J. Aysola is assistant professor of medicine and pediatrics, Division of General Internal Medicine, Department of Medicine, associate designated institutional official for health equity and inclusion, Graduate Medical Education, and assistant dean of graduate medical education and research director, Office of Inclusion and Diversity, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. The author is also affiliated faculty and senior fellow, Center for Health Incentives and Behavioral Economics (CHIBE) and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania. J.S. Myers is professor of clinical medicine, Division of General Internal Medicine, director of quality and safety education, Department of Medicine, and director, Center for Healthcare Improvement and Patient Safety, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Acad Med. 2018 Jan;93(1):31-34. doi: 10.1097/ACM.0000000000002021.
A recent call to address health care disparities has come from the Accreditation Council for Graduate Medical Education's (ACGME's) Clinical Learning Environment Review (CLER) program. The CLER program aspires that faculty and residents will identify the disparities among the patient populations they serve and engage in quality improvement (QI) activities designed to address them. In this Perspective, the authors provide a framework for integrating QI and health equity principles in graduate medical education to meet these ACGME expectations. The authors illustrate their four-step framework by describing a faculty development workshop that provides strategies and tools for embedding equity into existing QI educational efforts and using QI methods to address equity challenges. Using examples, the authors outline how medical educators can begin to integrate QI and equity initiatives to address health care disparities and involve their residents/fellows in the process. In addition, the authors emphasize the importance of applying an equity lens to QI interventions and of recognizing that QI initiatives will have different impacts on outcomes depending on the patient population. The authors conclude by discussing the need for institutional leadership to build capacity and training to improve data collection and reporting of quality metrics by demographic variables; provide resources to disseminate lessons learned; support faculty development to teach and mentor trainees through equity-related QI work; and prioritize time in the curriculum for learners to participate in equity improvement activities.
最近，研究生医学教育认证委员会 (ACGME) 的临床学习环境审查 (CLER) 计划呼吁解决医疗保健差异问题。CLER 计划希望教师和住院医师能够识别他们所服务的患者群体中的差异，并参与旨在解决这些差异的质量改进 (QI) 活动。在本观点中，作者提供了一个将 QI 和健康公平原则整合到研究生医学教育中的框架，以满足这些 ACGME 的期望。作者通过描述一个教师发展研讨会来说明他们的四步框架，该研讨会提供了将公平性纳入现有 QI 教育工作的策略和工具，并使用 QI 方法来解决公平性挑战。作者通过举例说明了医学教育工作者如何开始整合 QI 和公平倡议，以解决医疗保健差异问题，并让他们的住院医师/研究员参与这个过程。此外，作者强调了在 QI 干预措施中应用公平视角的重要性，以及认识到 QI 倡议将根据患者群体的不同对结果产生不同的影响。作者最后讨论了机构领导的必要性，以建立能力和培训，通过人口统计学变量来改进质量指标的数据收集和报告；提供资源来传播经验教训；支持教师发展，通过与公平相关的 QI 工作来教授和指导学员；并为学习者参与公平性改进活动在课程中安排时间。
