P3C203: We Hold These Truths to Be Self-evident: pediatric Populations Are NOT All Treated Equally – a Pediatrics Residency Curriculum for Learning About Healthcare Disparities and Social Determinants Through Clinical Experience

Background: Pediatricians know how to care for individual patients, but in order to create effective change for pediatric populations they must also recognize the influence of systems factors and advocate for change. It is well known that many disparities in health and healthcare outcomes are rooted in social and structural determinants of health (SDH), yet Pediatrics residents and faculty may fail to recognize evidence of this in clinical encounters. Many faculty did not receive formal education in SDH and healthcare disparities (HCD), which can further reinforce the hidden curriculum, perpetuate discrimination, and lead to dissatisfaction among trainees who want to understand how to apply these important subjects in their daily practice.
The Department of Pediatrics (Pediatrics) Residency Program at SIU SOM reviewed their annual graduate medical education survey and found that residents reported a perceived need for increased education around SDH and HCD. This was surprising given that examples of HCD exist in all pediatric subspecialties, but helped identify an important area of program evaluation.

Methods: Pediatrics worked with a resident champion to identify areas where this formal education already existed, including the Advocacy and Palliative Care rotations. In collaboration with the Department of Population Science and Policy (PSP), Pediatrics developed additional curriculum to aid residents and faculty in recognizing opportunities to incorporate these learning issues during all clinical encounters. This included lectures to residents and faculty on HCD and SDH with clinical examples, and a midyear progress review. A faculty development guide was developed to assist in teaching during clinical encounters using common examples like asthma, prematurity, and diaper dermatitis.
PSP also delivered this curriculum during each Pediatrics clerkship, reinforcing the role of residents as teachers of medical students. Surveys were conducted throughout the year to evaluate knowledge, confidence, and teaching.

Results: In the 2020-2021 academic year, residents reported a need for increased education on SDH and HCD, reported on the annual survey as 68% program compliant for “taught about health care disparities,” compared to 84% of all Pediatrics programs nationally.
After these curriculum changes were implemented, in 2021-2022 program compliance rose to 90% (compared to 83% nationally).
Ongoing surveys for residents and students also demonstrated positive receptiveness to teaching these topics.

Conclusion: Identifying HCD and understanding the influence of SDH is essential to creating pediatricians who will effect change, now and in the future. Through small adaptations to increase recognition of integrated curriculum on these topics, in just one year our program was able to assist learners at all levels of medical education to see the clinical correlations between SDH and HCD, and how they can change their practice. Beyond the educational benefits, we know that trainees who understand these concepts are better prepared to practice medicine that is effective and equitable.