Effectiveness of a Social Justice Curriculum Intervention on Cultural Competency among Internal Medicine Residents

Abstract

Abstract Introduction: There is a nationwide need to include social justice topics in medical education to reduce health disparities of culturally diverse patients. Cultural competence acts as a link between cultural diversity and social justice to foster health equity among patients. We implemented a Social Justice in Medicine curriculum in the Internal Medicine residency program to prepare cultural competencies for social justice among residents. We sought to investigate the impact of curriculum implementation on residents' cultural competency. Methods The social justice in medicine included a variety of educational strategies including online curriculum modules, immersive clinical experiences in continuity clinics, community engagement, a lecture series (Social Determinants of Health, social injustices, resident activism etc.), and the use of reflective practices (bias assessments, group discussions). We conducted a pre-post quasi-experimental study to evaluate the effect of implementation of an educational intervention on competency as measured by the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals - Revised, a 25-item 4-point Likert scale. This instrument assesses cultural awareness, knowledge, skill, encounters, and desire. The effect size was summarized with mean difference (MD) and 95% confidence interval (CI). Results A total of 40 residents participated in the study. Overall 11.7% relative improvement in cultural competency was observed following the intervention (MD = 7.7; 95%CI: 4.72, 10.68, p < 0.001). The intervention improved all the domains of competency including awareness (MD = 0.93; 95%CI: -0.02, 1.87), p = 0.05), knowledge (MD = 2.20; 95%CI: 1.33, 3.07, p < 0.001), skill (MD = 1.90; 95%CI: 1.12, 2.68, p < 0.001), encounters (MD = 1.10; 95%CI: 0.23, 1.97, p = 0.014), and desire (MD = 1.58; 95%CI: 0.80, 2.35, p < 0.001). Conclusions The implementation of social justice in medicine curriculum improved the cultural competencies among internal medicine residents in our study. Future longitudinal studies are required to investigate challenges, barriers, and modes of implementation strategies in a larger setting.