Developing an Outlook on Other Realities: A Curriculum Model Targeting the Importance of Patient Realities in the...

The DOORs curriculum is designed to equip emergency medicine (EM) residents with the knowledge and skills needed to address social determinants of health (SDH) and provide compassionate, patient-centered care. Vulnerable patient populations often experience disparities in healthcare access and outcomes, furthering a need for a curriculum that fosters awareness, empathy, and resource utilization. The curriculum aims to integrate ethical considerations, social factors, and resource navigation into EM training.

The DOORs curriculum was integrated into the weekly departmental conference, featuring eight or more 30-60-min sessions annually. Initial sessions assessed residents' familiarity with vulnerable populations and available resources. Topics included incarcerated individuals, refugees, homeless patients, sex workers, and others. Sessions included expert lectures, interactive discussions, and ethics case reviews. Resident demographics and pre-existing knowledge were analyzed through surveys.

Over 4 years, resident awareness of ED resources improved significantly. In 2020, 52% of residents reported that the curriculum influenced their practice, increasing to 62.5% in 2022. Pre- and post-curriculum surveys demonstrated statistically significant increases in awareness of resources for refugee populations (1.76-2.76) and hemodialysis patients (2.36-3.35). Residents valued sessions with speakers who had lived experiences and highlighted community engagement.

The DOORs curriculum works to enhance EM residents' ability to address SDH, utilize resources, and engage in meaningful community partnerships. Future directions include expanding to other specialties and strengthening collaborations with national and local programs to improve SDH education in medical training.

Our curriculum highlights the value of integrating social determinants of health (SDH) into resident education to deepen awareness and community connection. We found that tailoring content based on resident feedback, particularly emphasizing lived experience and community partnership, was essential for engagement. Notably, strong local support made implementation more feasible and cost-effective than expected, reinforcing the potential for scalability in similar settings.