excellent”) in addressing healthcare disparities
issues in a clinical setting: 78%, compared to 49% for the
comparison group, p<.02. Almost all respondents (96%)
described the health disparities curriculum as a valuable
learning resource. No data were available for the students
who chose not to complete the assessments (n=96).
Discussion
We present an innovative healthcare disparities cur-
riculum that was implemented in a resource conserving
manner by utilizing “teachable moments” to integrate a
healthcare disparities curriculum into pre-existing medi-
cal school lectures. We observed improved knowledge of
healthcare disparities topics and enhanced self-reported
confidence in addressing these topics in a clinical set-
ting. Both findings suggest that this approach may be
an important tool for medical institutions interested in
advancing equitable healthcare by promoting a height-
ened understanding of healthcare disparities among
trainees.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Page 5 of 7
Treacy‑Abarcaetal. BMC Medical Education (2021) 21:613
Capitalizing on teachable moments is a viable
resource-conserving strategy to implement guideline-
based healthcare disparities curricula like ours. A key to
harnessing teachable moments was use of an established
guideline, a team with knowledge of healthcare dispari-
ties, and administrative stakeholders who facilitated the
project. ese features also are important components to
generalize this work to other institutions in an efficient
and sustainable manner.
An effective healthcare disparities curriculum during a
physician’s formative pre-clinical years has the potential
to contribute to the advancement of equitable healthcare
for underserved populations. e evidence-based health
disparities content in our intervention exposes physi-
cians in training—with varying baseline knowledge and
interest of healthcare disparities—to information that
prepares them to care for patients from underserved
socioeconomic and racial and ethnic backgrounds. In
Table 2 Program evaluation for improvement in student knowledge and confidence post curriculum
Knowledge of
Health Disparities High Utilizers
N = 52 Low Utilizers
N = 40 High vs. Low
Utilizers
Average percent cor‑
rect answers (SD) 69
(15.6) 80 (13.8) 0.001 69
(12.1) 70.0 (14.7) 0.692 0.0013
Abilities & Con-
dence Post- Cur-
riculum
Poor/Fair % Good
%Very Good/ Excel-
lent % Poor/Fair % Good % Very Good/ Excel-
lent % X2 P-Value
Rate your present abil‑
ity to describe some
health disparities
among Blacks/African
Americans in the
United States?
20 53 27 37 57 6 0.048
Rate your present
confidence in address‑
ing health disparities
issues in a clinical
setting?
22 65 13 51 40 9 0.021
Rate your present
ability to describe
some health dis‑
parities among Native
American and Alaskan
Native populations in
the United States?
54 41 4 77 23 0 0.076
Rate your present
ability to describe
some health dispari‑
ties among Hispanic/
Latino populations in
the United States?
22 61 17 37 57 6 0.142
Rate your present
ability to describe the
impact of socio‑
economic status on
disease outcomes?
2 57 41 6 71 23 0.182
Rate your present abil‑
ity to describe impact
of commercially
obtained insurance
and government
health insurance on
health outcomes?
22 72 7 31 69 0 0.220
Rate your present abil‑
ity to describe major
barriers and drivers of
health disparity?
2 70 28 9 71 20 0.332
Composite of 16 True‑
False Questions Pre Correct
%Post Correct
%two sample
t-test p-value
Pre Correct
%Post Correct
%two sample
t-test p-value
two sample
t-test p-value
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Page 6 of 7
Treacy‑Abarcaetal. BMC Medical Education (2021) 21:613
our study, students’ knowledge of healthcare dispari-
ties improved significantly as did their confidence in
addressing these topics in a clinical setting. Incorporating
this information into the curriculum is one step toward
equipping physicians with the tools to address healthcare
disparities and to contribute to solutions for the care of
vulnerable populations.
URM students were more likely to utilize the learn-
ing materials than their non-URM counterparts. Under-
studied areas of medical education include the effects
of healthcare disparities curricula on both the short and
long-term success of URM students. Robust healthcare
disparities curricula may facilitate recruitment of URM
applicants to medical programs [7]. Further work should
examine how healthcare disparities teaching affects URM
student success in medical school and their long term
outcomes. Although non-URM students were less likely
to utilize the material, this finding provides an opportu-
nity for future studies to examine strategies to increase
self-motivated learning about healthcare disparities
among non-URM students, who represent the major-
ity of medical students nationwide. We hope findings
such as ours motivate institutional stakeholders to create
learning environments that ensure students from varying
demographic backgrounds are well versed in the exist-
ence and importance of addressing healthcare disparities.
