Down to the Last Dollar: Utilizing a Virtual Budgeting Exercise to Recognize Implicit Bias

Date of Review: October, 2024

This virtual interactive small-group budgeting exercise, from MedEdPortal, introduces medical students to the impact of poverty on families. The curriculum aims to demonstrate the effects of social determinants such as poverty on health outcomes as well as biases regarding patients living in poverty. The total duration of the session is 100 minutes. Students are first introduced to a case scenario, then broken into small groups to spend the majority of the session working independently on completing a budgeting form. Students are also asked to complete a group reflection to describe biases that come up during the budgeting exercise. The budgeting form has detailed instructions to support students in completing this exercise independently. After the small group exercise, students come back together for a 30 minute large group debrief with a facilitator. The session materials include a detailed facilitation guide. The session is highly interactive and immersive. In the post-session evaluation, students reported that the session was “eye-opening” and deepened their understanding of the day-to-day challenges of a family experiencing poverty. The virtual structure makes this session low-cost and feasible for any educational setting. The content is designed for medical students in their pediatric clerkship, but could be relevant to any clinical rotation. The content could also be delivered in the pre clerkship years, though students likely benefit from some clinical experience to provide context for the exercise. This session is likely best delivered as a component of a broader curriculum in health equity, so that students are prepared with a background in social determinants of health and implicit bias. The thorough facilitation guide and detailed student instructions in the budgeting exercise make it feasible to implement this session with any faculty with a baseline knowledge about the social determinants of health. It would be important for this faculty to have a background in implicit bias, in order to adequately discuss the biases that come up during the session and avoid reinforcing biases. While the facilitation guide provides examples of pertinent biases to the session, there is no discussion of strategies to mitigate these biases. –Emma Anselin, MD, NCEAS

Corresponding Author’s Email:

morancm@njms.rutgers.edu

Institution:

Rutgers Medical School

Where was the Curriculum Implemented:

Newark, New Jersey

Clinical specialty:

Pediatrics

Outcomes that Have Been Reported for the Curriculum:

Learner Satisfaction or reaction

Self-reported learner attitude

Outcome and Study Design:

Post Only

Level of Learner Assessment

Appreciation of content/attitude assessment (self-reflection, blogging with rubric)