Smith Wally R, Betancourt Joseph R, Wynia Matthew K, Bussey-Jones Jada, Stone Valerie E, Phillips Christopher O, Fernandez Alicia, Jacobs Elizabeth, Bowles Jacqueline
Division of Quality Health Care, Center on Health Disparities, Virginia Commonwealth University, Richmond, Virginia 23298-0306, USA.
Ann Intern Med. 2007 Nov 6;147(9):654-65. doi: 10.7326/0003-4819-147-9-200711060-00010.
Racial and ethnic minorities often receive lower-quality health care than white patients, even when socioeconomic status, education, access, and other factors are used as controls. To address these pervasive disparities, health care professionals should learn more about them and the roles they can play in eliminating them, but few curricula are focused on understanding and addressing racial and ethnic health disparities, and well-accepted guidelines on what and how to teach in this complex area are lacking. The Society of General Internal Medicine Health Disparities Task Force used a review and consensus process to develop specific recommendations and guidelines for curricula focusing on health disparities. Learning objectives, content, methods for teaching, and useful resources are provided. Although the guidelines were developed primarily for teaching medical students, residents, and practitioners in primary care, the Task Force's general recommendations can apply to learners in any specialty. The Task Force recommends that a curricula address 3 areas of racial and ethnic health disparities and focus on the following specific learning objectives:1) examining and understanding attitudes, such as mistrust, subconscious bias, and stereotyping, which practitioners and patients may bring to clinical encounters; 2) gaining knowledge of the existence and magnitude of health disparities, including the multifactorial causes of health disparities and the many solutions required to diminish or eliminate them; and 3) acquiring the skills to effectively communicate and negotiate across cultures, languages, and literacy levels, including the use of key tools to improve communication. The broad goal of a curriculum on disparities should be for learners to develop a commitment to eliminating inequities in health care quality by understanding and assuming their professional role in addressing this pressing health care crisis.
即使将社会经济地位、教育程度、医疗可及性和其他因素作为控制变量,少数族裔患者往往比白人患者获得的医疗服务质量更低。为解决这些普遍存在的差异,医疗保健专业人员应更多地了解这些差异以及他们在消除差异方面可以发挥的作用,但很少有课程专注于理解和解决种族和族裔健康差异问题,而且在这个复杂领域中关于教什么以及如何教的广泛认可的指导方针也很缺乏。普通内科医学健康差异特别工作组通过审查和达成共识的过程,为关注健康差异的课程制定了具体建议和指导方针。文中提供了学习目标、内容、教学方法和有用资源。尽管这些指导方针主要是为教授医学生、住院医师和初级保健从业者而制定的,但特别工作组的总体建议适用于任何专业的学习者。特别工作组建议课程应涵盖种族和族裔健康差异的三个领域,并专注于以下具体学习目标:1)审视和理解从业者和患者在临床接触中可能带来的态度,如不信任、潜意识偏见和刻板印象;2)了解健康差异的存在和程度,包括健康差异的多因素成因以及减少或消除这些差异所需的众多解决方案;3)掌握在不同文化、语言和读写水平之间有效沟通和协商的技能,包括使用关键工具来改善沟通。关于差异的课程的广泛目标应该是让学习者通过理解并承担他们在应对这一紧迫医疗危机中的专业角色,来致力于消除医疗服务质量方面的不平等。