B. Zhou is a first-year family medicine resident, Stanford University-O'Connor Family Medicine Residency Program, San Jose, California; ORCID: https://orcid.org/0000-0002-0253-9179 .
A.K. Louie is a professor, associate chair, and director of education, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; ORCID: https://orcid.org/0000-0002-6762-1835 .
Acad Med. 2022 Sep 1;97(9):1299-1304. doi: 10.1097/ACM.0000000000004744. Epub 2022 May 17.
In the wake of the Black Lives Matter and other antiracism justice movements, medical education is evolving to incorporate health equity principles for all medical students and residents, while also increasing institutional diversity recruitment of minoritized physicians. As the demographics of U.S. medical trainees shift to reflect a rapidly evolving patient population, the prevalence of culturally concordant patient-physician visits, where patients share elements of language, religion, customs, and identities with their physician, is also expected to increase. However, existing antiracist curricula are standardized to all learners and there is a dearth of cultural sensitivity training designed specifically for minoritized learners to interrogate the culturally concordant space they share with patients and mentors. In this article, the authors propose a new model for minoritized learners' cultural training, culturally reflective medicine (CRM) that identifies unanticipated tensions that may arise as minoritized learners bridge both White and Eurocentric professional and personal identities, examines how intersectionality can both strengthen encounters and lead to shared blind spots, and empowers minoritized physicians with tools for self- and group reflection to advocate for their communities. CRM is contextualized within the current landscape of cultural sensitivity training in medical education. The authors provide 2 clinical vignettes to demonstrate how CRM can unveil more nuanced understandings of health disparities than existing cultural training. As institutions work toward diversity, equity, justice, and antioppression, CRM provides a novel framework for redesigning medical education that better acknowledges and incorporates the unique knowledge of minoritized learners.
在“黑人的命也是命”(Black Lives Matter)和其他反种族主义正义运动之后,医学教育正在发展,将公平医疗原则纳入所有医学生和住院医师的课程中,同时增加机构多样性,招募少数族裔医生。随着美国医学受训者的人口统计数据发生变化,以反映迅速变化的患者群体,具有文化一致性的医患访问(即患者与医生共享语言、宗教、习俗和身份等元素)的比例预计也会增加。然而,现有的反种族主义课程是为所有学习者制定的标准化课程,缺乏专门为少数族裔学习者设计的文化敏感性培训,以质疑他们与患者和导师共同拥有的文化一致性空间。在本文中,作者提出了一种针对少数族裔学习者的文化培训新模式,即具有文化反思性的医学(Culturally Reflective Medicine,CRM),该模式可以识别少数族裔学习者在融合白人和欧洲中心主义的专业和个人身份时可能出现的意外紧张局势,研究交叉性如何既能加强接触,又能导致共同的盲点,并赋予少数族裔医生自我和群体反思的工具,以倡导他们的社区。CRM 是在医学教育中文化敏感性培训的当前背景下提出的。作者提供了 2 个临床案例,以展示 CRM 如何比现有的文化培训更深入地揭示健康差异。随着各机构努力实现多样性、公平、正义和反压迫,CRM 为重新设计医学教育提供了一个新的框架,更好地承认和纳入少数族裔学习者的独特知识。