P141: Education innovation: Equity, Diversity, Advocacy, and Cultural Safety (EDACS) curriculum

Abstract

Innovation Concept: Upon completion of training, Canadian physicians are expected to respond to patient needs to advocate for change both within and beyond the immediate clinical environment.1 In the current EM curriculum, residents are not explicitly taught skills necessary to engage in clinical care nor policy change that would improve the social determinants of health (SDOH) of patients. In response to this challenge, we have developed and are piloting a 2 year curriculum on “Equity, Diversity, Advocacy, and Cultural Safety (EDACS), to equip EM trainees with the knowledge and skills to advocate and influence policy - to empower residents to act on healthcare inequities rather than simply be aware of them. Methods: We developed the curriculum utilizing the Structural Competency paradigm, a theoretical framework within which clinical and advocacy skills to address the SDOH at a structural level can be taught and practiced. This paradigm includes five intersecting skill-sets, including recognizing the structures that shape clinical interactions, developing an extra-clinical language of structure, and imagining structural interventions. Curriculum, Tool, or Material: The educational intervention will consist of 8 hour-long sessions and one 3-hour long session held over a 2-year period. The 3-hour long session will consist of a walking tour of sites accessed by individuals living in poverty in the Toronto downtown core, including a homeless shelter, a needle exchange program, and others. This session will be facilitated by a physician lead, with input at each site from community organizers. Prior to the walking tour, residents will receive an introductory session outlining themes to reflect on during and after the walking tour. Hour-long sessions will be delivered by invited healthcare providers with specific clinical expertise in the topics of discussion, which will address the care of and advocacy for various marginalized populations. Conclusion: To our knowledge, this is the first curriculum of its kind being implemented in an EM training program in Canada. Upon completion of the curriculum, students will be able to apply the five skillsets outlined in the Structural Competency Framework to address and improve upon inequitable conditions that influence patients treated in the emergency department. We intend to use formal and informal feedback from residents, clinicians, and lecturers to refine future curriculum cycles, and hope to inform similar programs elsewhere.