University of Wisconsin, School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, Madison, Wisconsin.
University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan.
West J Emerg Med. 2023 Mar 6;24(2):119-126. doi: 10.5811/westjem.2023.1.58366.
Emergency medicine (EM) residency programs have variable approaches to educating residents on recognizing and managing healthcare disparities. We hypothesized that our curriculum with resident-presented lectures would increase residents' sense of cultural humility and ability to identify vulnerable populations.
At a single-site, four-year EM residency program with 16 residents per year, we designed a curriculum intervention from 2019-2021 where all second-year residents selected one healthcare disparity topic and gave a 15-minute presentation overviewing the disparity, describing local resources, and facilitating a group discussion. We conducted a prospective observational study to assess the impact of the curriculum by electronically surveying all current residents before and after the curriculum intervention. We measured attitudes on cultural humility and ability to identify healthcare disparities among a variety of patient characteristics (race, gender, weight, insurance, sexual orientation, language, ability, etc). Statistical comparisons of mean responses were calculated using the Mann-Whitney U test for ordinal data.
A total of 32 residents gave presentations that covered a broad range of vulnerable patient populations including those that identify as Black, migrant farm workers, transgender, and deaf. The overall survey response was 38/64 (59.4%) pre-intervention and 43/64 (67.2%) post-intervention. Improvements were seen in resident self-reported cultural humility as measured by their responsibility to learn (mean responses of 4.73 vs 4.17; P < 0.001) and responsibility to be aware of different cultures (mean responses of 4.89 vs 4.42; P < 0.001). Residents reported an increased awareness that patients are treated differently in the healthcare system based on their race (P < 0.001) and gender (P < 0.001). All other domains queried, although not statistically significant, demonstrated a similar trend.
This study demonstrates increased resident willingness to engage in cultural humility and the feasibility of resident near-peer teaching on a breadth of vulnerable patient populations seen in their clinical environment. Future studies may query the impact this curriculum has on resident clinical decision-making.
急诊医学（EM）住院医师培训计划在教育住院医师识别和管理医疗保健差异方面采用了不同的方法。我们假设，我们的课程通过住院医师主讲的讲座，将增加住院医师的文化谦逊感和识别弱势群体的能力。
在一个为期四年的单站点 EM 住院医师培训计划中，我们每年有 16 名住院医师，我们设计了一个从 2019 年到 2021 年的课程干预，所有第二年的住院医师选择一个医疗保健差异主题，并进行 15 分钟的演讲，概述差异，描述当地资源，并促进小组讨论。我们进行了一项前瞻性观察研究，通过在课程干预前后对所有现任住院医师进行电子调查，评估课程的影响。我们测量了对各种患者特征（种族、性别、体重、保险、性取向、语言、能力等）的文化谦逊和识别医疗保健差异的能力的态度。使用有序数据的曼-惠特尼 U 检验计算均值响应的统计比较。
共有 32 名住院医师进行了演讲，涵盖了广泛的弱势患者群体，包括那些自认为是黑人、流动农场工人、跨性别者和聋人的患者。总体调查回应率为干预前 38/64（59.4%）和干预后 43/64（67.2%）。住院医师自我报告的文化谦逊感有所改善，表现在他们学习的责任（平均反应分别为 4.73 与 4.17；P < 0.001）和对不同文化的认识责任（平均反应分别为 4.89 与 4.42；P < 0.001）。住院医师报告说，他们意识到患者在医疗保健系统中因种族（P < 0.001）和性别（P < 0.001）而受到不同的待遇。虽然不是统计学上显著的，但其他所有被查询的领域都表现出了类似的趋势。
这项研究表明，住院医师更愿意参与文化谦逊，并且可以通过住院医师的近邻教学来教授他们在临床环境中看到的各种弱势患者群体。未来的研究可能会询问该课程对住院医师临床决策的影响。
