The Medical School Curriculum Initiative

Description of the Initiative

The Medical School Curriculum Initiative (curriculum) enhances medical school instruction by helping medical students and health professionals appreciate their role in reducing health disparities in American communities. The curriculum is based on Title VI of the Civil Rights Act of 1964 (Title VI), which prohibits discrimination on the basis of race, color, and national origin.

The curriculum teaches future practitioners about the legal obligation recipients of federal financial assistance have to provide service to persons without regard to their race, color, or national origin, and how doing so reduces health disparities that disproportionately affect various communities. The curriculum also ensures that medical students and other health care professionals understand that some aspects of "culturally competent" care, including access for persons with limited English proficiency, are crucial in providing equitable, accessible, and optimal quality health care services.

The curriculum initiative began in 2004, when the National Institute of Health's National Heart, Lung and Blood Institute awarded a five-year grant to a consortium of 18 medical schools across the country to develop cultural competency curricula for medical schools. The medical school grantees then formed the National Consortium for Multicultural Education for Health Professionals (NCMEHP). Subsequently, OCR provided the framework for developing the Medical School Curriculum and partnered with the NCMEHP and the HHS Office of General Counsel to develop it.

The curriculum was piloted at Wake Forest University School of Medicine's Maya Angelou Center on Health Equity in 2008. The resulting curriculum was then published in the Association of American Medical Colleges' (AAMC) MedEdPORTAL – the leading web-based tool that facilitates the exchange of high-quality, peer-reviewed educational materials to medical schools nationwide.  At least three medical schools have used the curriculum: Emory University School of Medicine, University of Colorado School of Medicine, and the University of Kansas Medical School.

The Curriculum

The primary goal of the Medical School Curriculum is to train medical students and physicians on how to provide culturally competent, equitable, accessible, and high quality care to patients in compliance with Title VI (see: https://www.mededportal.org/publication/7740).

The objectives of the curriculum are to accomplish the following:

  • Discuss the application of federal civil rights laws – specifically Title VI – in health care practice;
  • Describe the current extent of racial and ethnic disparities in health care;
  • Utilizing hypothetical health care scenarios that highlight civil rights compliance concerns; and
  • Illustrate how OCR enforces Title VI through investigations and technical assistance to healthcare providers and covered entities.

The curriculum includes lectures, videos, case scenarios, group discussions, and power-point presentations. Instructors are supported by a comprehensive facilitator's guide and a hypothetical case that illustrates how ineffective care contributes to health disparities.  The curriculum is presented in medical schools by at least one physician and one attorney and can be delivered over a three-hour period, with 45 minutes allocated for discussion of a health disparities hypothetical case. The "Stopping Discrimination Before It Starts: The Impact of Civil Rights Laws on Health Care Disparities" curriculum covers the following topic areas:

  • The history of Title VI, how it is enforced, and how it applies to the health care practice;
  • Why physicians must be concerned about Title VI;
  • Why health disparities exist;
  • How physicians contribute to health disparities;
  • When racial bias amounts to a civil rights violation;
  • Analysis of a hypothetical case to identify health disparities and potential Title VI violations; and
  • A comparison of disparate treatment vs. disparate impact.

The Summer Health Professionals Education Program

Because of widespread interest in the curriculum, in 2014 OCR renewed its partnership with AAMC to reach new audiences through webinars and university-based presentations to undergraduate students. This renewed partnership has resulted in jointly conducted webinars marketing the curriculum to the AAMC's network of schools of medicine, medical students, faculty, and administration officials; and presentations by OCR to participants in AAMC's Summer Health Professionals Education Program (SHPEP).  Through the SHPEP, OCR has provided trainings to nearly 1,000 pre-medical and pre-dental college students at a dozen universities every summer since 2014.

Currently, the SHPEP trainings consist of two presentations.  The first presentation, which has been given to SHPEP students every summer since 2014, is a condensed 90-minute version of the above-referenced curriculum for medical students.  This presentation covers racial and ethnic health disparities, cultural and linguistic competence in health care, and compliance with Title VI and other civil rights authorities, such as authorities prohibiting sex discrimination (including sexual harassment) in education and health programs or activities funded by HHS.  The training also clarifies that individuals can file civil rights complaints with OCR, including sexual harassment complaints, against university programs or activities subject to OCR's legal authorities.

In 2019, OCR added a second civil rights presentation to its SHPEP trainings.  This 30-minute presentation focuses on effective communication requirements for individuals who are deaf or hard of hearing under Section 504 of the Rehabilitation of 1973, Title II of the Americans with Disabilities Act, and Section 1557 of the Affordable Care Act.

If you believe that you or someone else has been discriminated against because of race, color, national origin, disability, age, sex (including sexual harassment), or religion in programs or activities subject to OCR's legal authorities, you may file a complaint with OCR. You may file a complaint for yourself or for someone else here:  https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf

For more information on OCR's enforcement of authorities that prohibit sexual harassment, please visit: https://www.hhs.gov/civil-rights/for-individuals/special-topics/harassment/index.html

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