At the level of institutional stakeholders, our study
builds upon existing approaches that have focused on the
creation of standalone lectures and courses rather than
enhancing existing medical school lectures. One suc-
cessful example of a standalone course, implemented by
Vela etal., delivered an immersive healthcare disparities
curriculum prior to first year course work [13]. Similar to
our curriculum this course was built upon SGIM Health
Equity Commission learning objectives. 8 However, in
contrast we improved students’ knowledge of healthcare
disparities and their confidence in addressing healthcare
disparities without the creation of a standalone course.
ese analyses have some limitations. Our study inten-
tionally used a convenience sample, which allowed us
to study self-motivated learning for healthcare dispari-
ties across a diverse cohort of students. A randomized
controlled trial can provide additional insights into the
impact of the curricular enhancement and teachable
moment approach. An alternate strategy is to promote
participation in voluntary healthcare disparities curric-
ula across all members of the student body. For example,
providing additional benefits to students who voluntar-
ily participate in this program may increase utilization
of these enhanced curricula. is is a single center study,
which limits external validity; however, our student
cohort included substantial numbers of URM in medi-
cine, who are an understudied population in medical
education literature. As this project was an initial pilot
study of the curriculum and implementation strategy,
we made use true-false tests and simple metrics to assess
gains in knowledge and confidence. Future work should
incorporate more complex strategies, such as case-based
evaluation. Continued evaluation during students’ clini-
cal years is also important to study extinguishment/
sustainment of the intervention effect, and longer term
association of the curriculum with student knowledge,
confidence, and attitudes. Finally, additional work should
also be devoted to achieving consensus on core compe-
tencies that all medical students need to address health-
care disparities in their careers.
Conclusions
By harnessing teachable moments and delivering con-
tent that enhances healthcare disparities curriculum
concurrently with traditional lectures through an online
learning management system, we were able to increase
knowledge about healthcare inequities and self-rated
confidence in addressing disparities during the 8-week
course. Integrating these resource conserving approaches
into existing online learning management systems is a
viable strategy for many medical schools. e educa-
tional resources we developed have been made available
to other programs via an open access online repository
that will allow programs to tailor the curricula and strate-
gies to their programs.
Abbreviations
DGSOM: David Geffen School of Medicine; DTF: Disparities Task Force; SGIM:
Society of General Internal Medicine; URM: Underrepresented in Medicine
Minority.
Supplementary Information
The online version contains supplementary material available at https:// doi.
org/ 10. 1186/ s12909‑ 021‑ 03034‑7.
Additional le1.
Additional le2.
Additional le3.
Additional le4. Health Disparities Assessment.
Acknowledgements
We would like to thank Chandra Smart, MD and Bernard Ribalet, PhD for their
permission to conduct the study. Sheri Klein for her technical assistance with
uploading content to online course management system. The David Geffen
School of Medicine Class of 2021 for their participation in the study. Ayman
Ullah and Nivedita Keshav for expansion of the study.
Authors’ contributions
All co‑authors listed below have contributed significantly, agree with the
content of the manuscript, and have approved the manuscript. STA, MA
helped create and implement the intervention. EH, NEF, SV, and AB provided
technical guidance on educational curricula materials and data collection. All
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Page 7 of 7
Treacy‑Abarcaetal. BMC Medical Education (2021) 21:613
•
fast, convenient online submission
•
thorough peer review by experienced researchers in your field
•
rapid publication on acceptance
•
support for research data, including large and complex data types
•
gold Open Access which fosters wider collaboration and increased citations
maximum visibility for your research: over 100M website views per year
•
At BMC, research is always in progress.
Learn more biomedcentral.com/submissions
Ready to submit your research
Ready to submit your research
? Choose BMC and benefit from:
? Choose BMC and benefit from:
authors were responsible for IRB approval, study design, statistical analysis and
interpretation of the data.
Funding
This study was funded by the NIH National Center for Advancing Translational
Science (NCATS) UCLA CTSI Grant Number UL1TR001881 and the David Gef‑
fen Foundation. The funding institutions played no role in the design of the
study, data collection, analysis, interpretation of the data or in writing of the
manuscript.
