Stopping Discrimination Before it Starts: The Impact of Civil Rights Laws on Healthcare Disparities - A Medical School Curriculum

Publication ID Published Volume
7740 December 7, 2009 15

Abstract

This curriculum is a joint project of the National Consortium for Multicultural Education for Health Professionals, Stanford University School of Medicine, and the U.S. Department of Health and Human Services Office for Civil Rights. Some aspects of culturally competent care including access for limited English proficient persons and non-discrimination in healthcare on the basis of race, color, or national origin are not only essential for delivering high-quality care, but may be legally required.

This curriculum introduces medical students to Title VI of the Civil Rights Act of 1964, the law that prohibits recipients of federal funds, including hospitals that participate in the Medicare program, from discriminating on the basis of race, color or national origin. Through role-playing and discussion during an extensive hypothetical exercise, students not only learn about possible discriminatory actions under Title VI, but also gain new appreciation for the role that physicians can play as leaders in the broader public policy arena regarding healthcare disparities and discrimination. The content is presented in a 2 or 3-hour workshop aided by a detailed slide-by-slide facilitator guide including talking points, followed by a post-workshop assessment tool. This curriculum has a significant legal component. Medical schools considering use of this module may wish to consider partnering with their law school counterparts to co-present the material. Alternatively, medical schools may wish to contact the co-authors (see US Department of Health and Human Services Office for Civil Rights staff listed above). HHS Office for Civil Rights has regional offices across the country, and several of these offices are already partnering with medical schools to assist in presenting the curriculum. Also, the curriculum features a 6-minute film excerpt from the film series "Worlds Apart: A Four-Part Series on Cross-Cultural Health Care. The excerpt features Robert Phillips, an African American dialysis patient, who movingly describes his perceptions regarding encounters with healthcare providers. For copyright reasons, the excerpt could not be included in the MedEdPORTAL materials. However, Fanlight Productions has authorized showing the 6-minute excerpt in connection with presenting this curriculum. Copies of the Worlds Apart series may be purchased from Fanlight Productions (see www.fanlight.com). It should be noted, however, that although the excerpt is an excellent tool to inspire reflection and serves as an engaging visual segue into the curriculum's discussion of healthcare disparities, it is not critical to the success of the curriculum. The facilitator's guide consists of slide-by-slide details including talking points and background information to complement the workshop. Appendix A of the facilitator's guide is the workshop-specific assessment form for participants to self-assess after the workshop, but is not necessary for implementation.

This workshop addresses a missing link in medical school education. Students typically are exposed to the existence of healthcare disparities, but are rarely made aware of federal civil rights laws that impact the institutions where they practice. Through this curriculum, participants learn that healthcare providers have a role in identifying, preventing and addressing Title VI violations. The workshop has been modified based on participant feedback from prior pilot presentations.

To download the corresponding hypothetical case (non peer-reviewed), please visit: http://culturalmeded.stanford.edu/teaching/hypothetical.html.

This workshop was presented at the Maya Angelou Center for Health Equity at Wake Forest University School of Medicine in September 2008. The workshop was successful in exploring potential violations of Title VI of the Civil Rights Act of 1964 in healthcare settings. After learning about Title VI, and about the causes of health disparities including unequal access to healthcare, compromised patient-physician interaction, and racial bias/discrimination, as well as actual clinical differences - participants had the opportunity through role-playing to apply Title VI principles to a hypothetical case.

The hypothetical exercise served as a springboard to discussion, inspiring participants to share personal experiences regarding healthcare disparities and discrimination. A rich discussion ensued about the potential role of physicians in the broader public policy debate regarding these issues. Of 40 participants ranging from medical and dental students to clinician educators, 24 assessed their knowledge, skill, and attitude changes post-workshop (5-point scale, low to high), with significant self-assessed increases in knowledge in all domains. Participants noted high satisfaction (mean score 4.5), in addition to increases in knowledge of health and healthcare disparities, Title VI, and the role of the Office for Civil Rights (mean scores 3.8, 4.0, 4.8, 4.0, respectively). Participants also felt that the workshop improved their abilities to identify, prevent, and address Title VI violations (mean scores 4.6, 4.3, 4.3, respectively), and noted moderate change in attitude about physicians' roles (mean score 3.8). In addition, participants rated the impact of the workshop highly on both their likelihood of considering potential Title VI issues in their practice, educational setting, and home institution (mean score 4.7) and of teaching others about Title VI (mean score 4.4).

Citation

Bereknyei S, Foran S, Johnson K, Scott A, Miller T, Braddock III C. Stopping discrimination before it starts: the impact of civil rights laws on healthcare disparities - a medical school curriculum. MedEdPORTAL Publications. 2009;5:7740. http://dx.doi.org/10.15766/mep_2374-8265.7740

Educational Objectives

  1. To be able to discuss the relevance of civil rights law to healthcare practice.
  2. To be able to describe the current extent of health disparities.
  3. To be able to identify and address potential discrimination under Title VI of the Civil Rights Act of 1964.
  4. To be able to apply the law to hypothetical healthcare scenarios.
  5. To be able to understand how the HHS Office for Civil Rights (OCR) enforces Title VI through investigations and technical assistance to healthcare providers and entities.

Keywords

  • Title VI Violations, Prejudice, Civil Rights, Social Justice, Discrimination, Health Disparities, Bias, Federal Law, Health Equity Research

Prior Scholarly Dissemination

References

Bereknyei S, Braddock CH, Johnson K, Foran S. (November, 2007) Fostering Compliance of Title VI of the Civil Rights Act: An Educational Program. Workshop at the Association of American Medical Colleges Annual Meeting, Washington DC.

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ISSN 2374-8265