如何通过模拟解决少数民族健康差异

In the United States, approximately 36% of the population belongs to a racial or ethnic minority group – and this percentage is only expected to grow.¹As the U.S. becomes increasingly diverse, so too does the patient population.而且，这将影响医疗保健专业人员如何培训其角色。

Compared with white patients, members of racial and ethnic minorities are less likely to receive preventative health services and often receive lower-quality care.²即使考虑了收入，邻里和健康保险（通常用于解释种族差异的因素），黑人患者的健康状况仍然比白人患者更差。³为了打击健康差异，专家说，提供者必须承认，医疗保健中存在结构性种族主义和隐性偏见。⁴

数据表明，美国人口只会继续变得更加多样化，这意味着治疗所有患者的方法预计将完全溶解。人们通常会赞扬模拟培训，因为它给学习者与“真实”患者互动的机会。Why not enhance this realism by using a patient profile that is whole – complete with racial, ethnic, socioeconomic, geographical, and religious differences?

Below, we share how simulation can prepare your learners to treat patients who are part of a racial or ethnic minority. Specifically, we focus on the importance of developing cultural competence and a sensitivity to health literacy in patients. By focusing your training efforts on treating minority patients and creating an awareness of existing health disparities, your learners will inevitably improve in their ability to treat all patients.

种族和少数民族占美国总人口的25％以上，但仅占美国医疗保健提供者的10％。⁵尽管医疗保健系统敏锐地意识到多元化的员工和领导职务至关重要，但专家们也指出需要教育全部提供者认识到为什么文化差异很重要。

Culturally-competent, patient-centered care focuses on each patient’s cultural differences, needs, values, preferences, and individualized care provisions as a method of reaching the best possible patient outcome.⁶It is not so much an end-point to strive for as it is an ongoing learning process for healthcare professionals.The good news is that developing cultural competence does not require providers to be of the same race or ethnicity as their patients.It does, however, require that providers adapt how they communicate with, assess, and diagnose their individual patients.

Cultural competence training can improve:⁷

It can be difficult to teach cultural competence through textbooks and lecture alone. Research shows that it is best learned over time and should involve a self-reflection process.⁸Simulation can help to create a learning environment that is representative of the diverse society learners will be serving. And, simulation debrief can provide a setting that is conducive for each learner to reflect on their attitudes and behaviors.

一项双国研究表明，参加模拟经验后，护理学生在文化意识上得到了改善。⁹In this study, learners used an assessment checklist as a guide to understand their simulated patients. While the checklist reinforced questions and observations that are important in a cross-cultural (or any) patient interaction, the simulation itself provided the opportunity to put theory into practice.

Simulation can help create an eye-opening learning experience, leading to greater self-awareness in students who might otherwise be hard to reach. The cultural competence they can glean from simulation training can ultimately save the lives of minority patients.

A message said is not necessarily a message understood. For patient-provider interactions, in which healthcare professionals can often overestimate a patient’s health literacy, this can be very true. Depending on a patient’s understanding of their own health and a provider’s ability to communicate information in laymen terms, a lot of context can be missed.

From self-reported health knowledge, to preventative behaviors, chronic disease management, and hospitalization,健康素养有限的人比健康识字素养的人还要糟糕。¹¹Even more unsettling is that minority racial and ethnic groups, and those who are socioeconomically disadvantaged, elderly or immigrants, are disproportionately limited in their health literacy.¹²这可能导致患者完全避免护理，不遵守药物，更高的医疗费用和恢复效率低下的途径。^13、14

对于医疗保健专业人员（目前正在练习或培训），这是一个模拟培训可以提供大量改进的领域。除了发展文化能力外，学习者还可以故意努力增强其人际交往能力，以促进健康的患者支持者对话。这可以包括赚取患者的信任，帮助患者传达其需求，并在权衡治疗方案时促进共同的决策。¹⁶

学士学位护理学生的研究表明，模拟引起了学习者的同理心，并影响了他们未来与患者的沟通。¹⁷A separate study showed that clinical simulation can be used to elicit students’ attitudes toward cross-cultural situations and subsequently improve communication and nursing skills.¹⁸通过开发学习者移情和技能,提供者s are better prepared to interview, communicate medical information, and provide treatment to patients from diverse ethnic and racial backgrounds.

如果您正在寻找学习者对种族或少数民族患者的敏感性发展的方法，则可能需要将模拟培训作为解决方案。学习者可以通过采取精心的健康素养方法来提高患者的评估能力，这可能会导致更准确的诊断，更好的药物依从性以及挽救更多的生命。

The U.S. Bureau of Labor projects a demand for 1.1 million new nurses by 2022, when the aging population will require 575,000 newly created positions in addition to replacements for the 550,000 nurses expected to retire.¹⁹And, by this time, more than half of the nation’s children are expected to be part of a minority race or ethnic group.²⁰This means that increasing the number of providers and diversifying providers are important goals for healthcare. However, experts say that it is equally (if not more) important to increase the diversity and cultural competency of those providers.²¹

To effectively train the next generation of healthcare providers, and to prepare them to treat patients of all backgrounds, Laerdal is committed to developing our most popular simulation solutions indifferent skin tones. When using simulation to train for diverse patient bodies, learners should know the impact of cultural characteristics on a patient’s care. A simulator in a darker skin tone serves to add realism to the situation, rather than relying on sole imagination.

Above all things, simulation can help to develop your learners into vigilant healthcare professionals who are meticulous in their observations. First, you must bring learners from a state of “unconscious incompetence” to “conscious incompetence”; only then can you coach them to become fully-competent healthcare providers.

学习者可以开始重视我mpact of their cultural understanding and apply that understanding to their life-saving role.Training to care for various ethnic and racial backgrounds inevitably improves care for all.