Use of extramural ambulatory care curricula in postgraduate medical training.

INTRODUCTION: Extramural curricula developed for the purpose of sharing with other institutions have been designed to improve education on important topics in ambulatory care. We sought to assess the usage rates of these curricula among paediatric, internal medicine, and combined medicine-paediatrics residency programmes in the United States. METHODS: Surveys on aspects of trainee continuity clinic were sent to paediatric and medicine-paediatrics programme directors in 2012. Surveys contained an item asking respondents about their use of extramural ambulatory care curricula. Since no similar recent data were available for internal medicine, and to verify the accuracy of the paediatric survey data, we queried the editors of four widely used curricula for subscription information. Descriptive and inferential statistics were calculated. RESULTS: Responses from paediatric programmes indicated that 48 of 111 (43 %) were using an extramural curriculum, compared with 39 of 60 (65 %) medicine-paediatrics programmes (p = 0.007). Editor query revealed a collective subscription rate of internal medicine programmes (300 of 402, 75 %), which was greater than the subscription rate of paediatric programmes (90 of 201, 45 %) (p < 0.001). DISCUSSION: Training programmes in paediatrics, internal medicine, and combined medicine-paediatrics utilize extramural curricula to guide education in ambulatory care, but internal medicine and medicine-paediatrics programmes employ these curricula at greater rates than paediatric programmes.

Reducing health disparities and improving health equity in the United States and Saint Lucia

OBJECTIVE: To create a sustainable model for community health education, tracking and monitoring of selected health conditions (diabetes and mental health), research training, and health policy action in St. Lucia, which may be applicable to underserved African Americans in the U.S. DESIGN AND METHODS: Phase one of this pilot study included a mixed methods analytic approach. Adult clients at risk for or diagnosed with diabetes (n=157) and health care providers/clinic administrators (n=39) were recruited from 5 diverse healthcare facilities in St. Lucia to assess their views on health status, health care services and existing challenges/opportunities to improve health equity. Content analyses of the qualitative data were conducted. RESULTS: Preliminary analyses of qualitative data indicated an awareness of the relatively high prevalence of diabetes and other chronic illnesses. Patients generally acknowledged that one’s socioeconomic status (SES) has an overall impact on health outcomes, though anyone, regardless of SES, may be diagnosed with a chronic disease. Finally, participants indicated desire for better accessibility to healthcare services and improvements to existing healthcare infrastructures to provide better services. CONCLUSION: Findings from this pilot project could serve as a model to help advance health equity among diverse populations through evidence based, culturally tailored community education and prevention efforts. These activities may play a vital role in improving the health status and healthcare among St. Lucians with chronic health conditions and inform similar strategies that may be effective in the United States.