Department of Medicine, School of Medicine, University of California, San Francisco, California, USA.
Department of Obstetrics and Gynecology, School of Medicine, University of California, San Francisco, California, USA.
Clin Teach. 2020 Jun;17(3):298-304. doi: 10.1111/tct.13050. Epub 2019 Sep 5.
Diversifying the medical student body without striving for equity in the clerkship (first full-time clinical training year) learning environment disadvantages under-represented in medicine (UIM) students and undermines the educational process.
To characterise and address inequities within an internal medicine clerkship, we conducted a multi-phased process to promote equity in the clerkship learning environment at an urban medical school with multiple sites. … we conducted a multi-phased process to promote equity in the clerkship learning environment … INNOVATION: The process to improve the learning environment and equity in the clerkship included: (i) a literature review and needs assessment (focus group) with UIM students; (ii) a medicine clerkship retreat with school leaders and diversity experts to reflect on the needs assessment data and generate interventions to improve equity; (iii) a member checking session with UIM students to ensure that the proposed solutions addressed the inequities that were noted in the needs assessment.
The needs assessment revealed eight themes in the clerkship learning environment that were mapped to a published framework describing barriers encountered by UIM students. These themes informed the development of five clerkship pilot interventions. Implementing interventions inspired by UIM student perspectives may improve the learning environment in clinical clerkships by encouraging a culture of equity. The three-phased approach described here provides leaders who direct educational programmes with a framework to initiate change by characterising inequities as a springboard for developing solutions.
在实习（第一学年全职临床培训）学习环境中，不努力追求公平，而使医学生群体多样化会使医学领域代表性不足的学生（UIM）处于不利地位，并破坏教育过程。
为了描述和解决内科实习中的不公平现象，我们在一所拥有多个校区的城市医学院，进行了一个多阶段的过程，以促进实习学习环境的公平性。……我们进行了一个多阶段的过程，以促进实习学习环境的公平性……
改善学习环境和实习公平性的过程包括：（i）对 UIM 学生进行文献回顾和需求评估（焦点小组）；（ii）与学校领导和多样性专家一起进行内科实习务虚会，反思需求评估数据并提出干预措施以提高公平性；（iii）与 UIM 学生进行成员核对会议，以确保提出的解决方案解决了需求评估中指出的不公平问题。
需求评估揭示了实习学习环境中的八个主题，这些主题与描述 UIM 学生遇到的障碍的已发表框架相匹配。这些主题为五项实习试点干预措施的制定提供了信息。实施受 UIM 学生观点启发的干预措施，通过鼓励公平文化，可能会改善临床实习的学习环境。这里描述的三阶段方法为指导教育项目的领导者提供了一个框架，通过将不公平现象作为制定解决方案的跳板，来启动变革。
