J.K. Draper is a family medicine resident, Mountain Area Health Education Center, Asheville, North Carolina; ORCID: https://orcid.org/0000-0003-3355-8054 .
C. Feltner is assistant professor, Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0002-4773-2570 .
Acad Med. 2022 Aug 1;97(8):1226-1235. doi: 10.1097/ACM.0000000000004718. Epub 2022 Jul 21.
The education of health care professionals is a contributing factor to persistent health disparities. Although medical students are expected to understand racism, classism, and other social and structural drivers of health (SDH), standardization and best practices for teaching these concepts are lacking. Some medical schools are adopting social justice curricula (SJC) that prioritize health equity in teaching students to recognize SDH and preparing them to address the consequent health disparities. This systematic review sought to evaluate how these schools have integrated SJC into their core teaching; the criteria they have used to measure success and to what extent these criteria are met; and best practices in planning, implementing, and evaluating SJC.
The authors searched 7 databases for English-language studies published between January 2000 and April 2020, reporting on longitudinally integrated SJC at U.S. medical schools intended for all students. Quantitative and qualitative outcomes were synthesized and summarized.
Searches identified 3,137 articles, of which 11 met inclusion criteria. Results demonstrated schools use a variety of teaching methods over a wide range of didactic hours to teach SJC concepts. Surveys and objective tests indicated students in SJC are generally satisfied and demonstrated improved knowledge and skills related to understanding and mitigating SDH, although findings related to changes in attitudes were equivocal. Evaluations at graduation and in residency demonstrated students who experience SJC are more prepared than their peers to work with patients who are underserved. Best practices in SJC included addressing the hidden curriculum, considering medical mistrust, and using tools like the Racial Justice Report Card and Tool for Assessing Cultural Competence Training.
These findings indicated SJC can prepare students to better address the root causes of health disparities. Future research should consider the long-term influences of these curricula on students, patients, and the community.
医疗保健专业人员的教育是导致健康差距持续存在的一个因素。尽管医学生应该理解种族主义、阶级主义和其他社会和结构性健康驱动因素（SDH），但教授这些概念的标准化和最佳实践却缺乏。一些医学院正在采用社会公正课程（SJC），在教学中优先考虑健康公平，使学生认识到 SDH，并为他们准备解决由此产生的健康差距。本系统评价旨在评估这些学校如何将 SJC 纳入其核心教学；他们用来衡量成功的标准以及这些标准在多大程度上得到满足；以及规划、实施和评估 SJC 的最佳实践。
作者在 7 个数据库中搜索了 2000 年 1 月至 2020 年 4 月期间发表的关于美国医学院所有学生接受的纵向综合 SJC 的英语研究。对定量和定性结果进行了综合和总结。
搜索结果确定了 3137 篇文章，其中 11 篇符合纳入标准。结果表明，学校使用各种教学方法，在广泛的教学时间内教授 SJC 概念。调查和客观测试表明，接受 SJC 的学生通常对教学感到满意，并展示了与理解和减轻 SDH 相关的知识和技能的提高，尽管与态度变化相关的发现存在分歧。毕业和住院评估表明，经历 SJC 的学生比同龄人更有准备与服务不足的患者合作。SJC 的最佳实践包括解决隐性课程、考虑医疗不信任以及使用种族正义报告卡和文化能力培训评估工具等工具。
这些发现表明 SJC 可以使学生更好地解决健康差距的根本原因。未来的研究应考虑这些课程对学生、患者和社区的长期影响。
