Disparities in health and health care across a range of populations and conditions are well described. Yet, many physicians remain unaware of their existence. To address this lack of awareness, accrediting bodies have established requirements for medical schools and residencies to teach medical students and residents physicians about various aspects of disparities in health and health care. The Association of American Medical Colleges’ (AAMC) report “Cultural Competency Education” states that students should understand “demographic influences on health care quality and effectiveness, such as racial and ethnic disparities in the diagnosis and treatment of diseases” as well as “any personal biases in their approach to health care delivery.” Additionally, as part of their physician licensure requirements, New Jersey and California require documentation of cultural competency training in continuing medical education. Other states are debating such requirements, including Arizona, Colorado, Florida, Georgia, Kentucky, New Mexico, New York, Ohio and Washington. In New Jersey, this training must include strategies to recognize and respond to health care disparities as well as the impact of stereotyping on medical decision making. There is a limited understanding, however, of the best methods of teaching about health disparities. To date, health disparities education has had limited acceptance and implementation in medical schools and residency training programs. This reluctance is due, in part, to uncertainty about what should be taught in such a curriculum, how it should be taught and whether health disparities’ training has a significant impact on learners and patients. The California Endowment funded this supplement to help highlight innovations and progress in the evolution of health disparities education in order to enhance the scope and quality of medical education on this topic. While much of the health disparities literature focuses on disparities experienced by racial and ethnic populations compared to whites, the full spectrum of health care-related disparities includes those related to gender, language, socioeconomic status and other social characteristics of patients. The manuscripts in this supplement reflect the broad nature of health disparities education. The articles by Wakeman and Rich highlight the US prison population as one of most vulnerable to experiencing disparities. Diamond and Jacobs outline how limited English proficiency (LEP) contributes to disparities and recommend best strategies for clinicians to use when caring for patients with LEP. Bereknyei et al. elaborate on these strategies when the ideal situation of having trained medical interpreters is unavailable; their linguistic competency curriculum can provide measurable and enduring skills to students. This issue opens with a comparison of cultural diversity teaching methods and curriculum across the US, UK and Canada. The article by Dogra et al. emphasizes the inconsistency in terminology when discussing issues related to cultural competence, cultural awareness and cultural sensitivity. The lack of language precision continues to be an issue throughout the medical education literature. It is one reason why this supplement focuses on health care disparities education as a separate topic—and not under the guise of cultural competency. It has become increasingly clear that the definitions and approaches to cultural competency in this country, as well as in others, are varied and diverse. While there is general agreement on the meaning and overall impact of health