described as a potentially effective means to facilitate interprofessional learning events , reports in the literature about the use of on-line learning events are scant . 8 This project Involved development of a collaborative web-based health disparities educational activity for incoming first-year dental and medical students at West Virginia University . Implemented during the respective professional schools ’ student orientation week , the on-line learning module introduced topics concerning health care for individuals from different backgrounds . The impetus for the on-line format was time constraints in the schedules of the dental and medical students . Our project was undertaken to determine the effectiveness of an on-line learning module in raising dental and medical students ’ awareness of health disparities .
MATERIALS AND METHODS
As part of new student orientation , incoming dental and medical students participated in an on-line learning module approved by the West Virginia University Institutional Review Board ( protocol number : 1905556909 ). In the months prior to fall semester 2018 matriculation , incoming first year dental ( n = 48 ) and medical ( n = 120 ) students were assigned a web-based learning event . Instructions for the on-line assignment were sent to students via email and presented in a clear step-wise fashion with deadline for completion and grading methods explicitly stated . The assignment required the reading of twelve referenced articles related to health disparities and the review of one of three real-life clinical scenarios ( Box 1 ) in the dental or medical field . The assignment was developed and evaluated by the deans of admissions in the School of Dentistry and School of Medicine in consultation with an institutional diversity and disabilities fellow . The de-identified case-based scenarios , modeled after real patients , addressed the topics of religion , sexual preference , socioeconomic status , race , culture , and military veteran status . The program objectives , instructions and twelve referenced articles were posted on the institution ’ s on-line portal for the students ’ easy access by a specified deadline . Students received via email from their school ’ s admissions dean , a cover letter describing the learning event purpose , content and timeline . The study guide provided specific objectives and discussion questions ( Box 1 ). Students were given up to 5-weeks to complete the mandatory graded assignment . In addition to on-line materials , the orientation schedule included two hours of in-person instruction on diversity and health disparities . Students anonymously completed identical pre- and post-learning event on-line questionnaires . A total of seven questions assessed the students ’ level of agreement to the statements included in Box 2 . Responses to agreement with the statements in Q1 , Q2 , Q6 and Q7 were ranked on a 6-point Likert scale ( 1 = strongly disagree to 6 = strongly agree ). Responses to agreement with the statements in Q3 , Q4 , and Q5 were ranked on a 5-point frequency scale ( 1 = never to 5 = always ). Results are presented as median score with range in parenthesis ( Table ). Data were treated as four independent groups ( e . g ., Dental pre-test , Dental post-test , Medical pre-test , and Medical post-test ). Given the ordinal responses on the items , group differences were analyzed using the Mann-Whitney test for each pair , with alpha set to 0.05 . This non-parametric ranked-sum test is appropriate for testing differences on independent groups .
RESULTS
The seven item pre-and post-questionnaires ( Box 2 ) were completed by 45 dental students for a 94 % response rate , and 118 ( pre- ) and 116 ( post- ) medical students for 98 % and 97 % respective response rates . Medical students had a significant increase ( p < 0.05 ) in their scores for post- responses to Q1 and Q7 , indicating a greater agreement to statements that declare learning events about diversity and inclusion should be threaded throughout their four-year curriculum ( Q1 ) and that the health disparities are influenced by the quality of inter-personal care ( Q7 ). Dental students had a significant Increase in their awareness of the frequency of health disparities in West Virginia and the US as indicated in their increased scores for post-responses to Q4 and Q5 , respectively ( p < 0.05 ). In comparison to the dental students , the medical students reported a significantly higher awareness of the frequency of health disparities in West Virginia before the learning event as demonstrated in their responses to Q4 in the pre-questionnaire ( p < 0.05 ). Dental and medical students had a significant increase in their awareness of health disparities in the US as indicated in their increased scores to Q3 in the post- questionnaire ( p < 0.05 ), ( Table and Figure ).
DISCUSSION
Health profession programs have a responsibility to train competent and caring health providers . Understanding and addressing health disparities among certain populations is central to that mission . Even though the learning event described in this manuscript pre-dates COVID-19 , early statistics about COVID-19 related health disparities and death rates punctuates the importance of threading diversity and health disparity topics at all phases of health profession curricula . The American Dental Education Association and Association of American Medical Colleges , respectively , provide well-defined competencies for new dentists and physicians . 13-15 Both associations prescribe competencies regarding foundational skills and knowledge to engage with and care for diverse patient populations . The nation ’ s changing demographic landscape serves as a catalyst to the integration of multicultural concepts into health professions education . According to the US Census , in 2019 , Black or African American and Hispanic or Latino respectively , represented 13.4 % and 18.3 % of the US population . 16 Persons in poverty comprised nearly 11 %, and as of 2014-2018 , persons with a disability under age 65 years comprised 8.6 % of the US population . These demographic realities exemplify the necessity for early introduction to cultural awareness and health disparities training in the dental and medical school curricula . In the 2003 IOM report , attention was brought to cross-cultural training in Recommendation 6-1 which reads “ integrate cross-cultural education into the training of all current and future health professionals .” 1 The report specifically advocated for early introduction of these concepts into one ’ s training with re-enforced education throughout one ’ s career . 1 Creating cultural bridges between patient and provider is the beginning of quality health care . In his literary work on the topic , Storti warns that “ cross-cultural encounters don ’ t always go wrong ,
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