Challenges and lessons learned caring for diverse, vulnerable  
  populations in the ER  
    
    Date:  
        October 18, 2021  
    Source:  
        Michigan Medicine - University of Michigan  
    Summary:  
        Interviews with two dozen emergency medicine residents in academic  
        medical center found most placed importance on learning to deliver  
        high- quality care to diverse populations. However, many did not  
        feel their programs made enough effort to incorporate effective  
        cultural competency education into the curriculum.  
    
    
    
  FULL STORY  
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  The clock is always ticking in the emergency room.  
    
    
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  A patient is rushed in with a condition that may be serious or life-  
  threatening. Rapidly, the physician and staff must make decisions to  
  keep the person alive.  
    
  In those moments, however, information about the patient is limited  
  and relationships with them barely scratch the surface. This setting  
  creates situations in which physicians may dismiss, or make assumptions  
  about, patients from backgrounds that are not similar to their own,  
  said Adrianne Haggins, M.D., assistant professor of emergency medicine  
  at Michigan Medicine.  
    
  "You have so many things pulling you in different directions as an  
  emergency physician, this can lead to miscommunications that affect  
  the care you provide," Haggins said. "Despite requirements for all  
  specialties to teach cultural competent care, the nature of emergency  
  medicine and limited guidance by organizations makes delivering that  
  education more difficult."  Haggins and a team of researchers interviewed  
  24 emergency residents from three different academic medical centers. They  
  sought to understand how residents process caring for diverse patients  
  or underserved communities, as well as the challenges they faced and  
  lessons learned. All interviewees had experience training at an academic  
  medical center, a suburban hospital and a low-resource public hospital.  
    
  Throughout the conversations, most residents emphasized the importance  
  of their experiences and learning to deliver high-quality care to diverse  
  populations, according to results published in AEM Training and Education  
  Special Issue: Dismantling Racism with the Next Generation of Learners:  
  Teaching Advocacy, Health Equity, and Social Justice.  
    
  "After spending time working at [these] sites, I feel like I can connect  
  better culturally, linguistically with [the] patients," one resident said.  
    
    
    
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  That skill was often shaped through modeling senior residents or  
  faculty. With more diverse role models and teachers, many interviewees  
  said they gained a deeper perspective and enhanced communication skills.  
    
  "We have people with different sexual orientation, ethnicities [and  
  religions] ...that increases the odds of delivering good care because  
  you just have a better understanding," a resident said. "Sometimes,  
  if you don't have that supply or diverse experience [in the residency  
  program], you can be missing out on the efficacy of your care."  
  Still, many of the residents did not feel their programs made enough  
  effort to incorporate effective cultural competency education into the  
  curriculum. These discussions often occur during medical school, but  
  they taper off when you become a resident and are spending time caring  
  for patients autonomously, Haggins said.  
    
  "If we want our residents to be high-quality doctors and perform at a  
  level where they feel ready to care for diverse populations, we have  
  to continue incorporating that within the teaching that we provide  
  our residents," she said. "I am just not sure organizations are often  
  equipped, through programming or faculty makeup, to properly have these  
  discussions."  In the conversations, the research team urged residents to  
  think of moments when their personal identity differed from a patient's  
  and how that may have the affected care they provided.  
    
    
    
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  One resident mentioned spending 15 minutes in a room with an affluent  
  white patient, a person who closely matched their identity, compared to  
  spending a few minutes with a less affluent Black patient presenting with  
  a similar condition. Another noted their frustration when working with  
  a patient who required a translator, worrying communication struggles  
  may have resulted in less accurate care.  
    
  Several residents said their eagerness to work in underserved environments  
  waned over time. They felt defeated -- like they were not able to make  
  the difference they envisioned.  
    
  "It became a repetitive thing that I leave my shifts very frustrated and  
  being like, 'I didn't help anyone,'" one resident said. "It became just  
  very frustrating for me in terms of [it being] hard to teach, educate  
  and follow up.  
    
  It almost felt like a broken system to me."  Haggins and her team saw  
  this diminishing interest as a warning sign.  
    
  "If we continue to ignore this issue and simply expect residents to  
  meet the goal of high-quality care for diverse populations without  
  having more concrete discussions about race and its intersection with  
  economics, social infrastructure and systemic racism, this might have  
  lasting effects on who is willing to work with these populations and in  
  low-resource areas," she said.  
    
  Participants told researchers they would benefit from more deliberate  
  discussions on cultural competency, not necessarily meaning more lectures.  
    
  Researchers found this to be an opportunity for programs to innovate  
  and think of dynamic ways of engaging with the communities they serve.  
    
  "Community-based partnerships lead to more lasting, fruitful outcomes  
  for our patients," Haggins said. "Moving forward, educators in emergency  
  medicine should take insight from residents as a way to guide improvements  
  to their training. Not addressing it in a more deliberate manner is  
  potentially leading to errors in patient care. If emergency care is really  
  going to be, 'anytime, anywhere, anyone,' we need to fill this gap."  
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  Story Source: Materials provided by  
  Michigan_Medicine_-_University_of_Michigan. Original written by Noah  
  Fromson. Note: Content may be edited for style and length.  
    
    
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  Journal Reference:  
     1. Adrianne Haggins, Michael Clery, James Ahn, Emily Hogikyan,  
     Sheryl Heron,  
        Renee Johnson, Laura R. Hopson. Untold stories: Emergency medicine  
        residents' experiences caring for diverse patient populations. AEM  
        Education and Training, 2021; 5 (S1) DOI: 10.1002/aet2.10678  
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  Link to news story:  
  https://www.sciencedaily.com/releases/2021/10/211018082346.htm  
    
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