Introduction

Disparities in health and health care across a range of populations and conditions are well described. Yet, many physicians remain unaware of their existence. To address this lack of awareness, accrediting bodies have established requirements for medical schools and residencies to teach medical students and residents physicians about various aspects of disparities in health and health care. The Association of American Medical Colleges’ (AAMC) report “Cultural Competency Education” states that students should understand “demographic influences on health care quality and effectiveness, such as racial and ethnic disparities in the diagnosis and treatment of diseases” as well as “any personal biases in their approach to health care delivery.” Additionally, as part of their physician licensure requirements, New Jersey and California require documentation of cultural competency training in continuing medical education. Other states are debating such requirements, including Arizona, Colorado, Florida, Georgia, Kentucky, New Mexico, New York, Ohio and Washington. In New Jersey, this training must include strategies to recognize and respond to health care disparities as well as the impact of stereotyping on medical decision making. There is a limited understanding, however, of the best methods of teaching about health disparities. To date, health disparities education has had limited acceptance and implementation in medical schools and residency training programs. This reluctance is due, in part, to uncertainty about what should be taught in such a curriculum, how it should be taught and whether health disparities’ training has a significant impact on learners and patients. The California Endowment funded this supplement to help highlight innovations and progress in the evolution of health disparities education in order to enhance the scope and quality of medical education on this topic. While much of the health disparities literature focuses on disparities experienced by racial and ethnic populations compared to whites, the full spectrum of health care-related disparities includes those related to gender, language, socioeconomic status and other social characteristics of patients. The manuscripts in this supplement reflect the broad nature of health disparities education. The articles by Wakeman and Rich highlight the US prison population as one of most vulnerable to experiencing disparities. Diamond and Jacobs outline how limited English proficiency (LEP) contributes to disparities and recommend best strategies for clinicians to use when caring for patients with LEP. Bereknyei et al. elaborate on these strategies when the ideal situation of having trained medical interpreters is unavailable; their linguistic competency curriculum can provide measurable and enduring skills to students. This issue opens with a comparison of cultural diversity teaching methods and curriculum across the US, UK and Canada. The article by Dogra et al. emphasizes the inconsistency in terminology when discussing issues related to cultural competence, cultural awareness and cultural sensitivity. The lack of language precision continues to be an issue throughout the medical education literature. It is one reason why this supplement focuses on health care disparities education as a separate topic—and not under the guise of cultural competency. It has become increasingly clear that the definitions and approaches to cultural competency in this country, as well as in others, are varied and diverse. While there is general agreement on the meaning and overall impact of health care disparities, an accepted standard nomenclature remains elusive but would be useful in solidifying this arena. The supplement then moves to the areas of curriculum and approaches to teaching. The articles by Glick et al., Cene et al., Mostow et al. and Sheu et al. focus on novel curricular tools to teach about health care disparities both in undergraduate and graduate medical education. Current educators will find these educational innovations to be ideal tools to use in various settings. Cohen et al. shed light on the use of interdisciplinary educational forums (medical-legal) as a means of combating potential causes of disparities and train providers. The article by Chokshi provides practical advice regarding how to use a social determinants framework when teaching in this area. The role of the provider as a source of and solution to health disparities is highlighted in the article by Burgess et al., who caution us to be wary of the “stereotype” as a possible threat to the patient-physician and physician-trainee interaction. These scholars suggest that such threats can materialize as implicit biases on the part of patients and physicians, and thus may contribute to disparities. They recommend that we actively JGIM