Integrating a Health Equity Curriculum for General Surgery Residents: A Mixed-Methods Study.

Background: High-quality patient care necessitates knowledge of health disparities and strategies for cultural humility, yet no widely accepted health equity curriculum is available for general surgery residents. We developed such a curriculum based on adult learning theory and local public health priorities. The format included quarterly cultural complications Morbidity and Mortality conferences, interprofessional panels, and case-based discussions. We aimed to assess the impact of the integration of this curriculum.

Methods: Postsession surveys and focus groups with general surgery residents who participated in the health equity curriculum were assessed at a single academic institution. Open-ended focus group questions were designed to learn more about residents' experiences with the curriculum and the impact it has had on their thinking, clinical practice, and interactions with patients and staff. Transcripts were coded inductively by 2 independent researchers.

Results: About 143 evaluations were collected and twelve residents participated in 2 focus groups. An institutional commitment to the curriculum itself promoted both self-reflection and formal/informal discourse between department members across the surgical hierarchy. Residents described moral distress related to their shortcomings in practicing equitable medicine secondary to systems-level pressures. They felt most empowered when sessions provided them with practical applications to patient care, which was also perceived as a strategy for reaching residents with low buy-in to the curriculum. Residents believe that health equity education must be tailored to the needs and assets of the local community. Noticeably, despite positive survey reviews, residents rarely commented on the impact of the anti-racism sessions.

Conclusions: The implementation of a health equity curriculum for general surgery residents is feasible. Further study is needed to develop health equity curricular content that maximizes direct clinical applicability for surgical trainees as well as personal reflection with particular attention to more challenging topics like anti-racism.