Availability of data and materials
The datasets used and/or analysed during the current study are available from
the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
Not applicable, no human tissue or clinical data was utilized in this study.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Author details
1 UCLA David Geffen School of Medicine, Los Angeles, USA. 2 UCLA Fielding
School of Public Health, Los Angeles, USA. 3 UCLA Division of General Internal
Medicine & Health Services Research, Los Angeles, CA, USA. 4 Olive View‑UCLA
Medical Center, Sylmar, CA, USA. 5 Department of Medicine, David Geffen
School of Medicine, University of California, Los Angeles, CA, Los Angeles, USA.
6 UCLA Division General Internal Medicine and Health Services Research, 911
Broxton Plaza, Room 205, CA 90024 Los Angeles, USA.
Received: 25 November 2020 Accepted: 24 November 2021
References
1. Groman R, Ginsburg J. Racial and ethnic disparities in health care: a
position paper of the American College of Physicians. Ann Internal Med.
2004;141(3):226–32.
2. Education LCoM: Functions and Structure of a Medical School, Standards
for Accreditation of Medical Education Programs Leading to the MD
Degree. In. Online; 2016.
3. Denton GD, Papp KK. Tackling Some Wicked Problems in Medical Educa‑
tion. J General Internal Med. 2019;34(5):652–3.
4. Mangold KA, Bartell TR, Doobay‑Persaud AA, Adler MD, Sheehan
KM. Expert Consensus on Inclusion of the Social Determinants of
Health in Undergraduate Medical Education Curricula. Acad Med.
2019;94(9):1355–60.
5. Doobay‑Persaud A, Adler MD, Bartell TR, Sheneman NE, Martinez MD,
Mangold KA, Smith P, Sheehan KM. Teaching the Social Determinants of
Health in Undergraduate Medical Education: a Scoping Review. J General
Internal Med. 2019;34(5):720–30.
6. Underreprsented in Medicine Definition. AAMC Executive Committee;
2004. https:// www. aamc. org/ what‑ we‑ do/ equity‑ diver sity‑ inclu sion/
under repre sented‑ in‑ medic ine.
7. Vela MB, Kim KE, Tang H, Chin MH. Improving underrepresented minority
medical student recruitment with health disparities curriculum. J General
Internal Med. 2010;25(Suppl 2):S82‑85.
8. Nivet MA. Commentary: Diversity 3.0: a necessary systems upgrade. Acad
Med. 2011;86(12):1487–9.
9. Freeman BK, Landry A, Trevino R, Grande D, Shea JA. Understanding
the Leaky Pipeline: Perceived Barriers to Pursuing a Career in Medicine
or Dentistry Among Underrepresented‑in‑Medicine Undergraduate
Students. Acad Med. 2016;91(7):987–93.
10. Krishnan A, Rabinowitz M, Ziminsky A, Scott S, Chretien KC: Addressing
Race, Culture, and Structural Inequality in Medical Education: A Guide
for Revising Teaching Cases. Academic Medicine 9000, Publish Ahead of
Print.
11. Dickins K, Levinson D, Smith SG, Humphrey HJ. The minority student
voice at one medical school: lessons for all? Acad Med. 2013;88(1):73–9.
12. Mavis B, Keefe CW, Reznich C. Summer research training programme in
health care disparities. Med Educ. 2004;38(11):1192–3.
13. Vela MB, Kim KE, Tang H, Chin MH. Innovative health care disparities
curriculum for incoming medical students. J General Internal Med.
2008;23(7):1028–32.
14. Daniel H, American College of Physicians W, DC (H.D., Bornstein SS,
Texas Medical Home Initiative A, Texas SSB, Kane GC, Sidney Kimmel
Medical College TJU, Philadelphia, Pennsylvania (G.C.K.). Addressing
Social Determinants to Improve Patient Care and Promote Health Equity:
An American College of Physicians Position Paper. Ann Internal Med.
2020;168(8):577–8.
15. Tsai J, Ucik L, Baldwin N, Hasslinger C, George P. Race Matters? Examin‑
ing and Rethinking Race Portrayal in Preclinical Medical Education. Acad
Med. 2016;91(7):916–20.
16. Ross PT, Wiley Cene C, Bussey‑Jones J, Brown AF, Blackman D, Fernandez
A, Fernandez L, Glick SB, Horowitz CR, Jacobs EA, et al. A strategy for
improving health disparities education in medicine. J General Internal
Med. 2010;25(Suppl 2):S160‑163.
