Atrium Health, Department of Emergency Medicine, Charlotte, North Carolina.
University of North Carolina Chapel Hill School of Medicine, Chapel Hill, North Carolina.
West J Emerg Med. 2023 Jul 12;24(4):668-674. doi: 10.5811/westjem.59459.
It is important for physicians to learn how to provide culturally sensitive care. Cultural humility is defined as a lifelong process with a goal of fixing power imbalances and creating institutional accountability through learning about another's culture as well as performing self-exploration about one's own beliefs, identities, and biases. One way to teach cultural humility in medicine is simulation. However, there are no peer-reviewed published studies that examine whether the skin tone or gender of the high-fidelity simulation manikins (HFSM) used by emergency medicine (EM) residency programs reflects the US population nor whether high-fidelity simulation is used to teach cultural humility. We aimed to address that gap in the literature. Our primary objective was to evaluate what proportion of EM residency programs use HFS to teach cultural humility. Our secondary objective was to evaluate whether the skin tone and gender breakdown of the EM residency program HFSM is representative of the US population.
We conducted a simple random sample of 80 EM residency programs to characterize HFSM and cultural humility training. Selected programs were emailed a questionnaire. Key outcomes included HFSM skin tone and gender and whether cultural humility was taught via HFSM. We calculated point and interval estimates for the proportion of dark-, medium-, and light-toned skin and the proportion of female and male manikins. Confidence intervals were employed to test the null hypothesis that dark/medium/light skin tone was 20/20/60 and that the female/male ratio was 50/50. Both ratios were extrapolated from the US Census data.
Our response rate was 74% (59/80). Fifty-five of 59 EM residency programs that had manikins (0.93, 95% confidence interval [CI] 0.88-0.99) reported data on a total of 348 manikins. Thirty-nine of the 55 programs with manikins reported using HFS to teach cultural humility (0.71, 95% CI 0.60-0.82). Proportions of light-, medium-, and dark-toned manikins were 0.52 (0.43-0.62), 0.38 (0.29-0.47), and 0.10 (0.07-0.14), respectively. Proportions of male and female HFSM were 0.69 (0.64-0.76) and 0.31 (0.24-0.36), respectively. The null hypotheses that skin tone follows a 60/20/20 split and gender follows a 50/50 split were rejected, as not all confidence intervals contained these hypothesized values.
While most EM residency programs surveyed use high-fidelity simulation to teach cultural humility, the manikins do not reflect either the skin tone or gender of the US population.
医生学习如何提供文化敏感性护理很重要。文化谦逊被定义为一个终身的过程，其目标是通过了解他人的文化以及对自己的信仰、身份和偏见进行自我探索，来纠正权力失衡并建立机构问责制。在医学中教授文化谦逊的一种方法是模拟。然而，目前没有经过同行评审的已发表研究来检查急诊医学 (EM) 住院医师项目使用的高保真模拟人 (HFSM) 的肤色或性别是否反映了美国人口，也没有研究高保真模拟是否用于教授文化谦逊。我们旨在解决文献中的这一空白。我们的主要目标是评估有多少 EM 住院医师项目使用 HFSM 来教授文化谦逊。我们的次要目标是评估 EM 住院医师项目的 HFSM 的肤色和性别分布是否代表美国人口。
我们对 80 个 EM 住院医师项目进行了简单随机抽样，以描述 HFSM 和文化谦逊培训。选择的项目通过电子邮件发送了一份问卷。主要结果包括 HFSM 的肤色和性别，以及是否通过 HFSM 教授文化谦逊。我们计算了深色、中色和浅色以及女性和男性人体模型的比例的点估计值和区间估计值。置信区间用于检验肤色为 20/20/60 且男女比例为 50/50 的零假设。这两个比例均从美国人口普查数据中推断得出。
我们的回复率为 74%（59/80）。在 59 个拥有人体模型的 EM 住院医师项目中，有 55 个（0.93，95%置信区间 [CI] 0.88-0.99）报告了总计 348 个人体模型的数据。55 个拥有人体模型的项目中有 39 个（0.71，95%CI 0.60-0.82）报告使用 HFSM 教授文化谦逊。浅色、中色和深色人体模型的比例分别为 0.52（0.43-0.62）、0.38（0.29-0.47）和 0.10（0.07-0.14）。男性和女性 HFSM 的比例分别为 0.69（0.64-0.76）和 0.31（0.24-0.36）。肤色遵循 60/20/20 分布且性别遵循 50/50 分布的零假设被拒绝，因为并非所有置信区间都包含这些假设值。
尽管大多数接受调查的 EM 住院医师项目都使用高保真模拟来教授文化谦逊，但人体模型既不能反映美国人口的肤色，也不能反映美国人口的性别。
