Ryus Caitlin R, Yang David, Tsai Jennifer, Meldrum Jonathan, Ngaruiya Christine
Department of Emergency Medicine Yale University School of Medicine New Haven Connecticut USA.
AEM Educ Train. 2021 Sep 29;5(Suppl 1):S121-S125. doi: 10.1002/aet2.10681. eCollection 2021 Sep.
People experiencing homelessness (PEH) suffer higher burdens of chronic illnesses, have higher rates of emergency medicine (ED) use and hospitalization, and ultimately are at increased risk for premature death compared to housed counterparts. Structural racism contributes to a disproportionate burden of homelessness among people of color. PEH experience not only significant medical concerns but also complex social needs that need to be addressed concurrently for effective healing, issues that have been magnified by the COVID-19 pandemic. As health disparities and structural racism intersect among PEH, it is critically important to develop PEH-centered interventions to improve care and health outcomes as part of an effort to dismantle racism. One opportunity to address these disparities in care for PEH is through training ED physicians on methods for identifying and intervening on the unique needs of vulnerable patient groups. The Accreditation Council for Graduate Medical Education has outlined health quality pathways in the clinical learning environment to address health disparities. Community-based participatory research (CBPR) is particularly well suited for this scenario as it allows experiential learning for trainees to work with and understand a diverse group of stakeholders, to deepen their knowledge of local health disparities, and to lead research and measure outcomes of interventions to tackle health disparities. In this paper, we highlight the utility of CBPR in fostering experiential learning for EM residents on tackling health disparities and the importance of community collaboration in trainee-led interventions for comprehensive ED care.
与有住房的人相比,无家可归者患慢性病的负担更重,使用急诊医学(ED)和住院的比例更高,最终过早死亡的风险也更高。结构性种族主义导致有色人种中无家可归的负担过重。无家可归者不仅面临重大的医疗问题,还面临复杂的社会需求,为了有效康复,这些需求需要同时得到解决,而新冠疫情使这些问题更加突出。由于健康差距和结构性种族主义在无家可归者中相互交织,开发以无家可归者为中心的干预措施以改善护理和健康结果,作为消除种族主义努力的一部分,至关重要。解决无家可归者护理方面这些差距的一个机会是培训急诊医生识别和干预弱势群体独特需求的方法。研究生医学教育认证委员会已经在临床学习环境中概述了应对健康差距的健康质量途径。基于社区的参与性研究(CBPR)特别适合这种情况,因为它允许受训人员通过实践学习与不同的利益相关者合作并了解他们,加深他们对当地健康差距的认识,并主导研究和衡量解决健康差距的干预措施的结果。在本文中,我们强调了CBPR在促进急诊医学住院医师应对健康差距的实践学习中的作用,以及社区合作在受训人员主导的全面急诊护理干预中的重要性。