MD Program, University of Alberta, Edmonton, Canada.
Med Educ Online. 2024 Dec 31;29(1):2331852. doi: 10.1080/10872981.2024.2331852. Epub 2024 Mar 22.
Simulated cases are widely used in medical education to develop clinical reasoning skills and discuss key topics around patient care. Such cases present an opportunity to demonstrate real world encounters with diverse patient and health provider identities, impacts of social and structural determinants of health, and demonstrate a generalist approach to problems. However, despite many calls-to-action for medical schools to better incorporate equity, diversity and inclusion (EDI) and generalism, it remains difficult to evaluate how well these goals are being met.
A quality improvement project was completed at a single medical school to evaluate the domains of generalism and EDI within simulated cases used in the preclinical curriculum. Generalism was evaluated using the Toronto Generalism Assessment Tool (T-GAT). EDI was evaluated using a locally developed novel tool. Analysis included descriptive statistics and Pearson correlation coefficient.
A total of 49 simulated cases were reviewed. Twelve generalism and 5 EDI items were scored on a 5-point Likert scale, with higher scores indicating better demonstration of generalism or EDI within a case. Average generalism score across all cases was 45.6/60. Average EDI score across all cases was 11.7/25. Only 21/49 cases included representation of one or more diverse identity categories. The most common diverse identity represented was non-white races/ethnicities, and the identity represented the least was diversity in language fluency. Generalism and EDI scores demonstrated a weak positive correlation (R = 0.25).
Quantitative evaluation of simulated cases using specific generalism and EDI scoring tools was successful in generating insight into areas of improvement for teaching cases. This approach identified key content areas for case improvement and identities that are currently underrepresented in teaching cases. Similar approaches could be feasibly used by other medical schools to improve generalism and EDI in teaching cases or other curricular materials.
模拟病例被广泛用于医学教育中，以培养临床推理能力，并讨论围绕患者护理的关键主题。这些病例提供了一个机会，可以展示与不同患者和医疗服务提供者身份的实际遭遇、健康决定因素的社会和结构性影响，并展示对问题的通才方法。然而，尽管许多医学学校都呼吁更好地纳入公平、多样性和包容性（EDI）以及通才教育，但仍然难以评估这些目标的实现程度。
在一所医学院进行了一项质量改进项目，以评估基础临床课程中使用的模拟病例中的通才教育和 EDI 领域。通才教育使用多伦多通才评估工具（T-GAT）进行评估。EDI 使用本地开发的新工具进行评估。分析包括描述性统计和 Pearson 相关系数。
共审查了 49 个模拟病例。12 个通才教育和 5 个 EDI 项目按 5 点李克特量表评分，分数越高表示在一个病例中更好地展示了通才教育或 EDI。所有病例的平均通才教育得分是 45.6/60。所有病例的平均 EDI 得分是 11.7/25。只有 21/49 个病例包含一个或多个不同身份类别的代表。最常见的不同身份代表是非白种人种族/族裔，而代表最少的身份是语言流利度的多样性。通才教育和 EDI 得分表现出微弱的正相关（R=0.25）。
使用特定的通才教育和 EDI 评分工具对模拟病例进行定量评估，成功地为教学病例的改进提供了深入的了解。这种方法确定了病例改进的关键内容领域和目前在教学病例中代表性不足的身份。其他医学院校可以采用类似的方法，以提高教学病例或其他课程材料中的通才教育和 EDI。