17. Society of General Internal Medicine’s Disparities Task Force: ABIM Dispari‑
ties Module Support. In.; 2010.
18. Gonzalez CM, Kim MY, Marantz PR. Implicit Bias and Its Relation to Health
Disparities: A Teaching Program and Survey of Medical Students. Teach
Learn Med. 2014;26(1):64–71.
19. Dao DK, Goss AL, Hoekzema AS, Kelly LA, Logan AA, Mehta SD, Sand‑
esara UN, Munyikwa MR, DeLisser HM. Integrating Theory, Content,
and Method to Foster Critical Consciousness in Medical Students: A
Comprehensive Model for Cultural Competence Training. Acad Med.
2017;92(3):335–44.
20. Rabinowitz MR, Prestidge M, Kautz G, Bohnett MC, Racicot MJA, Beam M,
Muller BM, Zaman A. Assessment of a Peer‑Taught Structural Compe‑
tency Course for Medical Students Using a Novel Survey Tool. Med Sci
Educator. 2017;27(4):735–44.
21. Ruth A, SturtzSreetharan C, Brewis A, Wutich A. Structural Competency
of Pre‑health Students: Can a Single Course Lead to Meaningful Change?
Med Sci Educ. 2020;30(1):331–7.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in pub‑
lished maps and institutional affiliations.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

1.
2.
3.
4.
5.
6.
Terms and Conditions
Springer Nature journal content, brought to you courtesy of Springer Nature Customer Service Center GmbH (“Springer Nature”).
Springer Nature supports a reasonable amount of sharing of research papers by authors, subscribers and authorised users (“Users”), for small-
scale personal, non-commercial use provided that all copyright, trade and service marks and other proprietary notices are maintained. By
accessing, sharing, receiving or otherwise using the Springer Nature journal content you agree to these terms of use (“Terms”). For these
purposes, Springer Nature considers academic use (by researchers and students) to be non-commercial.
These Terms are supplementary and will apply in addition to any applicable website terms and conditions, a relevant site licence or a personal
subscription. These Terms will prevail over any conflict or ambiguity with regards to the relevant terms, a site licence or a personal subscription
(to the extent of the conflict or ambiguity only). For Creative Commons-licensed articles, the terms of the Creative Commons license used will
apply.
We collect and use personal data to provide access to the Springer Nature journal content. We may also use these personal data internally within
ResearchGate and Springer Nature and as agreed share it, in an anonymised way, for purposes of tracking, analysis and reporting. We will not
otherwise disclose your personal data outside the ResearchGate or the Springer Nature group of companies unless we have your permission as
detailed in the Privacy Policy.
While Users may use the Springer Nature journal content for small scale, personal non-commercial use, it is important to note that Users may
not:
use such content for the purpose of providing other users with access on a regular or large scale basis or as a means to circumvent access
control;
use such content where to do so would be considered a criminal or statutory offence in any jurisdiction, or gives rise to civil liability, or is
otherwise unlawful;
falsely or misleadingly imply or suggest endorsement, approval , sponsorship, or association unless explicitly agreed to by Springer Nature in
writing;
use bots or other automated methods to access the content or redirect messages
override any security feature or exclusionary protocol; or
share the content in order to create substitute for Springer Nature products or services or a systematic database of Springer Nature journal
content.
In line with the restriction against commercial use, Springer Nature does not permit the creation of a product or service that creates revenue,
royalties, rent or income from our content or its inclusion as part of a paid for service or for other commercial gain. Springer Nature journal
content cannot be used for inter-library loans and librarians may not upload Springer Nature journal content on a large scale into their, or any
other, institutional repository.
These terms of use are reviewed regularly and may be amended at any time. Springer Nature is not obligated to publish any information or
content on this website and may remove it or features or functionality at our sole discretion, at any time with or without notice. Springer Nature
may revoke this licence to you at any time and remove access to any copies of the Springer Nature journal content which have been saved.
To the fullest extent permitted by law, Springer Nature makes no warranties, representations or guarantees to Users, either express or implied
with respect to the Springer nature journal content and all parties disclaim and waive any implied warranties or warranties imposed by law,
including merchantability or fitness for any particular purpose.
Please note that these rights do not automatically extend to content, data or other material published by Springer Nature that may be licensed
from third parties.
If you would like to use or distribute our Springer Nature journal content to a wider audience or on a regular basis or in any other manner not
expressly permitted by these Terms, please contact Springer Nature at
onlineservice@springernature.com