Journal of Neurology & Neurophysiology

An Evaluation Of The Feasibility And Effectiveness Of A Health Equity Curriculum For Neurology Residents

Carol Williams^{* *}Correspondence: Carol Williams, Editorial office, Journal of Neurology & Neurophysiology, Brussels, Belgium, Email:

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Introduction

Health inequalities are characterized as preventable, unnecessary, and unfair health discrepancies. Health disparities are defined as "health gaps directly connected to economic, social, or environmental disadvantage" by Healthy People 2020, a US Department of Health and Human Services initiative. "Health disparities adversely affect groups of people who have systematically faced greater obstacles to health based on their racial or ethnic group; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or another characteristic historically linked to discrimination or exclusion," they continue. A growing body of research suggests that there are significant healthcare inequities in neurology. For example, studies have found strong racial and gender disparities in healthcare access, neurology care usage, and health outcomes.

In terms of racial and ethnic inequities, decades of socioeconomic policies entrenched in systematic racism have resulted in structural disadvantages among racial and ethnic minorities, which have disastrous consequences for neurologic health. For example, racial and ethnic minorities had worse management of vascular risk factors and worse clinical outcomes in stroke, owing mostly to socioeconomic determinants of health rather than genetic susceptibility. Structured barriers to healthcare access, as well as unconscious bias on the part of physicians, all contribute to these discrepancies. Patients with low English proficiency who were not seen by a professional medical translator were less likely to get excellent stroke treatment, have delays in acute stroke management, be offered stroke education, or be evaluated for post-stroke rehabilitation. Despite improvements in the availability of IV thrombolysis and mechanical thrombectomy in the previous 10 years, Asian, Black, and Hispanic individuals are still less likely to obtain these treatments for acute stroke. Women were also less likely to undergo thrombolysis and had longer door-to-needle times for acute stroke therapy than males, according to previous research. Even after correcting for race, ethnicity, age, and sex, patients with poorer income and disability have a greater frequency of stroke. Stroke care isn't the only area where neurologic inequities exist. Disparities in drug adherence and surgical care have been seen in epilepsy patients. In the case of movement disorders, Black patients are more likely to have a delayed diagnosis of Parkinson's disease and be started on therapy, as well as being treated by a neurologist or movement disorders specialist or referred for surgical procedures such as deep brain stimulation. There are also gender differences in Parkinson's care, with women being less likely to be treated by a neurologist or to undergo deep brain stimulation surgery.

The Institute of Medicine suggests that practitioners be educated about healthcare inequalities and cross-cultural communication to reduce prejudice in care. Furthermore, enhancing implicit bias awareness has been demonstrated to change provider behavior and minimize healthcare inequalities.

Residents are the future generation of our workforce, therefore education on these issues is very vital for them. Residents also care for a large number of patients from racial and ethnic minorities. For example, at the Hospital of the University of Pennsylvania's resident clinic, up to 40% of patients seen in follow-up are non-white, with 25% being Black. Despite the variety of the patient population for whom residents give care, formal education and training regarding healthcare inequities have been absent in neurology residency programmes, and comprehending health equity is not a core competence necessary for ABPN certification. In the University of Pennsylvania's neurology residency program, we established a oneyear curriculum addressing health disparities to meet this unmet need.

Conclusion

We've published our lessons learned to equip other programs with the resources they need to develop comparable curricula and raise awareness of some of the benefits and pitfalls of doing so. Future measures to properly analyze the efficacy of our programme include a longer curriculum, more systematic resident attendance in lectures, consensus competency indicators, and monitoring of individual resident data during overall years of residency. Tracking resident attendance at specific lectures and comparing statistics between residents who engage in the curriculum and those who do not may assist measure the curriculum's success. On a bigger scale, obtaining patient assessments of their providers, faculty/peer assessments, and an overall improvement in neurological outcomes of patients from various backgrounds is the best approach to analyze the success of this programme.

To ensure resident engagement, programmes should set aside specific protected time free of clinical commitments, as well as make health equality a key competency subject in the neurology residency teaching curriculum.

These topics are important in the education of independent neurologists, but they are even more so in major teaching hospitals where residents' primary clinical responsibilities include caring for underserved communities or where residents volunteer in community health clinics serving marginalised communities. Increasing cultural humility among residents through increasing awareness of issues impacting historically disadvantaged patient communities and accepting that achieving cultural competency may not be a realistic goal because it is hard to be wellversed in all cultures. Our ultimate goal is to develop a clinician workforce that is better prepared to reduce disparities in neurologic care and ensure health equity for all patients regardless of age, sex, race, ethnicity, sexual orientation, gender identity, religious affiliation, geographic location, socioeconomic status, immigrant status, or physical and mental ability by educating residents on health equity. Our experiences with this pilot curriculum suggest that including a health equity curriculum into resident didactics is viable, and residency programmes should explore introducing these curricula, albeit they should ensure that residents have the time to fully engage in these lectures. We see this as a first step in broadening the present core competencies of the American Board of Psychiatry and Neurology by emphasizing disparities in neurological outcomes in historically marginalized populations in the United States.