ABSTRACT
Learning Objectives: Covering the domains of knowledge, skills and attitudes, residents were expected to analyze structural violence and health gaps, demonstrate inclusive and trauma-informed care, recognize implicit bias, use strategies to reduce it, and critically assess the EM health equity literature. Introduction/Background: Since the 2003 Unequal Treatment report showed that health gaps are not due to access or income, racial injustice and COVID-19 have laid bare worse inequities. In 2021, the ACGME EM Milestones addressed recognition of health gaps and personal bias, however there is no guidance on how to do this. ED patients require an unbiased evaluation to ensure rapid and accurate diagnosis and treatment, but implicit bias reigns with high cognitive load. Thus, we describe a deliberate and formal diversity, inclusion and racial equity (DIRE) curriculum. Educational Objectives: Residents were expected to analyze structural violence and health gaps, demonstrate inclusive and trauma-informed care, recognize implicit bias, use strategies to reduce it, and critically assess the EM health equity literature. Curricular Design: An ED survey confirmed the need for this curriculum. Since July 2020, the course has been available to all ED staff but is mandatory for residents. The free online platform, Canvas, was chosen for ease of access and use, and for resource sharing, discussion facilitation, and quiz scoring. Biweekly articles, online videos, a journal club and quarterly book clubs led to health equity discourse. Residents took part in simulated cases involving diverse patients. A workshop reviewed strategies to reduce implicit bias. Residents were assessed with quizzes, reflective writing and direct observation. Based on feedback, sessions are now held monthly with more media resources, live seminars, and diverse content. Impact/Effectiveness: As of July 2021, residents have had positive feedback, 100% completion rates, and high knowledge retention. Structural violence must be included in resident didactics. Simulated cases provide an avenue to assess interpersonal communication skills for residents to develop tools to partner with patients. This model may serve as a blueprint for those seeking to improve DIRE knowledge, skills and attitudes.