Healthcare Disparities: An e-learning course for physicians

Objective: Evidence suggests that unconscious physician bias may be a contributing factor in healthcare disparities. At the same time, physicians are less likely than the general public to recognize the existence of healthcare disparities. This paper presents highlights from an evidence-based e-learning course for physicians that seeks to raise awareness of healthcare disparities and motivate interest in further education and behavior change.

Design: Introduction to Healthcare Disparities (IHD) is a web-based program which uses interactive graphics, quizzes, and self assessments to engage physicians in learning and self-reflection. IHD teaches about the latest evidence on healthcare disparities, with data on preventive, ambulatory, hospital, and nursing home care, invasive procedures, pain treatment, and chronic disease; the significance of healthcare disparities in affecting health outcomes, including denying care to the neediest patients and violating ethical principles such as distributive and procedural justice; the changing meanings of race and ethnicity in healthcare, covering topics such as race and medical experimentation, “ethnic” drugs, and efforts of the U.S. census to track race/ethnicity; the possible causes of healthcare disparities, presenting data on access to care, potential biological causes, patients' values and preferences, providers' bias, and patient-provider relationships; and the medical community's response to the problem of healthcare disparities, suggesting action areas for physicians in their roles as clinicians, educators, advocates, and researchers.

Methods: The educational effectiveness of IHD was evaluated with resident physicians (N = 56) at two Northwest teaching hospitals using a two group, pre-post randomized design. The control group completed an online tutorial of comparable length that was not germane to healthcare disparities.

Results Compared to the control group, the IHD group showed greater improvement in knowledge of healthcare disparities, F(1,54) = 35.08, p< .001. Participant comments indicated that they found the information to be thought provoking and appreciated the discussion of ethics and the history of race/ethnicity. Usage data indicated that the intervention took less than an hour to complete for most users, indicating that IHD is well-suited to a fast-paced medical learning environment.

Conclusions: This is the first course in a proposed series on Healthcare Disparities intended to improve knowledge of racial/ethnic disparities, increase self-awareness of racial attitudes, and enhance skills for patient-provider communication to reduce healthcare disparities that are attributable to the patient-provider relationship. Currently IHD is being hosted by Qualis Health, a Quality Improvement Organization for the states of Washington and Idaho, on their Learning Management System.