Health disparities refer to the unequal distribution of health outcomes and access to health care among different populations. These disparities disproportionately affect marginalized communities, such as people of color, low-income individuals, and those living in rural areas. These communities often experience a higher burden of disease and have less access to preventative care and treatment.

As physicians increasingly face the challenge of managing clinical encounters with patients from a range of cultural backgrounds,¹ cross-cultural training has emerged as a means of improving the quality of medical care and addressing or minimizing health disparities.^2-4 Although training physicians to enter the workforce with the confidence, knowledge, and ability to treat disease regardless of underlying social determinants of health is important,⁵ there is little clinical time allotted to this.^4,6

One practical solution to increasing hands-on training in cultural competence, while simultaneously providing care to underserved and historically marginalized communities, is to develop targeted interventions. Examples of this range in scale and could include increasing access to virtual care (eg, telehealth services), providing transportation assistance to patients, or addressing social determinants of health through policy and advocacy. However, little to no scholarship exists describing a “gold standard” for addressing health disparities, particularly in surgical specialties such as urology. Inherent barriers also exist limiting experiences for trainees (eg, lack of time, role models, formal training).^4-8 Here we present examples of targeted programming to address health disparities and underlying social determinants of health, while also promoting critical training experiences: (1) local multidisciplinary program for patients at an academic center, (2) local community clinic providing specialty care to underserved patients, and (3) international mission trip serving patients in a rural community.

At our academic medical center, we designed and implemented a multidisciplinary Comprehensive Kidney Stone Program for our community-based outpatient facility. This program helps Medicaid and low-income patients navigate through the acute and preventive aspects of kidney stone disease by increasing interdisciplinary referrals to nephrology and dietary services, along with a central nurse coordinator to help facilitate referrals and follow-up. More than 180 patients were followed over 3 years to evaluate program implementation and efficacy: since the program’s inception in 2018, referrals to multidisciplinary specialists and compliance to stone prevention strategies have increased, “no-show” rates at first follow-up visit decreased from 20% to 6.3%, and emergency department visits have remained stable.⁹ This program is now self-sustainable. Additionally, our residents rotate regularly through this hospital and have both observed and participated in patient care as part of this collaborative clinical team.

We have established a partnership with Physicians CareConnection, a local third-party volunteer-based charitable organization that provides free or reduced services to patients in the Central Ohio area. This community clinic serves a high rate of immigrant and non–English-speaking patients seeking specialty care, and the organization brings in clinicians to staff a weekly evening clinic pro bono. The clinic provides transportation services to patients, as well as in-house prescriptions and lab work. Since 2019, a faculty attending and residents have staffed the urology referrals in this clinic monthly. Each postgraduate year 2-4 resident attends 1-2 evenings annually with a rotating faculty member, and together this initiative has provided free urological specialty care to more than 100 underserved patients in our community (Figures 1 and 2).¹⁰

Figure 1. One faculty attending and 1-2 residents staff a local community clinic monthly to treat urology patients seeking specialty services.

Figure 2. As part of a “local” global health curriculum, 1 faculty member and 1-2 residents staff urology specialty referrals monthly. The clinical team is often accompanied by a research coordinator and the department’s education specialist.

Figure 3. Surgical team performing kidney stone surgery at Santo Hermano Pedro Hospital in Catacamas, Honduras.

Figure 4. Surgical team (Medical College of Wisconsin, Kansas University, and The Ohio State University) at Santo Hermano Pedro Hospital in Catacamas, Honduras, on March 2020 urological surgery mission trip.

Mission trips can provide an immersive clinical experience that is unparalleled in medical practice and otherwise unavailable to surgical trainees. This unique learning opportunity allows trainees to see more complex or advanced cases than is typical of academic medical centers, while addressing health ailments with limited diagnostic and therapeutic resources available. These immersive experiences require preparation ahead of time, including the acquisition of funding to cover costs of travel or borrowed equipment, establishing a Program Letter of Agreement for trainees to participate in clinical treatment off-site, and general coordination across participants, institutions, and schedules to staff this experience. A surgical brigade consisting of urologists, residents, anesthesiologists/certified registered nurse anesthetists, nurses, and translators from Medical College of Wisconsin, Kansas University, and The Ohio State University coordinate an annual trip to serve local patients in Juticalpa, in the Catacamas region of Honduras. The clinical impact of this type of surgical care cannot be understated: approximately 100 patients were seen on the first day, while 68 surgical cases were performed in the following days. Two operating rooms focused primarily on benign prostatic hyperplasia procedures, with a third room treating kidney stone patients with newly acquired endoscopic stone equipment (Figures 3 and 4). Acute collaborative mission trips such as this provide otherwise unavailable continuity of care, sustainability, and continual expansion of the mission in future years, and truly profound positive impacts on the patients served in this local rural community.

Continuing to provide excellent patient care to an increasingly diverse patient population, particularly to those otherwise underserved due to community-specific social determinants of health, is critical. Clinicians must continue to provide these services, while also preparing the next generation of clinicians and surgeons in real time. Now, more than ever, descriptions of effective cross-cultural care and programming to increase skillset and confidence in our trainees is warranted. It is heartening to see the American Urological Association promote this discussion and scholarship—AUA2023 will have 2 new abstract categories this year: (1) Diversity, Equity, and Inclusion and (2) Global Health and Humanitarian abstract categories. We hope these sessions will provide a forum for clinicians to share experiences, network with other clinicians interested in this work, and elevate discussions on how to best serve some of our most vulnerable and underserved patients. By focusing on targeted interventions and services at institutional, local, and global levels, we can work towards reducing health disparities and improving health outcomes for these marginalized communities of patients, while training our incoming workforce to do the same.