Improving Colon Cancer Screening by Incorporating a Diversity Equity and Inclusion Curriculum in an Internal Medicine Residency

Abstract

Introduction

Colon cancer causes significant morbidity and mortality in marginalized communities in the United States. Screening can improve outcomes by identifying pre-cancerous and early stage colon cancers allowing for timely intervention. Diversity Equity and Inclusion (DEI) curriculum can increase awareness of health disparities and be a component of a multifaceted strategy to improve health outcomes. We evaluated the impact of a DEI educational intervention upon colon cancer screening rates in an internal medicine residency at an urban university medical center that serves a majority (64%) African-American population.

Methods

Community-based focus groups that included healthcare learners and African-American community members were conducted. Discussions were transcribed and thematic analysis was performed. An internal medicine residency DEI curriculum was developed based upon focus group learnings. Curriculum included education about colon cancer disparities, bias mitigation, social determinants of health, culturally responsive care along with experiential learning through a visit to an African American history museum and community exploration workshop. Colon cancer screening rates during a 2 year period were assessed prior to and following the educational intervention.

Results

Focus groups discussion, involving African-American community members and internal medicine residents, provided the foundation for curriculum development. Barriers impacting colon cancer screening included awareness, insurance status, colonoscopy logistics, fear of cancer or procedures, physician trust and communication. In addition, African Americans, compared to health care learners, more frequently identified racial disparity in health care (p=0.0278), physician respect toward patients (p=0.0278) and inadequate physician communication (p=0.0013). All internal medicine residents during a 1 year period participated in the DEI curriculum. Patient navigation, an identified community need, was incorporated into the colon cancer screening recommendations offered by resident physicians. Colon cancer rates were among 2426 patients seen by physicians increased from 57.8% to 72.3% following the educational intervention.

Discussion

There are a variety of DEI educational strategies that have been designed for resident physicians. However, most of the programs are one-time sessions, although some have spanned over 3 years. The most common assessment of DEI educational strategies has been pre- and post-intervention knowledge testing. There has been limited information about the impact of resident physicians’ patient care. This study was unique because it developed a multifaceted DEI curriculum which resulted in an improvement in colon cancer screening at an urban university medical center. While it can be difficult to directly measure the impact of DEI educational programs on health care delivery, this program highlights the importance of continued efforts to establish interventions that are focused on decreasing disparities in health care and improving clinical outcomes.