care disparities, an accepted standard nomenclature remains elusive but would be useful in solidifying this arena. The supplement then moves to the areas of curriculum and approaches to teaching. The articles by Glick et al., Cene et al., Mostow et al. and Sheu et al. focus on novel curricular tools to teach about health care disparities both in undergraduate and graduate medical education. Current educators will find these educational innovations to be ideal tools to use in various settings. Cohen et al. shed light on the use of interdisciplinary educational forums (medical-legal) as a means of combating potential causes of disparities and train providers. The article by Chokshi provides practical advice regarding how to use a social determinants framework when teaching in this area. The role of the provider as a source of and solution to health disparities is highlighted in the article by Burgess et al., who caution us to be wary of the “stereotype” as a possible threat to the patient-physician and physician-trainee interaction. These scholars suggest that such threats can materialize as implicit biases on the part of patients and physicians, and thus may contribute to disparities. They recommend that we actively JGIM

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很好地描述了一系列人群和条件在健康和医疗保健方面的差异。然而，许多医生仍然不知道他们的存在。为了解决这种缺乏意识的问题，认证机构已经制定了要求医学院和住院医师向医学生和住院医师教授健康和医疗保健差异的各个方面的要求。美国医学院协会 (AAMC) 的“文化能力教育”报告指出，学生应该了解“人口对医疗保健质量和有效性的影响，例如疾病诊断和治疗中的种族和民族差异”以及“任何在他们提供医疗保健的方法中存在个人偏见。” 此外，作为其医师执照要求的一部分，新泽西州和加利福尼亚州要求提供继续医学教育的文化能力培训文件。其他州正在讨论此类要求，包括亚利桑那州、科罗拉多州、佛罗里达州、乔治亚州、肯塔基州、新墨西哥州、纽约州、俄亥俄州和华盛顿州。在新泽西州，这种培训必须包括识别和应对医疗保健差异以及陈规定型观念对医疗决策的影响的策略。然而，对关于健康差异的最佳教学方法的理解有限。迄今为止，健康差异教育在医学院和住院医师培训计划中的接受和实施有限。这种不愿意的部分原因是不确定在这样的课程中应该教授什么，应该如何教授以及健康差异的培训是否对学习者和患者产生重大影响。加州捐赠基金资助了本增刊，以帮助突出健康差异教育发展过程中的创新和进步，以提高有关该主题的医学教育的范围和质量。虽然大部分健康差异文献都侧重于种族和族裔人口与白人相比所经历的差异，但与医疗保健相关的所有差异包括与患者的性别、语言、社会经济地位和其他社会特征相关的差异。本增刊中的手稿反映了健康差异教育的广泛性质。Wakeman 和 Rich 的文章强调美国监狱人口是最容易遭受不平等待遇的群体之一。Diamond 和 Jacobs 概述了有限的英语水平 (LEP) 如何导致差异，并推荐临床医生在护理 LEP 患者时使用的最佳策略。Bereknyei 等。当无法获得训练有素的医疗口译员的理想情况时，详细说明这些策略；他们的语言能力课程可以为学生提供可衡量和持久的技能。本期首先比较了美国、英国和加拿大的文化多样性教学方法和课程。Dogra 等人的文章。在讨论与文化能力、文化意识和文化敏感性相关的问题时，强调术语的不一致。语言精确度的缺乏仍然是整个医学教育文献中的一个问题。这就是为什么本增刊将医疗保健差异教育作为一个单独的主题而不是以文化能力为幌子的原因之一。越来越清楚的是，这个国家以及其他国家对文化能力的定义和方法是多种多样的。虽然人们普遍同意医疗保健差异的含义和整体影响，但公认的标准命名法仍然难以捉摸，但将有助于巩固这一领域。然后，补充内容转向课程和教学方法领域。Glick 等人、Cene 等人、Mostow 等人的文章。和 Sheu 等人。专注于新的课程工具，以教授本科和研究生医学教育中的医疗保健差异。当前的教育工作者会发现这些教育创新是在各种环境中使用的理想工具。科恩等人。阐明使用跨学科教育论坛（医学法律）作为消除差异的潜在原因和培训提供者的手段。Chokshi 的文章提供了有关在该领域教学时如何使用社会决定因素框架的实用建议。Burgess 等人的文章强调了提供者作为健康差异来源和解决方案的作用，他提醒我们要警惕“刻板印象”，因为它可能对患者-医生和医生-实习生互动构成威胁. 这些学者认为，这种威胁可以体现为患者和医生的隐性偏见，从而可能导致差异。他们建议我们积极 JGIM 阐明使用跨学科教育论坛（医学法律）作为消除差异的潜在原因和培训提供者的手段。Chokshi 的文章提供了有关在该领域教学时如何使用社会决定因素框架的实用建议。Burgess 等人的文章强调了提供者作为健康差异来源和解决方案的作用，他提醒我们要警惕“刻板印象”，因为它可能对患者-医生和医生-实习生互动构成威胁. 这些学者认为，这种威胁可以体现为患者和医生的隐性偏见，从而可能导致差异。他们建议我们积极 JGIM 阐明使用跨学科教育论坛（医学法律）作为消除差异的潜在原因和培训提供者的手段。Chokshi 的文章提供了有关在该领域教学时如何使用社会决定因素框架的实用建议。Burgess 等人的文章强调了提供者作为健康差异来源和解决方案的作用，他提醒我们要警惕“刻板印象”，因为它可能对患者-医生和医生-实习生互动构成威胁. 这些学者认为，这种威胁可以体现为患者和医生的隐性偏见，从而可能导致差异。他们建议我们积极 JGIM Chokshi 的文章提供了有关在该领域教学时如何使用社会决定因素框架的实用建议。Burgess 等人的文章强调了提供者作为健康差异来源和解决方案的作用，他提醒我们要警惕“刻板印象”，因为它可能对患者-医生和医生-实习生互动构成威胁. 这些学者认为，这种威胁可以体现为患者和医生的隐性偏见，从而可能导致差异。他们建议我们积极 JGIM Chokshi 的文章提供了有关在该领域教学时如何使用社会决定因素框架的实用建议。Burgess 等人的文章强调了提供者作为健康差异来源和解决方案的作用，他提醒我们要警惕“刻板印象”，因为它可能对患者-医生和医生-实习生互动构成威胁. 这些学者认为，这种威胁可以体现为患者和医生的隐性偏见，从而可能导致差异。他们建议我们积极 JGIM 谁警告我们要警惕“刻板印象”，因为它可能对患者-医生和医生-实习生互动构成威胁。这些学者认为，这种威胁可以体现为患者和医生的隐性偏见，从而可能导致差异。他们建议我们积极 JGIM 谁警告我们要警惕“刻板印象”，因为它可能对患者-医生和医生-实习生互动构成威胁。这些学者认为，这种威胁可以体现为患者和医生的隐性偏见，从而可能导致差异。他们建议我们积极 JGIM