Although women comprise half of all medical students, the number of female academic emergency medicine (EM) physicians remains at approximately 27%. In addition, despite having equivalent credentials, female EM faculty remain underrecognized and undercompensated when compared to their male counterparts. Recent studies have shown superior outcomes among patients treated by EM physicians who are women; however, disparities in advancement persist. This white paper, prepared on behalf of the Academy for Women in Academic Emergency Medicine, describes recent evidence demonstrating gender disparities in the EM workforce including content presented at the 2019 Society for Academic Emergency Medicine Annual Scientific Meeting. The authors describe strategies to address the identified problems. Specific recommendations include individual as well as institutional/systems-level approaches to creating directed programming and initiatives to recruit, support, and promote women at all aspects of the career continuum.

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Objective: Prior research suggests that health care providers are susceptible to implicit biases, specifically prowhite biases, and that these may contribute to health care disparities by influencing physician behavior. Despite these findings, implicit bias training is not currently embedded into emergency medicine (EM) residency training and few studies exist that evaluate the effectiveness of implicit bias training on awareness during residency conference. We sought to conduct a mixed-methods program evaluation of a formalized educational intervention targeted on the topic of implicit bias. Methods:We used a design thinking framework to develop a curricular intervention. The intervention consisted of taking the Harvard Implicit Association Test (IAT) on race to introduce the concept of implicit bias, followed by a facilitated discussion to explore participant's perceptions on whether implicit bias may lead to variations in care. The facilitated discussion was audio recorded, transcribed, and coded for emerging themes. An online survey assessed participant awareness of these topics before and after the intervention and was analyzed using paired t-tests. Results: After the intervention, participant's awareness of their individual implicit biases increased by 33.3%(p = 0.003) and their awareness of how their IAT results influences how they deliver care to patients increased by 9.1% (p = 0.03). Emerging themes included skepticism of the implicit bias test results with the desire to have "neutral" results, acknowledgment that pattern recognition may lead to "blind spots" in care, recognition that bias exists on a personal and systemic level, and interest in regular educational interventions to address implicit bias.Conclusions: This novel educational intervention on implicit bias resulted in improvement in participants' awareness of their implicit biases and how it may affect their patient care. Our intervention can serve as a model for other residency programs to develop and implement an intervention to create awareness of implicit bias and its potential impact on patient care.

Implicit bias training is not currently a required component of residency education, yet implicit bias in medicine exists and may influence care provided to patients. We propose an innovative exercise that allows trainees to explore implicit bias outside of the clinical environment, in an interdisciplinary manner with museum anthropologists and archaeologists. The curriculum was designed with leaders at the Penn Museum and focuses on differentiating between objective and subjective assessments of historical objects. The first part of the exercise consists of a pre-brief, to introduce trainees to bias through the lens of an anthropologist/archaeologist. The second part guides trainees through “deep description,” where they explore objective and subjective findings of three different objects. The exercise concludes with a debrief and application of concepts learned to everyday clinical practice. This innovation was successful at introducing trainees to implicit bias in a nontraditional environment, and participants reported an improved understanding of implicit bias. Residency programs could consider partnering with local museums to implement a similar exercise as a component of conference curriculum.

Over the past decade, the number of refugees arriving in the United States (U.S.) has increased dramatically. Refugees arrive with unmet health needs and may face barriers when seeking care. However, little is known about how refugees perceive and access care when acutely ill. The goal of this study was to understand barriers to access of acute care by newly arrived refugees, and identify potential improvements from refugees and resettlement agencies. Methods: This was an in-depth, qualitative interview study of refugees and employees from refugee resettlement and post-resettlement agencies in a city in the Northeast U.S. Interviews were audiotaped, transcribed, and coded independently by two investigators. Interviews were conducted until thematic saturation was reached. We analyzed transcripts using a modified grounded theory approach. Results: Interviews were completed with 16 refugees and 12 employees from refugee resettlement/post-resettlement agencies. Participants reported several barriers to accessing acute care including challenges understanding the U.S. healthcare system, difficulty scheduling timely outpatient acute care visits, significant language barriers in all acute care settings, and confusion over the intricacies of health insurance. The novelty and complexity of the U.S. healthcare system drives refugees to resettlement agencies for assistance. Resettlement agency employees express concern with directing refugees to appropriate levels of care and report challenges obtaining timely access to sick visits. While receiving emergency department (ED) care, refugees experience communication barriers due to limitations in consistent interpretation services. Conclusion: Refugees face multiple barriers when accessing acute care. Interventions in the ED, outpatient settings, and in resettlement agencies, have the potential to reduce barriers to care. Examples could include interpretation services that allow for clinic phone scheduling and easier access to interpreter services within the ED. Additionally, extending the Refugee Medical Assistance program may limit gaps in insurance coverage and avoid insurance-related barriers to seeking care. [