Goodwin Emily T, Kavanagh Maurice J, Samuel Anita
Department of Family Medicine, Uniformed Services University of Health Sciences, Bethesda, MD 20814, United States.
Center for Health Professions Education, Uniformed Services University of Health Sciences, Bethesda, MD 20814, United States.
Mil Med. 2025 Jul 1;190(Supplement_1):34-36. doi: 10.1093/milmed/usaf265.
Education in healthcare disparities is a requirement for all residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). In 2023, the ACGME family medicine (FM) residency program requirements became more stringent than past iterations. Navy FM programs were not equipped to meet this need. Only 1 out of 4 Navy FM programs had a structured curriculum. In 1 navy program, 59% of residents reported receiving education in healthcare disparities compared to an average of 86% across all FM residencies accredited by ACGME. There is an unmet need for a comprehensive healthcare disparities curriculum.
One navy FM residency created a longitudinal HD curriculum using Kern's Six-Step method. A needs assessment was conducted using program self-assessment surveys and ACGME survey data. Objectives were designed with input from residents and faculty. Five sessions (1 per objective) were given over 1 academic year. Pre-session and post-session surveys as well as precurriculum and postcurriculum surveys were completed by the residents. Pre-session and post-session surveys were analyzed for statistical change in resident attitudes using a Wilcoxon Signed-Rank test and change in medical knowledge using a McNemar's test. Pre-curriculum and post-curriculum surveys were compared with descriptive statistics.
According to Post-curriculum surveys, 79% of residents felt the sessions they had attended were meaningful to their practice. Objectives 1, 2, and 3 showed significant changes in resident attitudes after session completion. Objective 1 showed significant changes in medical knowledge. An 18% increase in education about HD was reported on the annual ACGME resident survey.
Although residents demonstrated positive attitude changes after most sessions and ACGME compliance with HD education improved, demonstrating objective knowledge gain and measuring impact of the curriculum is a challenge for educators.
Longitudinal comprehensive didactics on HD topics are viewed positively by most residents and increase resident-reported adherence to ACGME requirements. Immediate change in resident attitudes was observed in most sessions. Additional research on long-term influences and practice implications may be helpful.
医疗保健差异教育是所有经研究生医学教育认证委员会（ACGME）认证的住院医师培训项目的一项要求。2023年，ACGME家庭医学（FM）住院医师培训项目要求比以往更加严格。海军FM项目无法满足这一需求。4个海军FM项目中只有1个有结构化课程。在1个海军项目中，59%的住院医师报告接受了医疗保健差异教育，而在ACGME认证的所有FM住院医师培训项目中，这一比例平均为86%。对全面的医疗保健差异课程存在未满足的需求。
一个海军FM住院医师培训项目采用克恩六步法创建了一个纵向的医疗保健差异课程。使用项目自我评估调查和ACGME调查数据进行了需求评估。目标是在住院医师和教员的参与下设计的。在1个学年内进行了5次课程（每个目标1次）。住院医师完成了课前和课后调查以及课程前和课程后调查。使用威尔科克森符号秩检验分析课前和课后调查中住院医师态度的统计变化，并使用麦克尼马尔检验分析医学知识的变化。课程前和课程后调查通过描述性统计进行比较。
根据课程后调查，79%的住院医师认为他们参加的课程对他们的实践有意义。目标1、2和3在课程结束后住院医师态度有显著变化。目标1在医学知识方面有显著变化。在ACGME年度住院医师调查中，报告的医疗保健差异教育增加了18%。
尽管大多数课程后住院医师表现出积极的态度变化，并且ACGME对医疗保健差异教育的合规性有所提高，但对教育工作者来说，证明客观知识的获得和衡量课程的影响是一项挑战。
大多数住院医师对关于医疗保健差异主题的纵向综合教学法评价积极，并增加了住院医师报告的对ACGME要求的遵守情况。在大多数课程中观察到住院医师态度的立即变化。对长期影响和实践意义的进一步研究可能会有所帮助。
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