地域医療と健康教育

抽象的な

Addressing Health Disparities and Increasing Cultural Competency of Medical Trainees with Community Engagement

Liana R Gefter, Morioka-Douglas N, Srivastava A and Rodriguez E

Objective: With the goal of increasing medical trainees’ ability to practice effectively with underserved populations, the authors investigated i) whether trainees perceived that participation in a community engagement program contributed to acquisition of competencies and milestones addressing health disparities; and ii) whether the amount of time spent in community engagement affected the acquisition of competencies.
Methods: From 2014 to 2016, five medical training programs (San Jose, CA; Philadelphia, PA; Cincinnati, OH; Ann Arbor, MI; and Huntsville, AL) partnered with five high schools serving youth from socioeconomically disadvantaged, and racial and ethnic minority communities. Medical trainees served as instructors, providing the eight-week Stanford Youth Diabetes Coaches Program at each school, and then completed online post-participation surveys.
Results: Responses to retrospective post-then-pre questions from 60 participants showed significant improvements in their: confidence to provide sensitive and culturally responsive care to diverse patient populations (p<0.001); understanding of barriers to care that diverse patient populations face (p<0.001); ability to communicate effectively with youth (p<0.001); ability to empower patients and their families to participate in their care (p=0.002); and plans to use “action plans” with patients in clinical settings (p<0.001). Analysis of Likert-style questions demonstrated medical trainees agreed or strongly agreed program participation facilitated achievement of these milestones with 95% reporting participation gave them an opportunity to learn more about the communities they serve as physicians. Qualitative data analysis confirmed these findings. Stratification by trainees who taught one class (N=20) versus two or more classes (N=40), demonstrated that only trainees who taught 2 or more classes reported significant improvements in competency and milestone acquisition.
Conclusion: Community engagement opportunities can directly contribute to acquisition of competencies and milestones developed to address health disparities, and continuity of participation appears important to maximize benefit.