Marshall Jessie Kimbrough, Cooper Lisa A, Green Alexander R, Bertram Amanda, Wright Letitia, Matusko Niki, McCullough Wayne, Sisson Stephen D
Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Health Equity. 2017 Feb 1;1(1):43-49. doi: 10.1089/heq.2016.0010. eCollection 2017.
Training residents to deliver care to increasingly diverse patients in the United States is an important strategy to help alleviate racial and ethnic disparities in health outcomes. Cross-cultural care training of residents continues to present challenges. This study sought to explore the associations among residents' cross-cultural attitudes, preparedness, and knowledge about disparities to better elucidate possible training needs. This cross-sectional study used web-based questionnaires from 2013 to 2014. Eighty-four internal medicine residency programs with 954 residents across the United States participated. The main outcome was perceived preparedness to care for sociocultural diverse patients. Regression analysis showed attitude toward cross-cultural care (beta coefficient [β]=0.57, 95% confidence interval [CI]: 0.49-0.64, <0.001) and report of serving a large number of racial/ethnic minorities (β=0.90, 95% CI: 0.56-1.24, <0.001), and low-socioeconomic status patients (β=0.74, 95% CI: 0.37-1.10, <0.001) were positively associated with preparedness. Knowledge of disparities was poor and did not differ significantly across postgraduate year (PGY)-1, PGY-2, and PGY-3 residents (mean scores: 56%, 58%, and 55%, respectively; =0.08). Residents' knowledge of health and healthcare disparities is poor and does not improve during training. Residents' preparedness to provide cross-cultural care is directly associated with their attitude toward cross-cultural care and their level of exposure to patients from diverse sociocultural backgrounds. Future studies should examine the role of residents' cross-cultural care-related attitudes on their ability to care for diverse patients.
在美国，培训住院医师为日益多样化的患者提供护理是一项重要战略，有助于缓解健康结果方面的种族和民族差异。对住院医师进行跨文化护理培训仍然面临挑战。本研究旨在探讨住院医师的跨文化态度、准备情况与对差异的了解之间的关联，以更好地阐明可能的培训需求。这项横断面研究使用了2013年至2014年基于网络的调查问卷。美国84个内科住院医师项目的954名住院医师参与了调查。主要结果是对为社会文化背景多样的患者提供护理的感知准备情况。回归分析表明，对跨文化护理的态度（β系数[β]=0.57，95%置信区间[CI]：0.49 - 0.64，<0.001）、为大量种族/民族少数群体服务的报告（β=0.90，95% CI：0.56 - 1.24，<0.001）以及为低社会经济地位患者服务的报告（β=0.74，95% CI：0.37 - 1.10，<0.001）与准备情况呈正相关。对差异的了解较差，在研究生一年级（PGY）-1、PGY-2和PGY-3住院医师中没有显著差异（平均得分分别为：56%、58%和55%；=0.08）。住院医师对健康和医疗差异的了解较差，且在培训期间没有改善。住院医师提供跨文化护理的准备情况与其对跨文化护理的态度以及接触不同社会文化背景患者的程度直接相关。未来的研究应考察住院医师与跨文化护理相关的态度对其护理不同患者能力的作用。
