Development of a health equity journal club to address health care disparities and improve cultural competence among emergency medicine practitioners.

Health care disparities have been magnified by the COVID-19 pandemic. Only recently has the medical community acknowledged implicit bias and systemic racism as a public health emergency. Graduate medical education has been slow to adopt curricula beyond lecture-based formats that specifically address social determinants of health (SDOH) and its impact on communities. Curricula addressing unconscious (implicit) biases and their influence on patient care has not been widely adopted. The emergency department (ED) has a unique role in addressing health care disparities. Approximately 69% of emergency medicine residency programs incorporate cultural competency training in their curricula. Most are primarily lecture-based without a longitudinal component, and gaps exist in content, quality, and expertise of the presenters. Lecture-based formats may not be best suited to manage the nuanced conversations necessary to dismantle biases and socialized beliefs that result in disparities for marginalized communities. Reporting little or no education in medical school related to SDOH, residents acknowledge that barriers to care exist, but have limited or no knowledge of what those barriers are or how mitigate them. To improve health equity, understanding and competence in caring for culturally and ethnically diverse populations, we developed a monthly, longitudinal, SDOH- and cultural competency-based "health equity journal club" (HEJC) for all levels of ED staff. Four educational domains were developed, and specific content within each domain was selected based on predetermined criteria. Content for each session was mapped to the ACGME program and core competency milestone requirements, ACGME Clinical Learning Environment (CLER) mandates, and The Joint Commission's institutional recommendations for culturally competent care. The HEJC series has been successful in reducing barriers to identifying biases in health care; translating literature to clinical care; generating initiatives and interdisciplinary research; and cultivating interest in community health, health advocacy, and public policy.

Google Internet searches on residency applicants do not facilitate the ranking process.

BACKGROUND: Information used by program directors (PDs) to evaluate and rank residency applicants is largely limited to the Electronic Residency Application Service and the interview day. The Internet represents a potential source of additional data on applicants. Recent surveys reveal that up to 90% of United States (US) companies are already using the Internet to post jobs and to screen candidates. However, its use in residency applicant evaluation is not well studied. OBJECTIVE: We hypothesize that the Internet, through the use of a Google search, will provide useful information to PDs in ranking applicants. METHODS: This prospective observational study was completed by six Accreditation Council for Graduate Medical Education-accredited Emergency Medicine residency programs. After the interview process, programs formed their rank order list in their usual fashion. Then participating programs performed a Google search on applicants from their list. A standardized search was used and information reviewed was limited to the first two Google pages. The main outcome measure was change in an applicant's status on the rank order list. Change in status was based on the judgment of the individual program's PD. RESULTS: A total of 547 applicants were reviewed. The time for review of information was 4,386 min total and a mean of 7.2 min per resident. Position on the rank order list was changed for three applicants; two moved up on the list and one moved down. Four programs made no changes. No applicants were removed. CONCLUSIONS: The Internet, through the use of a Google search, did not appear to provide useful information in a time-effective manner to PDs in ranking applicants.

Incorporating evidence-based medicine into resident education: a CORD survey of faculty and resident expectations.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) invokes evidence-based medicine (EBM) principles through the practice-based learning core competency. The authors hypothesized that among a representative sample of emergency medicine (EM) residency programs, a wide variability in EBM resident training priorities, faculty expertise expectations, and curricula exists. OBJECTIVES: The primary objective was to obtain descriptive data regarding EBM practices and expectations from EM physician educators. Our secondary objective was to assess differences in EBM educational priorities among journal club directors compared with non-journal club directors. METHODS: A 19-question survey was developed by a group of recognized EBM curriculum innovators and then disseminated to Council of Emergency Medicine Residency Directors (CORD) conference participants, assessing their opinions regarding essential EBM skill sets and EBM curricular expectations for residents and faculty at their home institutions. The survey instrument also identified the degree of interest respondents had in receiving a free monthly EBM journal club curriculum. RESULTS: A total of 157 individuals registered for the conference, and 98 completed the survey. Seventy-seven (77% of respondents) were either residency program directors or assistant/associate program directors. The majority of participants were from university-based programs and in practice at least 5 years. Respondents reported the ability to identify flawed research (45%), apply research findings to patient care (43%), and comprehend research methodology (33%) as the most important resident skill sets. The majority of respondents reported no formal journal club or EBM curricula (75%) and do not utilize structured critical appraisal instruments (71%) when reviewing the literature. While journal club directors believed that resident learners' most important EBM skill is to identify secondary peer-reviewed resources, non-journal club directors identified residents' ability to distinguish significantly flawed research as the key skill to develop. Interest in receiving a free monthly EBM journal club curriculum was widely accepted (89%). CONCLUSIONS: Attaining EBM proficiency is an expected outcome of graduate medical education (GME) training, although the specific domains of anticipated expertise differ between faculty and residents. Few respondents currently use a formalized curriculum to guide the development of EBM skill sets. There appears to be a high level of interest in obtaining EBM journal club educational content in a structured format. Measuring the effects of providing journal club curriculum content in conjunction with other EBM interventions may warrant further investigation.