Background/Purpose: Health disparities (HD) are pervasive in all fields of medicine including rheumatology. Low income patients as well as patients from racial and ethnic minority groups are disproportionately affected by the rheumatic diseases and have increased mortality. We previously conducted a needs assessment of rheumatology fellows that showed that while they felt the impact of the social determinants of the health on the well-being of their patients, they did not feel adequately trained to address these issues. Because of these findings, we now report a needs assessment of rheumatology fellowship program directors (PDs) to evaluate their views on the creation of a HD curriculum and to elucidate potential barriers to implementation.

Methods: We conducted an anonymous, survey-based study of rheumatology fellowship PDs at the annual PDs conference of the American College of Rheumatology held in March, 2019. Out of 74 unique fellowship programs that were registered to attend the conference, 49 completed the survey — most from the Northeast (n=17) or Southeast (n=10). Our survey was modified from the 2016 survey that Cardinal et al. administered to internal medicine program directors assessing graduate medical education in disparities.

Results: 73% of the PDs reported that ≥ 10% of their fellows’ patients are of limited English proficiency (LEP). 51% reported that ≥ 25% of patients were ≤ the US poverty level. At least 25% of the fellows’ patients were from racial and ethnic minorities in 69% of programs and ≥50% in 39% of programs.

Overall 15 programs (30%) provided no training in cultural competency (CC), recognizing or addressing health disparities, or addressing health literacy in patients. Despite 51% of programs reporting that they train fellows to recognize (HD) in their populations, 71% give no training on how to address these HD. With regards to the care of LEP patients, 69% provided no training in how to care LEP patients, 75% offered no formal interpreter training, though interpreter services were widely available. In addition, 46% of PDs were neutral or disagreed with the statement that fellows had had prior training in HD and CC prior to fellowship, and 37% were unsure.

Barriers to the implementation of a curriculum that addresses CC, HD and LEP were:

• 78% of PD were neutral/disagreed that their faculty could assess their fellows providing CC care
• 88% were neutral/disagreed that they had the tools to assess fellows providing CC care
• 57% reported a lack of time in the curriculum

51% reported a lack of institutional resources

Conclusion: Our needs assessment of PDs shows that few programs are addressing HD and the social determinants of health despite the fact that HD are prevalent in rheumatology, and the fellows are caring for significant numbers of patients that are directly impacted by these disparities. While issues such as time and resources are commonly cited for many new initiatives, it is important to note that PDs feel that there is a paucity of faculty that can help address these issues. We, as a specialty, will need a two-pronged approach to implement a HD rheumatology curriculum, given we will have to train the faculty so that they can develop their skills in order to impart this education onto our trainees.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/needs-assessment-of-rheumatology-fellowship-program-directors-on-the-need-for-a-health-disparities-curriculum-for-our-fellowship-programs/