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    Original Investigation
    Medical Education
    August 10, 2020

    Assessment of Training in Health Disparities in US Internal Medicine Residency Programs

    Author Affiliations
    • 1Mayo Clinic College of Medicine and Science, Rochester, Minnesota
    • 2Icahn School of Medicine at Mount Sinai, Yonkers, New York
    • 3University of Alabama School of Medicine, Birmingham
    • 4Research Center, American College of Physicians, Philadelphia, Pennsylvania
    JAMA Netw Open. 2020;3(8):e2012757. doi:10.1001/jamanetworkopen.2020.12757
    Key Points español 中文 (chinese)

    Question  Are internal medicine residents being trained to address health disparities, and what are their perceptions of such training?

    Findings  This survey study of 227 program directors and 22 723 internal medicine residents in training found that residents’ perceptions of training in health disparities and its quality were not associated with the presence of a curriculum.

    Meaning  These findings suggest that adding health disparities curricula in their current forms may not adequately train residents to address gaps in care.


    Importance  Health disparities continue to exist despite the call to increase education of health care practitioners. An assessment of health disparities education has not been previously studied in a national cohort.

    Objective  To describe and compare the curriculum on health disparities from the perspective of program directors and perceptions of training among internal medicine residents.

    Design, Setting, and Participants  This cross-sectional survey study used a survey of US internal medicine program directors, the 2015 Association of Program Directors in Internal Medicine annual survey, which included questions about health disparities curriculum, and a 1-time survey of US internal medicine residents that asked questions related to their training in health disparities on the American College of Physicians 2015 Internal Medicine In-Training Examination. All internal medicine program directors who were members of Association of Program Directors in Internal Medicine (368 of 396 accredited programs), and internal medicine residents who took the Internal Medicine In-Training Examination were eligible. Final analysis of the merged data set was completed in 2018.

    Exposures  Questions were included on the annual Association of Program Directors in Internal Medicine survey and the Internal Medicine In-Training Examination.

    Main Outcomes and Measures  Program directors reported on presence of health disparities curriculum, educational methods, quality, barriers and challenges to curriculum, and Clinical Learning Environment Review. Residents reported whether they received training and quality of the training in health disparities.

    Results  A total of 227 program directors (response rate, 61.7%) and 22 723 residents (response rate, 87.2%) responded to the surveys. A total of 90 program directors (39.6%) reported a curriculum in health disparities, but among these, only 16 program directors (17.8%) felt quality of their education was very good or excellent. In more than half of the programs (52 programs [55.9%]), outcomes of the curriculum were not measured. After merging, the combined data set included 18 883 residents from 366 APDIM member programs with 225 program director responses. Among these, 13 251 residents (70.2%) reported some training in caring for patients at risk for health disparities. Of residents who reported receiving training, 10 494 (79.2%) rated the quality as very good or excellent.

    Conclusions and Relevance  These findings suggest that that despite the Clinical Learning Environment Review mandate and Accreditation Council for Graduate Medical Education required competencies for training in health disparities, relatively few internal medicine programs in the US provided educational curriculum. Additionally, the existence of health disparities curricula in internal medicine training programs was not associated with resident’s perception of training or its quality.