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Manos en la equidad de la salud: Simulación y reflexión espaciada en la educación médica de posgrado
Kamna S Balhara1,2, Sean Tackett3, Jessica Bienstock4
1Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Resumen
Este estudio desarrolló una educación de equidad en salud basada en la simulación para los residentes, mejorando la humildad cultural y la confianza en abordar el sesgo y los determinantes estructurales de la salud (SDOH). Los impactos positivos en las interacciones de los pacientes se mantuvieron a largo plazo.
Área de la Ciencia:
- Educación médica y educación médica.
- Investigación de equidad en salud Investigación de equidad en salud.
- Aprendizaje basado en la simulación.
Sus antecedentes:
- El avance de la equidad en salud requiere que los médicos clínicos aborden las disparidades estructurales y mitiguen los prejuicios.
- La educación de equidad en salud existente a menudo carece de componentes experimentales e integración interdisciplinaria.
- Se necesitan intervenciones eficaces y longitudinales para preparar a los residentes para los complejos desafíos clínicos.
Objetivo del estudio:
- Describir una intervención educativa de equidad en salud basada en la simulación longitudinal y en toda la institución para residentes de primer año.
- Evaluar el impacto del aprendizaje experiencial en los determinantes estructurales de la salud (SDOH) y la mitigación de sesgos.
- Evaluar los cambios en la humildad cultural, las habilidades de comunicación y la confianza de los residentes para abordar las disparidades de salud.
Principales métodos:
- Los residentes del primer año participaron en encuentros simulados de pacientes con pacientes estandarizados (SP).
- La intervención incluyó la retroalimentación de SP, la reflexión narrativa, el informe de grupo utilizando las artes visuales y una actividad metacognitiva de seguimiento de 3 a 6 meses.
- Las encuestas midieron los impactos autoinformados en la toma de decisiones clínicas, la comunicación, la comprensión de SDOH y la humildad cultural.
Principales resultados:
- Una mejora estadísticamente significativa en la humildad cultural y la confianza se observó inmediatamente después de la simulación.
- Los residentes informaron habilidades mejoradas para abordar el lenguaje estigmatizante, el sesgo y la SDOH durante los encuentros con los pacientes.
- La mayoría de las mejoras, incluidos los impactos positivos en las interacciones de los pacientes, se mantuvieron en el seguimiento de 3 a 6 meses.
Conclusiones:
- La educación de equidad en salud basada en la simulación puede mejorar efectivamente las habilidades de los residentes para abordar las disparidades.
- La intervención demuestra un modelo de aprendizaje interdisciplinario y experiencial en equidad de salud.
- La replicación con casos específicos del sitio puede fomentar el compromiso organizacional con las necesidades del paciente y la equidad.
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