Medical Scientist Training Program, Department of Biochemistry, Duke University School of Medicine, Durham, NC, USA.
Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
J Natl Med Assoc. 2023 Aug;115(4):428-435. doi: 10.1016/j.jnma.2023.06.005. Epub 2023 Jul 6.
Current sociopolitical events coupled with requirement modifications by the Liaison Committee on Medical Education have reinvigorated a need for training in cultural awareness and health disparities in undergraduate medical education. Many institutions, however, have not established longitudinal courses designed to address this content. Additionally, little is known about the change in learners' awareness of cultural determinants of health and health disparities after enrollment in such curricula. In 2016, the authors developed a yearlong required course entitled Cultural Determinants of Health and Health Disparities for first year medical students at a large university medical school in the United States. The course launched in the 2017 academic year.
Two cohorts participated in twelve 2.5 to 3-hour multi-modal sessions focused on various aspects of healthcare delivery for marginalized populations and factors that contribute to health disparities. The Multicultural Assessment Questionnaire was used pre and post course to assess students' self-evaluated changes in knowledge, skills, and awareness related to cultural competency in healthcare.
Students' self-reported knowledge, skills, and awareness scores regarding cultural competence in health care increased from pre to post-course assessment. On the knowledge scale, students' mean score increased from 2.63 to 2.97 (P < .001), with 16% reporting a decreased score, 30% reporting no change, and 54% reporting growth. On the skills scale, students' mean score increased from 2.64 to 3.38 (P < .001), with 11% reporting a decreased score, 17% reporting no change, and 72% reporting growth. On the awareness scale, students' overall score increased from 3.76 to 3.97 (P < .05), with 16% reporting a decreased score, 50% reporting no change, and 34% reporting growth. There were no changes in KSA scores across cohorts pre and post course.
Perceived knowledge, skills, and awareness related to the importance of cultural competence in healthcare delivery increased at the end of the academic year. This type of longitudinal course model could be broadly adopted at other institutions to enhance patient, peer, and future provider awareness regarding cultural impacts on care and health disparities among vulnerable populations.
当前的社会政治事件以及医学教育联络委员会的要求修改，重新激发了在本科医学教育中培养文化意识和健康差异的需求。然而，许多机构尚未建立旨在解决这一内容的长期课程。此外，在参加此类课程后，学习者对健康的文化决定因素和健康差异的认识变化知之甚少。2016 年，作者为美国一所大型大学医学院的一年级医学生开发了一门为期一年的必修课，题为“健康的文化决定因素和健康差异”。该课程于 2017 学年开始。
两个队列参加了十二次 2.5 到 3 小时的多模式课程，重点是为边缘化人群提供医疗服务的各个方面以及导致健康差异的因素。在课程前后使用多元文化评估问卷评估学生自我评估的与医疗保健中的文化能力相关的知识、技能和意识变化。
学生自我报告的与医疗保健中的文化能力相关的知识、技能和意识得分从课程前评估到课程后评估有所增加。在知识量表上，学生的平均分数从 2.63 增加到 2.97（P<.001），有 16%的人报告分数下降，30%的人报告没有变化，54%的人报告分数增长。在技能量表上，学生的平均分数从 2.64 增加到 3.38（P<.001），有 11%的人报告分数下降，17%的人报告没有变化，72%的人报告分数增长。在意识量表上，学生的总分从 3.76 增加到 3.97（P<.05），有 16%的人报告分数下降，50%的人报告没有变化，34%的人报告分数增长。课程前后，两个队列的 KSA 分数均无变化。
在学年结束时，学生对文化能力在医疗服务中的重要性的感知知识、技能和意识有所提高。这种纵向课程模式可以在其他机构广泛采用，以提高患者、同行和未来提供者对文化对弱势群体护理和健康差异的影响的认识。
