O3008: Combatting Health Disparities Among Critically Ill Children: A Health Equity Curriculum

Background: Health disparities adversely affect health outcomes and are common in the hospitalized child, particularly in the critically ill. The Accreditation Council for Graduate Medical Education (ACGME) charges training programs with implementing curricula that identify social determinants of health (SDH) and address health disparities. There is a paucity of literature on healthcare provider training on structural competencies and biases that contribute to poor health in the critical care setting.

Methods: We created both a longitudinal and “Just-In-Time” (JIT) health equity curriculum at Morgan Stanley Children’s Hospital (MSCH). During their PICU rotation, residents engaged in weekly one-hour interactive sessions that highlight and address health disparities in core topic areas: (1) trauma-informed care, (2) children with medical complexity, (3) challenging conversations. Attending faculty and trainees were invited to participate in a two-hour, virtual simulation workshop that incorporates the three core topic areas into a 40-minute didactic followed by a 20-minute standardized patient (SP) encounter, during which learners are divided into breakout rooms to deliver challenging news, among inequity-driven mistrust, to critical care families. Workshops conclude with a 1-hour facilitator guided-debrief to employ reflection and appreciative inquiry exercises to bridge inequity and build skills in humanistic medicine. Pre- and post- curriculum and simulation surveys were administered.

Results: In the pre-curriculum survey, 90% of residents reported addressing healthcare disparities as an important aspect of pediatric subspecialty care; however, two-thirds reported a perceived lack of subspecialty commitment to creating and distributing health equity curriculum (n=24). From July 2021 through April 2022, 43 of 65 residents participated in the longitudinal PICU-based curriculum. Trainee understanding of health disparities among critically ill children was strongly correlated with perceived preparedness in delivering effective care coordination (rho= 0.76, p< 0.001) and weakly correlated with willingness to incorporate a daily bias mitigation tool in patient and family interactions (rho= 0.36, p< 0.02). 54 out of 80 participants completed the simulation evaluation. Beforehand, despite perceived ability to disclose difficult news, almost 40 percent of attendings did not feel either confident recognizing or comfortable responding to medical distrust in patients and families. Attending physician participation (n=23) significantly increased reported confidence in recognizing and responding to medical distrust among patients and families. Educational value and time allotment was highly rated by all participants.

Conclusion: Health equity training is multi-faceted and valued by trainees and attending physicians. A subspecialty health equity curriculum, both longitudinal and JIT, can equip providers with the tools to confidently provide socially responsive care to critically ill children and families. Further research is needed to evaluate curriculum-associated knowledge and skill retention.