Answer to "Why does EDI matter in medical education?"
Disparity in healthcare accessibility and delivery is a serious problem. Racial and ethnic minorities experience lower standards of care, even after controlling for access-related factors (e.g., insurance status and socioeconomic status; Smedley, Stith and Nelson, 2003). Given this, healthcare agencies have turned to the clinical encounter as both a potential contributor and point of intervention.
Care that does not take diversity into account may contribute to inequitable health outcomes. More specifically, negative outcomes may include: missing opportunities for screening and care, due to lack of familiarity with prevalent conditions among minority groups; failing to consider differing responses to medication and treatment; lacking knowledge about traditional remedies, leading to potentially harmful drug interactions; and committing diagnostic errors resulting from miscommunication (Lavizzo-Mourey and Mackenzie, 1996; Lawson, 1996; Moffic and Kinzie, 1996). Accordingly, we must understand how culture contributes to these possible lapses in cares and the ways in which medical education may help close them.
Many studies suggest that, despite the best of intentions and education, providers may be susceptible to the implicit biases that affect us all. For example, overburdened individuals such as healthcare providers are more likely to use stereotypes, which are shortcuts used by the brain in decision-making (Fiske, 1993).
As such, the medical field has increasingly focused on developing culturally sensitive providers. Providing medical professionals with specific tools can facilitate the delivery of equitable patient care (Paasche-Orlow, 2004). Systematic reviews have found that training physicians in cultural competency can improve important knowledge, skills, and attitudes, ultimately resulting in higher patient satisfaction (Smedley, Stith and Nelson, 2003; Beach et al., 2005). Culturally competent providers can communicate and build trust with patients more effectively, leading to greater impacts beyond a single encounter – e.g., more frequent engagement in care and better adherence to prescribed health plans.
We have increasingly trained students to consider patient diversity and how to ensure that patients are given equitable care. We have to date paid little attention to the diversity there is in our student body. So perhaps now as medical educators we need to consider how we address student diversity. We know that some students and trainees have less positive experiences of training, and this may relate to teacher bias in the same way that doctor bias can influence health care. More about this is discussed in faculty development.
Beach, M. C., Price, E. G., Gary, T. L., Robinson, K. A., et al. (2005) ‘Cultural competency: A systematic review of health care provider educational interventions’, Medical care, 43(4), pp. 356–373.
Fiske, S. T. (1993) ‘Controlling other people: The impact of power on stereotyping’, American Psychologist, 48(6), pp. 621–628. https://doi.org/10.1037/0003-066X.48.6.621.
Lavizzo-Mourey, R. and Mackenzie, E. R. (1996) ‘Cultural competence: essential measurements of quality for managed care organizations’, Annals of Internal Medicine, 124(10), pp. 919–921.
Lawson, W. B. (1996) ‘The art and science of the psychopharmacotherapy of African Americans’, The Mount Sinai Journal of Medicine, New York, 63(5–6), pp. 301–305.
Manson, A. (1988) ‘Language concordance as a determinant of patient compliance and emergency room use in patients with asthma’, Medical Care, 26(12), pp. 1119–1128.
Moffic, H. S. and Kinzie, J. D. (1996) ‘The history and future of cross-cultural psychiatric services’, Community Mental Health Journal, 32(6), pp. 581–592.
Paasche-Orlow, M. (2004) ‘The ethics of cultural competence’, Academic Medicine, 79(4), pp. 347–350.
Smedley, B. D., Stith, A. Y. and Nelson, A. R. (2003) Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC, US: The National Academies Press. Available at: http://www.nap.edu/read/12875/chapter/1 (Accessed: 18 October 2015).