Utilizing the Modified OMP Model for Health Equity in a Family Medicine Residency Clinic

Many racial and ethnically minoritized communities have higher mortality rates from chronic diseases such as cancer, diabetes, and cardiovascular disease than non-Hispanic Whites.¹ According to the Kaiser Family Foundation, 32% of Hispanic/Latinos, 22% of African Americans, 19% of Asian Americans and 30% of American Indians are uninsured compared to 14% of non-Hispanic Whites. The impact is documented in the primary care setting, with African Americans, Asian Americans, and Hispanic/Latinos less likely than non-Hispanic Whites to have a personal primary care provider. Racial and ethnically diverse populations are more likely than non-Hispanic Whites to report experiencing poor quality patient-provider interactions and perceived discrimination from the health care team.² More than one approach will be needed to address health disparities and systemic racism in health care to achieve consistent health equity.³

In a recent review of existing literature on US-based graduate medical education programs that train residents to care for underserved populations and address health disparities showed that the majority of these programs were from primary care including pediatrics, family medicine, and internal medicine.⁴ A little over half (56%) of the programs in this review had defined learned competencies which included communication, cultural competency, research, and clinical skills. With regard to training format and content, half had longitudinal training, less than half (44%) had block experiences, and one reported a one-time internet-based module.  About a quarter of these programs had residents complete a research project and about 38% included community-based clinical training. Most of the programs provided didactics, demonstrations, and small group discussions while one program offered graduate level courses in epidemiology and health policy. Two cited barriers for implementation of health equity education and training initiatives in residency programs include inadequate faculty training and insufficient interest in health equity education.⁵

Despite the urgency to overcome this barrier, there is limited literature on faculty development as it is related to racial equity in medical education. Falusi and colleagues developed a “teaching the teacher” racial equity curriculum that was well received and demonstrated increased knowledge and comfort with teaching health equity topics.⁶  Ross and colleagues developed another curriculum intended to upskill faculty in developing, implementing, and evaluating health disparities education.⁷ To address racial health disparities during brief clinical teaching, the University of North Carolina at Chapel Hill created a modified One-Minute Preceptor Model (OMP) for Health Equity.³ The OMP Teaching Method utilizes five micro skills (get a commitment, probe for supporting evidence, reinforce what was done well, give guidance about errors, and teach a general principle) guiding the faculty member’s interaction with brief teaching and immediate feedback to the learner.^8-10 The modified OMP method for provides a structured approach for faculty to have targeted discussions relating to racial health equity with learners and focus on practical changes that learners and faculty can apply in practice to reduce racial health disparities.³

In an effort to further develop the primary care workforce, this quality improvement (QI) project focuses on assessing the level of faculty engagement in addressing health disparities and residents’ perception of the intervention, discussing racial health disparities with learners during precepting time using the modified OMP Model for Health Disparities.  Recently, the Accreditation Council for Graduate Medical Education (ACGME) has issued the most significant changes to residency training requirements seen to date, which will be effective July 2023. The new program requirements are aimed at training resident physicians in ways that enhance health equity and population health in the communities they serve. This QI project could serve as an example for programs to implement health equity longitudinally throughout residency training.