CE Cultural Competency Health Equity CME

SDOH framework and screening

• Identify the five domains of social determinants of health as defined by Healthy People 2030 and provide clinical examples of how each domain affects patient health outcomes.
• Explain the pathways through which social determinants influence health including material deprivation, psychosocial stress, health behavior patterns, and differential healthcare access.
• Describe validated SDOH screening tools including the PRAPARE tool, AHC-HRSN, and Protocol for Responding to and Assessing Patient Assets and explain their integration into clinical workflows.
• Analyze how food insecurity, housing instability, and transportation barriers affect medication adherence, chronic disease management, and emergency department utilization in clinical populations.

SDOH intervention

• Evaluate the evidence for clinical interventions addressing social determinants including screening and referral programs, prescription food programs, and medical-legal partnerships.
• Identify community resources and referral pathways for addressing social determinants including 211 services, community benefit programs, and social services navigation platforms.
• Design a clinical SDOH screening and referral program including screening tool selection, workflow integration, closed-loop referral tracking, and outcome measurement.
• Analyze the ethical considerations of SDOH screening including patient autonomy, data privacy, the risk of pathologizing poverty, and the obligation to act on identified needs.

Historical context and manifestations

• Identify historical examples of structural racism in healthcare including the Tuskegee Syphilis Study, Henrietta Lacks, forced sterilization programs, and their lasting impact on medical mistrust.
• Explain how race-based clinical algorithms and race-adjusted diagnostic criteria have perpetuated disparities and the movement to eliminate race correction from eGFR, pulmonary function, and VBAC calculators.
• Describe the evidence for racial disparities in pain management including differential opioid prescribing, pain assessment bias, and false beliefs about biological differences between racial groups.
• Analyze the mechanisms through which residential segregation, differential insurance access, and hospital resource allocation perpetuate racial health disparities in maternal mortality and cardiovascular outcomes.

Anti-racist healthcare practice

• Evaluate the effectiveness of organizational anti-racism initiatives in healthcare including workforce diversity, supplier diversity, community investment, and disaggregated quality reporting.
• Identify the distinction between cultural competency, cultural humility, and structural competency and explain how each framework addresses different aspects of healthcare disparities.
• Analyze how clinical trial recruitment practices perpetuate health disparities when study populations do not reflect the patient populations who will receive the treatments.
• Design an organizational health equity action plan that addresses workforce diversity, community health needs assessment, disaggregated outcome tracking, and structural barrier identification.

Health literacy assessment

• Identify the prevalence and impact of limited health literacy on medication adherence, preventive care utilization, emergency department use, and mortality outcomes.
• Explain health literacy screening approaches including single-item screening questions, the REALM, S-TOFHLA, and Newest Vital Sign and their appropriate clinical application.
• Describe the universal precautions approach to health literacy that assumes all patients may have difficulty understanding health information and designs systems accordingly.

Communication strategies

• Explain the teach-back method for verifying patient comprehension including proper technique, non-judgmental phrasing, and integration into clinical encounters for medication instructions and discharge planning.
• Analyze patient education materials for readability and cultural appropriateness using validated assessment tools including the Flesch-Kincaid score and Suitability Assessment of Materials.
• Evaluate the impact of numeracy limitations on patient understanding of risk communication, medication dosing, and shared decision-making about treatment options.
• Design a health literacy-friendly clinical communication program including plain language standards, visual aids, teach-back training, and patient material review processes.

Legal requirements and interpreter services

• Identify the federal language access requirements under Title VI of the Civil Rights Act and Section 1557 of the ACA that mandate meaningful access for limited English proficiency patients.
• Explain the differences between qualified medical interpreters, bilingual staff, telephonic interpretation, and video remote interpretation and the evidence-based recommendations for each modality.
• Describe the risks of using ad hoc interpreters including family members, friends, and untrained bilingual staff and the documented adverse outcomes associated with inadequate interpretation.

Effective cross-language care

• Analyze the impact of language barriers on informed consent, patient safety, patient satisfaction, and healthcare utilization to quantify the clinical importance of language-concordant care.
• Evaluate the effectiveness of different interpreter service delivery models including in-person, telephonic, and video remote interpretation for various clinical scenarios.
• Identify best practices for working with medical interpreters including pre-session briefing, positioning, speaking directly to the patient, and managing sensitive conversations.
• Design a comprehensive language access plan for a healthcare organization that addresses interpreter availability, signage, translated materials, staff training, and compliance monitoring.

