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Observational Study
. 2023 Mar 6;24(2):119-126.
doi: 10.5811/westjem.2023.1.58366.

Cultural Humility Curriculum to Address Healthcare Disparities for Emergency Medicine Residents

Ryan E Tsuchida  1 , Jessica Doan  2 , Eve D Losman  2 , Adrianne N Haggins  2 , Robert D Huang  2 , Daniel J Hekman  1 , Marcia A Perry  2
Affiliations
Observational Study

Cultural Humility Curriculum to Address Healthcare Disparities for Emergency Medicine Residents

Ryan E Tsuchida et al. West J Emerg Med. .

Abstract

Introduction: Emergency medicine (EM) residency programs have variable approaches to educating residents on recognizing and managing healthcare disparities. We hypothesized that our curriculum with resident-presented lectures would increase residents' sense of cultural humility and ability to identify vulnerable populations.

Methods: At a single-site, four-year EM residency program with 16 residents per year, we designed a curriculum intervention from 2019-2021 where all second-year residents selected one healthcare disparity topic and gave a 15-minute presentation overviewing the disparity, describing local resources, and facilitating a group discussion. We conducted a prospective observational study to assess the impact of the curriculum by electronically surveying all current residents before and after the curriculum intervention. We measured attitudes on cultural humility and ability to identify healthcare disparities among a variety of patient characteristics (race, gender, weight, insurance, sexual orientation, language, ability, etc). Statistical comparisons of mean responses were calculated using the Mann-Whitney U test for ordinal data.

Results: A total of 32 residents gave presentations that covered a broad range of vulnerable patient populations including those that identify as Black, migrant farm workers, transgender, and deaf. The overall survey response was 38/64 (59.4%) pre-intervention and 43/64 (67.2%) post-intervention. Improvements were seen in resident self-reported cultural humility as measured by their responsibility to learn (mean responses of 4.73 vs 4.17; P < 0.001) and responsibility to be aware of different cultures (mean responses of 4.89 vs 4.42; P < 0.001). Residents reported an increased awareness that patients are treated differently in the healthcare system based on their race (P < 0.001) and gender (P < 0.001). All other domains queried, although not statistically significant, demonstrated a similar trend.

Conclusion: This study demonstrates increased resident willingness to engage in cultural humility and the feasibility of resident near-peer teaching on a breadth of vulnerable patient populations seen in their clinical environment. Future studies may query the impact this curriculum has on resident clinical decision-making.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Measurement of cultural humility pre- and post- implementation responses.
Figure 2
Figure 2
Rate of recognizing healthcare disparities pre- and post- implementation responses.
See this image and copyright information in PMC

References

    1. Fields WW, Asplin BR, Larkin GL, et al. The Emergency Medical Treatment and Labor Act as a federal health care safety net program. Acad Emerg Med. 2001;8(11):1064–9. - PubMed
    1. Weissman JS, Betancourt J, Campbell EG, et al. Resident physicians’ preparedness to provide cross-cultural care. JAMA. 2005;294(9):1058–67. - PubMed
    1. ACGME Common Program Requirements (Residency) Accreditation Council for Graduate Medical Education. 2020. [Accessed August 10, 2022]. Available at: https://www.acgme.org/globalassets/PFAssets/ProgramRequirements/CPRResid....
    1. Weiss KB, Co JPT, Bagian JP CLER Evaluation Committee. Challenges and Opportunities in the 6 Focus Areas: CLER National Report of Findings 2018. J Grad Med Educ. 2018;10(4 Suppl):25–48. - PMC - PubMed
    1. Michael SH, Kaplan B, Sungar WG, et al. Building residents’ competence to support diverse, equitable, and inclusive environments in emergency medicine must start with the milestones. AEM Educ Train. 2021;5(S1):S144–8. - PMC - PubMed

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