Preparing Health Professionals to Practice in a Diverse Community
Author: Catie Chung
I teach in a post-graduate health professions university in the southwestern United States. Our community population is remarkably diverse. We are one of six states in the US with a non-white majority, and the diversity in my community creates a feeling of acceptance and inclusion at sporting events, children’s school events, and community festivals.
However, our community is medically underserved. We have a dramatic shortage of primary care providers (physicians, physician assistants, and nurse practitioners) who can provide evidence-based care to our diverse population. Our current community health improvement plan’s top two priority areas are chronic disease and access to care. These priorities require additional primary care providers to serve the community.
The solution seems simple: educate more primary care providers!
Yes, health professions education is certainly an important part of the equation for increased health equity in our community. Let’s discuss how providing equitable evidence-based care to our diverse population is more complex than numbers alone.
Evidence-Based Healthcare
The World Health Organization (WHO) considers evidence-based healthcare a foundation for quality healthcare and improved outcomes across the globe. Evidence-based practice happens when clinicians use research (evidence) to determine patients’ course of treatment.
Healthcare research is progressing at breakneck speed. Thanks in part to technological advances, more health research is happening faster than ever before. A natural result is many more publications representing the mushrooming body of evidence. In addition to the abundance of quality research publications, clinicians are coping with publications called ‘predatory journals’ that publish submitted articles without appropriate review or oversight.
Further complicating the evidence base is the historical lack of diverse population representation in healthcare research – how does a clinician provide evidence-based care for patients who aren’t included in the evidence? Increasingly, researchers are aware of this issue and now aim to include more diverse participants in healthcare studies.
Critical Appraisal as a Skill for Evidence Assessment
We know that healthcare research is focusing more on diverse populations and determining the best practices to support diverse populations. This raises many important questions related to the feasibility, applicability and meaningfulness of healthcare practice, including patient and caregiver experiences, reporting on costs, diagnostics and prognostics, etc. These clinical questions require the appraisal of different types of evidence and different approaches to evidence synthesis.
Our university committed to providing our health professions students with a method to determine the quality of published healthcare research in real-time so that they could evaluate this broad evidence base as it develops. The skill we decided to focus on was critical appraisal.
The critical appraisal process is used to examine published research in a systematic and unbiased manner using predetermined criteria to decide if the published research is trustworthy. With faculty staff, we evaluated several systems of critical appraisal for ease of use and the variety of types of evidence that could be appraised.
A decision was then made to pursue a partnership with the JBI Collaboration (JBIC). The JBIC offers short courses, and one is the JBI Comprehensive Systematic Review Training Program (CSRTP). This program teaches critical appraisal of all types of quantitative and qualitative evidence using transparent objective methods and checklists.
While critical appraisal is only one portion of the full CSRTP, it is a portion that we feel is very impactful for our health professions students. Students in some programs, such as our Master of Science in Nursing – Family Nurse Practitioner students, use the JBI Critical Appraisal checklists to evaluate evidence related to chronic disease treatment interventions within a diverse population in the community. Our students use these tools to determine whether the interventions in the evidence were examined with high-quality research studies. Our Doctor of Osteopathic Medicine Year 1 students can take the full CSRTP. Students work in groups of 2–4 with a faculty mentor on a topic relating to best practices for diverse populations. This critical appraisal process has proven to be eye-opening for these medical students.
Faculty staff who mentor the student groups have shared student comments such as:
‘I thought if the research was in a journal that meant it was good quality but that’s not always true.’
‘The critical appraisal checklists showed how much can be missing from a publication!’
Comments like these tell us we are on the right track with this initiative!
The rapid advancement of health research and the increased focus on diverse populations will take time to become published evidence, and to then be implemented in patient care. With critical appraisal skills, the next generation of healthcare providers can determine what evidence is best for the patients they are treating.
In our highly diverse community that is medically underserved, patients’ lives depend on providers’ abilities to determine the best evidence-based healthcare as the evidence develops. We are hopeful that equipping our health professions students with critical appraisal skills will positively impact thousands of patients.
Key Messages
• Health professions academia benefits all our stakeholders when we keep the patient at the centre of the initiative. Remind yourself often that patient care is the ‘why’!
• Educate across an institution when possible – executive leadership, other faculty staff, community members, and clinical partners all benefit from understanding more about evidence-based healthcare.
• Celebrate successes! Positive comments from your stakeholders tell you you’re on the right track – celebrate and share large and small changes!
Disclaimer
The views expressed in this World EBHC Day Blog, as well as any errors or omissions, are the sole responsibility of the author and do not represent the views of the World EBHC Day Steering Committee, Official Partners or Sponsors; nor does it imply endorsement by the aforementioned parties.
