Healthcare Disparities: Encouraging Change Through Continuing Professional Development

ABSTRACT

Throughout history, healthcare disparities have contributed harm to patient’s physical, mental, and financial wellbeing. Use of continuing professional development (CPD) can relay practical application of strategies to mitigate healthcare disparities. However, there is limited data on the impact of disparities focused CPD. In this article, we summarise quantitative data surrounding seven CPD programmes with a focus on healthcare disparities. In totality 41,588 healthcare providers interacted with educational content in these programmes. Learners responding to assessment questions yielded a 25% improvement in knowledge-based questions and a 27% improvement competence-based questions (p < 0.05 for each). Lastly, 1101 (2.5%) learners participated in a post-activity evaluation. Of those, 59% reported use of the information from these CPD programmes to reinforce their current practice, while 34% planned to make changes in their current practice to implement strategies to reduce or mitigate healthcare disparities. These findings show promise for use of CPD to improve awareness and help healthcare providers understand and mitigate disparities.

KEYWORDS:

• Healthcare disparities
• continuing education
• healthcare professionals
• continuing professional development

Introduction

Healthcare disparities impact all of us and solutions are not individualised, they are often systemic [1,2]. Living in a diverse and constantly changing world, our patients’ backgrounds, cultures, and belief systems are also constantly evolving and adapting. Therefore, continuing professional development (CPD) providers are uniquely positioned to help identify and address disparities in healthcare [3,4]. This can be done as a single programme or as part of a series.

Historically, medical training programmes have inconsistently included content regarding addressing disparities among underrepresented populations in their curricula. This is seen in a 2011 survey demonstrating that 33% of medical schools reported zero hours of LGBTQIA+ education within their curriculum [5]. In another survey, only 16.4% of radiologists believed they received proper education and training in healthcare disparities [6]. Additionally, one study assessing pharmacists comfortability with social determinants of health (SDOH) found that 65% did not have SDOH addressed in their didactic curriculum and 45% report SDOH were not addressed during their residency [7]. The void in meaningful education within healthcare training for the prevention of future healthcare disparities is vast. From the lack of appropriate education within healthcare programme schools’ curricula, patients in minorities are highly impacted [2,5]. Taken in sum, this data illustrates the need for healthcare professionals to engage in timely education for disparities mitigation in their practice.

While standalone programming can certainly be impactful, partnerships between CPD providers and healthcare entities can also yield meaningful education in healthcare disparities. For example, Siamet is a partnership between the Maniilaq Association in northwest Alaska and the Massachusetts General Hospital and Harvard Medical school. This organisation has brought attention to tribal health disparities by providing healthcare team with effective CPD to improve care [8]. These educational programmes gave healthcare professionals the opportunity to interact with members of the tribal community and equip other healthcare professionals with strategies to effectively address the disparities affecting this community [8].

Individual institutions also may have targeted training programmes. For example, the Tea House Series was designed and implemented to build anti-racist and anti-oppressive faculty and staff at the University of California San Francisco. The programme highlighted increasing awareness, engaging in dialogue and self-reflection, and understanding data. The Tea House series found that participants developed an increase in confidence in the learning objectives proposed during each session, indicating the growth of the participants following the series [4].

At Clinical Education Alliance (CEA), the ability to educate learners on different strategies to reduce healthcare disparities has been an established focus, specifically in high-risk therapeutic areas, to yield valuable strategies for use in clinical practice. Importantly, CEA highlights how SDOH impacts quality of care, which can help learners recognise these barriers and ultimately bridge the gap between at risk patients and improved healthcare.

Main Text

Between September 2021 and December 2022, the authors identified and summarised 7 CPD programmes with a focus on healthcare disparities for this pilot analysis. The CPD programmes and corresponding learning objectives addressing healthcare disparities are listed in Table 1. For each CPD programme, content was disseminated through various educational formats including live in-person and virtual meetings. Enduring components were available online for asynchronous learners. When provided by the learner, demographic information included healthcare profession and practice speciality. Learners could also participate in a pre-test and post-test to assess knowledge and competency in addressing healthcare disparities in the corresponding disease state. Assessment questions were categorised using the Moore’s level framework [9]. Finally, learners provided information on the applicability within their practice setting and details on changes or barriers to implementing change. Descriptive statistics were used to summarise learner demographic data and nominal data was analysed using Chi Squared.

