Background/Purpose: Health disparities (HD) are pervasive across all specialties including rheumatology; such that the ACGME has mandated that all programs teach house officers about HD. To inform future curriculum development, we conducted a qualitative study to explore rheumatology fellows perceptions of and experiences with HD instruction.

Methods: We conducted 5 focus groups (FG) in New York and Pennsylvania using a semi-structured interview guide. Questions focused on fellows’ experiences with HD in their practices and if/how they have been taught to address these issues. FG audio recordings were transcribed by a third party contractor, de-identified and systematically analyzed using grounded theory by 2 reviewers. FG were conducted until there was a saturation of themes. This project was approved by the Einstein IRB and fellowship names/locations are not reported to protect the fellows’ anonymity.

Results: 25 fellows participated in our FG –most saw what they considered to be urban/suburban populations; 1 program treated rural patients. 3 major themes emerged from our data: 1. HD Create a Sense of Being Overwhelmed 2. Scarcity of Role-Modeling 3. Learning is Haphazard.

1.BEING OVERWHELMED: All fellows felt that they were seeing evidence of disparate care among their patients and were at a loss on how to address these issues: “you can’t do things for the patients, and I think over time it gets really burdensome and frustrating.” “I think these are the things we bang our heads against the wall on”.

2.ROLE-MODELS: Fellows were not observing their faculty regularly address these issues and potentially encounters can be problematic. “…there are a few faculty members who I think understand certain barriers and certain patients as opposed to others who can’t.” “I know I have seen their implicit bias play out… I’ve had patients who may get frustrated if they find out who the precepting attending is for them. Like oh, I got to see this one – – . It exists. Then the fellow role actually becomes sometimes protecting the patient a little bit. Which is awkward.”

3.HAPHAZARD LEARNING: In addition to this lack of informal instruction and occasional negative role modeling, there is a lack of formal instruction. “I can’t remember it being done. I don’t know, but maybe I’m blanking but I don’t remember having anything formal.” Fellows are left to discuss issues with each other: “I was going to say talk about it amongst each other case by case, but not as a group, not as a division officially. Just a lot of complaining in the fellow’s office”. This is reinforced by the programs “A lot of social aspects of medicine we put on the back burner because I don’t know, in two years of fellowship I still feel like there’s so much other stuff that I also need to know.” “It’s just the culture but it has what’s expected and what’s expected is you pick a topic that is rheumatology … like a good randomized controlled trial study and then you talk about that…”

Conclusion: Currently fellows are not learning about HD in a formal way or how to address HD in their patients, despite the fact that this is mandated by the ACGME, . The development of GME specialty-specific curricula will be key if we are to train providers that will advocate for our most marginalized populations and contribute to health equity.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/current-rheumatology-fellows-experiences-with-health-disparities-and-disparity-education-a-qualitative-study/