Understanding implicit bias

• Identify the concept of implicit bias and distinguish it from explicit bias, prejudice, and discrimination in the context of healthcare decision-making.
• Explain the Implicit Association Test methodology, its application in healthcare research, and the evidence linking clinician implicit bias to differential treatment recommendations.
• Describe the evidence for implicit bias affecting clinical decisions in pain management, cardiovascular care, pediatric treatment, and mental health diagnosis across racial and gender dimensions.
• Analyze how implicit bias interacts with systemic factors including time pressure, cognitive load, diagnostic uncertainty, and patient-clinician power dynamics to amplify disparate treatment.

Bias mitigation strategies

• Identify individual-level implicit bias mitigation strategies including perspective-taking, counter-stereotypic imaging, individuation, and mindfulness-based approaches.
• Evaluate the evidence for implicit bias training programs including the limitations of one-time awareness training and the characteristics of effective longitudinal bias reduction curricula.
• Analyze institutional-level strategies for mitigating implicit bias including standardized clinical protocols, structured clinical decision tools, and diverse team composition.
• Design a multi-level implicit bias reduction program for a healthcare organization that integrates individual training, institutional process changes, and outcome measurement with disparity tracking.

CHW roles and integration

• Identify the roles and competencies of community health workers including health education, care coordination, social service navigation, cultural mediation, and advocacy.
• Explain the evidence base for CHW effectiveness in chronic disease management, maternal and child health, cancer screening, and COVID-19 response and the mechanisms driving improved outcomes.
• Describe the training and certification models for community health workers including state-level certification programs, core competency frameworks, and scope of practice boundaries.

CHW program implementation

• Analyze the sustainable funding models for CHW programs including Medicaid reimbursement, managed care contracts, grant funding, and return-on-investment calculations for health systems.
• Evaluate the challenges of integrating CHWs into clinical care teams including professional boundary negotiation, documentation access, supervision models, and team communication protocols.
• Design a CHW-integrated care model for a patient population with significant health disparities including needs assessment, CHW role definition, workflow integration, and impact evaluation.

Equity measurement

• Identify the distinction between health equality and health equity and explain why equal treatment may not produce equitable outcomes for populations with different baseline health burdens.
• Explain the methodology for stratifying healthcare quality measures by race, ethnicity, language, socioeconomic status, and geography to identify disparities in clinical outcomes.
• Describe health equity metrics including the Index of Disparity, slope index of inequality, and concentration index and their application to measuring progress in reducing healthcare disparities.

Equity-focused quality improvement

• Analyze stratified quality data to identify disparities in clinical outcomes and determine whether observed differences reflect differential care quality, social determinants, or measurement artifacts.
• Evaluate the CMS equity-focused quality measures and accreditation requirements including health equity structural measures and disparities-sensitive condition-specific metrics.
• Identify the role of REAL (Race, Ethnicity, and Language) and SOGI (Sexual Orientation and Gender Identity) data collection in enabling health equity measurement and the best practices for data collection.
• Design a health equity dashboard for a healthcare organization that integrates stratified quality measures, SDOH screening data, access metrics, and workforce diversity indicators into actionable reporting.

Cultural humility framework

• Identify the key principles of cultural humility including lifelong self-reflection, recognition of power imbalances, institutional accountability, and partnership with communities.
• Explain how cultural factors influence health beliefs, illness explanatory models, treatment preferences, and end-of-life decision-making across diverse patient populations.
• Describe the Kleinman explanatory model interview technique and other cultural assessment frameworks for eliciting patient perspectives on illness causation and treatment expectations.

Cross-cultural clinical practice

• Analyze clinical scenarios involving cultural conflicts in care including refusal of blood products, traditional healing practices, family-centered decision-making, and gender-concordant care preferences.
• Evaluate the effectiveness of cultural competency training programs in improving clinical outcomes and patient satisfaction for diverse patient populations.
• Identify the health disparities experienced by LGBTQ+ patients including barriers to care, minority stress effects, and evidence-based strategies for creating affirming clinical environments.
• Design a cultural competency curriculum for clinical staff that moves beyond cultural knowledge checklists to incorporate cultural humility, structural competency, and community engagement.

Identify the ADA requirements for healthcare facility accessibility and reasonable accommodations for patients with physical, sensory, cognitive, and psychiatric disabilities.

Explain the health disparities experienced by people with disabilities including barriers to preventive care, provider communication challenges, and the impact of diagnostic overshadowing.

Analyze clinical scenarios involving patients with disabilities to identify accommodation needs and communication adjustments that ensure equitable care delivery.

Design an accessibility audit and improvement plan for a clinical practice that addresses physical access, communication accommodations, staff training, and feedback mechanisms for patients with disabilities.