“Advancing a More Inclusive Blood and Transplant System for Marginalized Groups”: Development and Evaluation of a Transfusion Medicine Health Equity and Advocacy Curriculum

Introduction: Health advocacy is an important skill for healthcare professionals to develop, but is challenging to teach. Here, we describe the development & evaluation of a curriculum to support healthcare professionals & trainees to develop as health advocates through advancing health equity across donation products for marginalized groups.

Methods: We developed a transfusion medicine health equity & advocacy curriculum “Advancing a more inclusive blood and transplant system for marginalized groups”. This curriculum included two workshops focusing on advancing inclusion across donation products for 1) LGBTQIA+ & 2) racialized peoples. The first workshop, “Building a more inclusive blood and transplant system for LGBTQIA+ peoples” outlined blood, stem cell, & organ & tissue donation in Canada for gay, bisexual, & other men who have sex with men, starting from the historical policies & the context in which they were first put in place, to today's policies & where future policies may lie. The second workshop, “Addressing racial disparities in blood, stem cell, and organ & tissue donor pools”, outlined disparities in donor pools across donation products, barriers to donation impacting racialized/ ethnic populations, & structural racism in donation policies (i.e. policies which disproportionately impact racialized/ ethnic peoples). The workshops also presented content from national campaigns to engage LGBTQIA+ peoples (stemcellclub.ca/SavingLivesWithPride) & Black peoples (stemcellclub.ca/BlackDonorsSaveLives) to donation (Figure 1). Both workshops concluded with facilitated discussion groups supporting participants to reflect on donation policies for marginalized groups & their consequences, & how to help overcome barriers to donation. The curriculum was published to stemcellclub.ca/training & piloted with a national cohort of Canadian medical students. Quantitative & qualitative analyses (using a thematic analysis approach) were conducted to evaluate participants' perspectives on the impact of the workshop on their development as health advocates.

Results: We hosted these workshops at 9 medical schools across Canada 10/2020-3/2023. 142 medical students participated, of whom 103/142 completed pre- & post- workshop surveys (73% response rate). 64/103 (62%) of survey respondents were female, 47/103 (46%) identified as racialized or LGBTQIA+, & 86/103 (83%) were pre-clerkship with 17/103 (17%) in clerkship.

Results from quantitative & qualitative analyses of participants' perspectives on the role of these workshops in their development as health advocates are shown in Table 1A-B. Nearly all participants strongly agreed/ agreed the workshops supported their development as health advocates (101/103, 98%), including the abilities to: advocate for patients beyond the clinical environment; work with patients/ communities to address & identify determinants of health that affect them; respond to the needs of communities/ populations by advocating with them for system-level change; apply a process of continuous quality improvement to health promotion activities; & contribute to a process to improve the health of a community/ population they will serve. Nearly all felt that the workshop should be incorporated into medical curricula (99/103, 96%).

Following each workshop, a subset of medical students (n = 38 for each) participated in focus groups to share their perspectives on what they learned. Qualitative analysis identified rich examples of participants' development as health advocates through their participation in the workshops, across the following themes: prioritize inclusion; recognize discrimination; understand barriers to change; collaborate with advocates from diverse communities to address disparities; & build a culture which supports inclusion.

Conclusion: We present the first-ever curriculum in health equity in transfusion medicine to our knowledge, focusing on advancing inclusion across donation products & addressing disparities impacting patients & donors from marginalized groups. We also share the perspective of a national cohort of medical students in Canada that their participation in this curriculum contributed to their development as health advocates. This workshop is a model for teaching health advocacy to healthcare professionals & trainees, and is relevant to a wide audience across medicine.