Bridging Knowledge and Practice: Exploring the Application of Health Equity Education in Graduate Medical Education Clinical Settings

BACKGROUND: Despite growing emphasis on health equity education in graduate medical education, little is known about how classroom learning translates into clinical practice. OBJECTIVE: To examine how Internal Medicine residents, fellows, and faculty trained in health equity navigate applying health equity principles in practice and what internal and external factors facilitate or hinder implementation. DESIGN: Constructivist study using semi-structured interviews and grounded theory to examine individual developmental processes within multilevel contextual influences. PARTICIPANTS: Eleven Internal Medicine physicians (seven residents/fellows, four faculty) at a military academic medical center who participated in a case-based health equity curriculum. APPROACH: Interviews explored experiences applying health equity principles. Two researchers independently coded transcripts using constant comparative method. Thematic analysis examined patterns across career stages within three domains: individual awareness and identity development, interpersonal dynamics in clinical encounters, and institutional and structural contexts. KEY RESULTS: Participants' ability to apply health equity skills developed through iterative cycles of awareness, reflection, and deliberate practice, but this growth was continually shaped by external constraints. Clinical encounters served as learning opportunities only when attending physicians created space for reflection and dialogue. Infrastructure gaps, policy limitations, and organizational culture frequently restricted what physicians could enact, contributing to moral distress, particularly among trainees who felt unable to apply what they had learned. Developmental patterns showed movement from reactive navigation of barriers to more proactive efforts to influence team processes and environments. CONCLUSIONS: Health equity in clinical settings emerges through negotiation between individual transformation and environment. Without attention to power dynamics, resource allocation, and institutional culture, health equity educational interventions risk developing demoralized physicians who recognize inequity but lack support to address it. Programs require aligned curriculum, faculty development, and institutional infrastructure to enable equity-oriented action.