Toward Structural Competency in Emergency Medical Education.
Bisan A SalhiJennifer W TsaiJeffrey DruckJacqueline Ward-GainesMelissa H WhiteBernard L LopezPublished in: AEM education and training (2019)
As the emergency department (ED) is the "front door" of the hospital and the primary site by which most patients access the health care system, issues of inequity are especially salient for emergency medicine (EM) practice. Improving the health of ED patients, especially those who are stigmatized and disenfranchised, depends on having emergency physicians that are cognizant and attentive to their needs in and out of the medical encounter. EM resident education has traditionally incorporated a "cultural competency" model to equip residents with tools to combat individual bias and stigma. Although this framework has been influential in drawing attention to health inequities, it has also been criticized for its potential to efface differences within groups (such as socioeconomic differences), overstate cultural or racial differences, and unintentionally reinforce stereotypes or blaming of patients for their ill health or difficult circumstances. In contrast, emerging frameworks of structural competency call for physicians to recognize the ways in which health outcomes are influenced by complex, interrelated structural forces (e.g., poverty, racism, gender discrimination, immigration policy) and to attend to these causes of poor health. We present here the framework of structural competency, extending it to the unique ED setting. We provide tangible illustrations of the ways in which this framework is relevant to the ED setting and can be incorporated in EM education.
Keyphrases
- emergency department
- healthcare
- public health
- end stage renal disease
- mental health
- newly diagnosed
- medical education
- ejection fraction
- chronic kidney disease
- primary care
- peritoneal dialysis
- magnetic resonance
- prognostic factors
- health information
- magnetic resonance imaging
- emergency medicine
- patient safety
- quality improvement
- computed tomography
- patient reported outcomes
- working memory
- risk assessment
- african american
- antiretroviral therapy
- hepatitis c virus
- human health
- social media
- mental illness
- electronic health record
- human immunodeficiency virus
- contrast enhanced
- drug induced