A. Krishnan is a fourth-year medical student, Johns Hopkins University School of Medicine, Baltimore, Maryland. M. Rabinowitz is a first-year pediatric resident, Kaiser Permanente Northern California, Oakland, California. A. Ziminsky is production associate, Aquifer, Lebanon, New Hampshire. S.M. Scott is senior associate dean for educational affairs and accreditation and professor of medical education, Texas Christian University and University of North Texas Health Science Center School of Medicine, Fort Worth, Texas. K.C. Chretien is associate dean for student affairs and professor of medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.
Acad Med. 2019 Apr;94(4):550-555. doi: 10.1097/ACM.0000000000002589.
Sociodemographic identities, including race, culture, ethnicity, gender, and sexual orientation (race and culture), are recognized as important determinants of health, with significant impacts on patients' health outcomes, but teaching medical students about this is challenging. The authors sought to identify areas for improvement in delivery of critical content about race, culture, structural inequalities, and health disparities within a set of virtual patient cases used by U.S. medical schools and develop revision guidelines.
A workgroup (medical students and faculty) conducted a literature review in 2017 to identify challenges and best practices for teaching and learning about race and culture in medicine. Using an analytic framework informed by this review, they analyzed 63 Aquifer virtual patient teaching cases for effectiveness of the presentation of race and culture, resulting in six main themes describing common mistakes or pitfalls. They then developed an evidence-based guide for systematic case revision.
The authors present a novel, practical guide for medical educators to use to revise existing teaching cases and improve the delivery of critical concepts surrounding race and culture. This guide includes fundamental definitions and six sections to guide structured case revision based on the main themes. It includes examples of language, suggested edits, and the rationale and evidence for recommendations.
Feedback from faculty and students regarding implementation of the guide and delivery of revised content in Aquifer cases will be critical in determining the guide's effectiveness. This structured guide may be adapted to a variety of teaching modalities in medicine.
社会人口学特征，包括种族、文化、民族、性别和性取向（种族和文化），被认为是健康的重要决定因素，对患者的健康结果有重大影响，但教授医学生了解这些内容具有挑战性。作者试图确定在美国医学院使用的一系列虚拟患者案例中，在提供关于种族、文化、结构不平等和健康差距的关键内容方面需要改进的领域，并制定修订指南。
一个工作组（医学生和教师）于 2017 年进行了文献回顾，以确定在医学领域教授和学习种族和文化方面的挑战和最佳实践。他们使用该综述提供的分析框架，分析了 63 个 Aquifer 虚拟患者教学案例，以评估呈现种族和文化的效果，从而得出描述常见错误或陷阱的六个主要主题。然后，他们为系统案例修订制定了一份基于证据的指南。
作者提出了一种新颖的、实用的指南，供医学教育者使用，以修订现有的教学案例，并改进有关种族和文化的关键概念的传授。该指南包括基本定义和六个部分，以基于主要主题指导结构化案例修订。它包括语言示例、建议的编辑、推荐的理由和证据。
教师和学生对指南实施情况以及 Aquifer 案例中修订内容的传授的反馈对于确定指南的有效性至关重要。该结构化指南可适应医学中的各种教学模式。
