Exploring the Physician & Healthcare Resource Shortage in Oahu’s Moku

Abstract

Context: The John A. Burns School of Medicine’s (JABSOM) Learning Community Program aims to address different social determinants of health, including unequal access to healthcare and the resulting health inequities, within the context of Oahu’s six moku, or land divisions. Access to healthcare is limited by the size of the physician workforce and the availability of healthcare resources, especially in rural areas. Physicians should be aware of the underlying factors contributing to these shortages and the resources available to address these issues. Currently, there are few opportunities for students to engage with community physicians and discuss these issues in the pre-clerkship portion of undergraduate medical education.

Objectives: Understand the physician shortage in Hawaii Discuss barriers and facilitators to healthcare access Identify the healthcare resources within each moku on Oahu

Description of Innovation: The project began with a survey of the distribution of specific healthcare resources throughout Oahu, which was then organized according to their respective moku. In September 2021, a lecture was given to first and second year medical students describing the physician shortage in Hawaii and healthcare accessibility. The students then divided into their respective moku and discussed three hypothetical patient scenarios that helped them identify specific resources available within their moku. The resource list was also provided to students to demonstrate the disparity in resource availability. Community healthcare providers then offered their perspectives, especially in light of the COVID-19 pandemic, through a panel discussion and pre-recorded interviews. Students shared their findings and reflections using a shared Google Slides presentation.

Evaluation of Innovation: Students completed a 17-item Google Form survey after the presentation to assess their change in understanding of the physician shortage in Hawaii, their confidence in identifying barriers to healthcare access, and their knowledge about resources compared to prior to the presentation. The project’s success and relevance to their future careers were also assessed after the presentation. Students rated all responses on a 5 point Likert scale.

Discussion/Key Message: On average, students’ (n=138) self-rating of their knowledge of the physician shortage in Hawaii increased from 3.4 to 4.2 (p < 0.001). Furthermore, their ability to identify solutions to barriers to care in their respective moku increased from 3.3 to 4.1 (p < 0.001), while their understanding of differences of healthcare and access between moku increased from 3.1 to 4.0 (p < 0.001). Of the surveyed students, 78.3% of students agreed that the presentation was relevant to their future practice, and 85.5% agreed that the various activities helped them understand the importance of addressing their patients’ social determinants of health. The presentations and activities gave JABSOM students the opportunity to further understand the patients’ perspective of how unevenly distributed resources affect their healthcare experience. This project also provided an opportunity to understand the importance of patience and compassion in providing holistic care. The project was well-received, and students particularly enjoyed the personal accounts from healthcare providers from different moku. Based on these findings, future studies can compare and contrast healthcare resources or other healthcare topics between the six moku of Oahu and the neighbor islands.

Target audience: Medical school educators, medical students, and health care professionals in Hawaii.