Table 1. CPD programmes and associated learning objective.

CPD Program	Learning Objective
Addressing Barriers to Improved Outcomes in African American Patients with Multiple Myeloma	Identify strategies for incorporating culturally sensitive approaches to engage, educate, and advocate for African American patients with multiple myeloma
Myelodysplastic Syndromes: Guidance on the Optimal Management of Older Adult Patients	Foster collaborative discussions between older patients/caregivers and HCPs on guidelines and recent clinical evidence to guide personalised treatment planning for older patients with MDS
The Biggest Risk to Cardiovascular Health: Addressing Social Determinants of Health in Non-valvular Atrial Fibrillation	Examine effect SDOH and disparities on Non-valvular Atrial Fibrillation anticoagulation prescribing and adherence
Tackling Racial Disparities in Care for HIV and Viral Hepatitis	Implement strategies to combat implicit racial biases that affect optimal care of individuals with or at risk of HIV or viral hepatitis
Racial Disparities and COVID-19: Causes, Consequences, and Clinical Strategies	Identify factors driving COVID-19 racial disparities
Strategies for Addressing Treatment Challenges and Health Inequities in Inflammatory Bowel Disease	Implement strategies to reduce health inequities among patients with Inflammatory Bowel Disease
Smarter. Stronger. Together. Education and Resources to Optimize Clinical Outcomes in Gynecologic Cancers	Identify populations of patients who are at increased risk for poor prognosis and proactively provide education and support throughout all stages of diagnostic and treatment regimens

Results

Among the seven CPD programmes, a total of 41,588 learners engaged with the educational content with an even distribution of US and non-US learners. The professions of the learners who participated in the CPD programmes are presented in Table 2. Among the seven programmes, 43 questions were included. Overall, there was a 25% improvement from baseline in knowledge assessment items and a 27% improvement from baseline in competence assessment items (Table 3).

Table 2. Selected healthcare professions breakdown.

Total Respondents	29303
Physicians	13412 (46%)
Advanced Practice Providers (APPs)	8524 (29%)
Other	2855 (10%)
Pharmacists	2682 (9%)
Registered Nurses	1830 (6%)

Table 3. Assessment question change.

Assessment Questions (N = 43)	Pre-Test	Post-Test	Delta	p-value
Knowledge (n = 25)	39%	65%	25%	p<0.05
Competency (n = 18)	37%	64%	27%	p<0.05

Of the healthcare providers who participated in the post-activity evaluation (2.5%, n = 1101), 35% were open to making changes to their current practice; 59% reported they already implement the procedures in practice, and 6% reported that they would not make changes to their practice. Additionally, it was found that 30% of healthcare providers acknowledge that financial issues/insurance are barriers to change, followed by patient adherence (Table 4).

Table 4. Percentage of participants willingness to change practice.

Practical Application to Workflow	Percentage of Participants (n = 1101)
Planned change to practice	34.79%
Apply latest guidelines	43.1%
Choice of treatment/management approach	24.3%
Change in pharmaceutical therapy	8.7%
Change in current practice for referral	12.0%
Change in diagnostic testing	6.2%
Change in differential diagnosis	3.4%
Reinforced current practice	59.31%
No change to practice	5.90%
Formulary restrictions	6.4%
Insurance/financial issues	3.3%
Time constraints	14.3%
Lack of multidisciplinary support	3.3%
System Constraints	5.0%
Treatment-related adverse events	4.6%
Patient adherence	2.0%
None	12.3%

Discussion

This pilot analysis illustrates several optimistic areas in the CPD. Following the CPD programmes, more than one-third of the participants reported a willingness to make changes to their practice to combat healthcare disparities. This is a necessary first step in breaking down barriers affecting marginalised populations.

