LAUSR

aimed to fill these gaps. What was tried? We developed the distance-based, online HESP based on adult and collaborative learning principles, adapting content based on the Society of General Internal Medicine health disparities curriculum. Effectively, designated learning objectives concerned: (i) examination of the personal attitudes brought to encounters by providers and patients; (ii) understanding SDoH and their influence on access and health behaviours; (iii) application of course concepts as future providers, and (iv) investigation into the prevalences and causes of disparities, and into evidence-based interventions to narrow them. Course components included bi-monthly, 2-hour didactic sessions, online and teleconference-based group discussions, presentations by guest speakers, readings, reflective journaling and final practicum projects over a 6-month period. We included disparities both commonly (e.g. racial/ethnic, sexual orientation) and uncommonly (e.g. geographic, differences in ability) represented in extant curricula. During 2015–2017, 16 pre-medical and 23 medical students participated in two HESP iterations. Guided by Kirkpatrick’s four-level model of evaluation, we assessed the attainment of, and barriers and facilitators to, the learning objectives through the administration of end-ofcourse retrospective evaluation surveys and qualitative content analyses of course discussions. All students completed community-based practicum projects, including podcasts, blogs, advocacy days, editorials and contributions to health disparities curricula at their home institutions. What lessons were learned? Most participants (92.1%) demonstrated statistically significant improvements in the first two learning objectives, and 100% demonstrated an intention to apply the concepts as physicians. We did not find any significant change in knowledge of the prevalences or causes of disparities and potential interventions, which indicates that this area requires enhanced focus. Encouragingly, we observed the largest gains in participants’ recognition of their own (sub)conscious attitudes about cultural identity, a concept we were uncertain would be well suited to an online platform. Participants consistently identified practicum projects, periodic reflections and a specific lesson on structural competency as critical factors supporting their enjoyment, acquisition and application of course content. The mixed education-level cohort and the lack of application to clinical environments were cited as barriers. We plan to improve future iterations by enhancing the factors described as facilitating, firstly by providing support for the implementation of practicum work through peer-to-peer discussion, formalised check-in points, and the recruitment of institution-specific faculty mentors, and, secondly, by integrating content on the structural drivers of inequalities throughout the programme, rather than focusing predominantly on culturally competent care. We will also address barriers by: (i) creating distinct course objectives for pre-medical versus medical learners, and (ii) piloting the use of videos that showcase challenging patient interviews to promote real-world application. In conclusion, we demonstrate the preliminary efficacy of an interactive online curriculum encompassing a range of disparities, and identify points for improvement. Subsequent implementations and longitudinal evaluations will allow for more robust investigation of the HESP’s impact on behavioural and clinical outcomes.