Development of a health equity journal club to address health care disparities and improve cultural competence among emergency medicine practitioners

Abstract

Health care disparities have been magnified by the COVID-19 pandemic. Only recently has the medical community acknowledged implicit bias and systemic racism as a public health emergency. Graduate medical education has been slow to adopt curricula beyond lecture-based formats that specifically address social determinants of health (SDOH) and its impact on communities. Curricula addressing unconscious (implicit) biases and their influence on patient care has not been widely adopted. The emergency department (ED) has a unique role in addressing health care disparities. Approximately 69% of emergency medicine residency programs incorporate cultural competency training in their curricula. Most are primarily lecture-based without a longitudinal component, and gaps exist in content, quality, and expertise of the presenters. Lecture-based formats may not be best suited to manage the nuanced conversations necessary to dismantle biases and socialized beliefs that result in disparities for marginalized communities. Reporting little or no education in medical school related to SDOH, residents acknowledge that barriers to care exist, but have limited or no knowledge of what those barriers are or how mitigate them. To improve health equity, understanding and competence in caring for culturally and ethnically diverse populations, we developed a monthly, longitudinal, SDOH-and cultural competency-based "health equity journal club" (HEJC) for all levels of ED staff. Four educational domains were developed, and specific content within each domain was selected based on predetermined criteria. Content for each session was mapped to the ACGME program and core competency milestone requirements, ACGME Clinical Learning Environment (CLER) mandates, and The Joint Commission's institutional recommendations for culturally competent care. The HEJC series has been successful in reducing barriers to identifying biases in health care; translating literature to clinical care; generating initiatives and interdisciplinary research;

2022 consensus conference on diversity, equity, and inclusion: Developing an emergency medicine research agenda for addressing racism through health care research

“…In the preconference literature review, we found articles in the literature that highlight strategies for addressing racism and racial bias on internalized, interpersonal, institutional, and systemic levels 26,44–52 . Much of the literature focused on describing workshops and efforts to address racism in health care and diversity in recruitment of health care professionals 45,47,48,50,51 . While several of the available articles raise awareness of issues and provide suggestions for interventions, few articles exist with data measuring the impact of such interventions 53,54 .…”

“…In the preconference literature review, we found articles in the literature that highlight strategies for addressing racism and racial bias on internalized, interpersonal, institutional, and systemic levels. 26,[44][45][46][47][48][49][50][51][52] Much of the literature focused on describing workshops and efforts to address racism in health care and diversity in recruitment of health care professionals. 45,47,48,50,51 While several of the available articles raise awareness of issues and provide suggestions for interventions, few articles exist with data measuring the impact of such interventions.…”

“…26,[44][45][46][47][48][49][50][51][52] Much of the literature focused on describing workshops and efforts to address racism in health care and diversity in recruitment of health care professionals. 45,47,48,50,51 While several of the available articles raise awareness of issues and provide suggestions for interventions, few articles exist with data measuring the impact of such interventions. 53,54 Available data primarily focus on measuring the effectiveness of education in improving awareness of racism.…”

“…53,54 Available data primarily focus on measuring the effectiveness of education in improving awareness of racism. Studied interventions that have been found to be successful at improving awareness of racial bias and racism include health equity retreats for EM residents, 48 critical race theory curricula in EM education, 55 health equity journal clubs for EM staff, 45 and online courses for EM faculty. 56 Literature focused on improving outcomes related to emergency medical care included incorporating medical Spanish in residency to improve patient satisfaction, 57 decreasing barriers for Black and Hispanic men to receive opioid use disorder treatment, 58 and emergency department (ED)-based interventions…”

Beyond diversity and inclusion: Developing a research agenda for anti‐racism in emergency medicine education

“…web-based, interactive teaching sessions, etc.). [16][17][18][19] Care should also be taken in maintaining learners' psychological safety. Implementation of implicit bias training within UME/ GME increases trainee awareness of their individual implicit biases but may also induce stress when learners begin to recognize bias within themselves.…”