In the research space of continuing medical education, there is a gap of quantitative findings focused on healthcare disparities. However, a literature search uncovered many articles with helpful strategies and suggestions to mitigate health disparities, as discussed above [1,3–8]. Importantly, much of this data focused on qualitative metrics, yielding a robust foundation of instructing educators on proper techniques for producing positive outcomes to improve healthcare disparities.

Another opportunity to enhance CPD’s impact on health disparities is to collaborate with patient advocacy groups. In our research, a variety of healthcare professionals attended the CPD programmes, but there was a gap in patient representation. Patients are experts in their own experiences, and their voices are essential to improving healthcare. When building the CPD programmes, it may be beneficial to include a patient’s perspective to allow the healthcare providers to view the topic through a different lens. Their perspectives can provide valuable insights into the challenges that patients face, and they can help to ensure that CPD programmes are relevant to the needs of real people. As healthcare continues to move towards a more patient-centred and shared decision-making model, inclusion of the patient’s voice in all aspects of practice, including CPD, is necessary.

Lastly, as noted throughout this article, educating on health disparities within healthcare professional curricula is needed. Therefore, engaging healthcare students should be a high priority to initiate change in the healthcare of high-risk patients. Institutional education of future healthcare professionals should include content focused on disparities that specific populations face every day. From that reamplification of standard education, post-graduate trainees can then take their new knowledge of healthcare disparities and practice it in their practice setting. Then, not only will post-graduate trainees apply their education to their occupation, but also highly influence institutional change within individual healthcare systems.

While our pilot analysis yielded noteworthy results, there are important limitations, including the potential for response bias and low response rates. This may contribute to the discrepancies between activity level learners and response to assessment and demographic questions. Likewise, we were dependent on learners self-reported metrics with no ability to confirm patient impact. This limits the ability to translate intention into confirmed practice change. Lastly, selection bias in choosing the seven CPD programmes may exist. The authors attempted to mitigate this by soliciting programmes for inclusion by peer colleagues not included in this research. These limitations are important to consider for others attempting to conduct future research in this space.

Conclusion

The contribution of new research in this space can provide healthcare professionals with actionable tools to equip them for successful mitigation when encountering inequality at the individual patient level. Then, the newly found research and information could be carried back into education, training, and the workforce to encourage systematic change throughout the healthcare process. We encourage any CPD programme to consider content through the lens of health disparities and encourage integration of patient and trainee representation into applicable programming for healthcare professionals.

Table

CPD Program	Accredited Education Supported By
Addressing Barriers to Improved Outcomes in African American Patients with Multiple Myeloma	AbbVie Inc., Amgen, BMS, Janssen Biotech, Inc.
Myelodysplastic Syndromes: Guidance on the Optimal Management of Older Adult Patients	Bristol Myers Squibb. Provided by Rush University Medical Center partnership with the MDS Foundation.
The Biggest Risk to Cardiovascular Health: Addressing Social Determinants of Health in Non-valvular Atrial Fibrillation	Bristol Myers Squibb and Pfizer Alliance
Tackling Racial Disparities in Care for HIV and Viral Hepatitis	Bristol Myers Squibb and Pfizer Alliance
Racial Disparities and COVID-19: Causes, Consequences, and Clinical Strategies	AbbVie, Gilead Sciences, Inc. Janssen Therapeutics
Strategies for Addressing Treatment Challenges and Health Inequities in Inflammatory Bowel Disease	Janssen Biotech, Inc.
Smarter. Stronger. Together. Education and Resources to Optimize Clinical Outcomes in Gynecologic Cancers	AstraZeneca, GlaxoSmithKline and Merck Sharp & Dohme Corp. Provided in partnership with Smart Patients.

Acknowledgments

- Sophia Fitzgerald, PharmD Candidate 2025

- Jay’La Lin, PharmD Candidate2026

- Norvinyo Abiti, PharmD Candidate2026

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was not funded by any outside body. However, the individual programmes were funded as accredited education outlined in the table above. All research, analyses, and findings were done independently of the educational funders. The educational funders had no role in reviewing data, writing the manuscript, or presenting the findings.