Introduction
The Association of American Medical Colleges (AAMC) introduced Core Entrustable Professional Activities (EPAs) to outline the essential competencies expected of medical graduates entering residency. Despite this, there is a notable absence of EPAs focusing on diversity, equity, and inclusion (DEI), particularly in the care of vulnerable patient populations (VPPs). Given the complex needs of these populations, there is an urgent need to address this gap in medical education to better prepare future physicians.
Methods
This qualitative study involved teleconferenced focus group interviews with U.S. medical trainees, including final-year medical students and first-year residents, conducted between October 2021 and March 2022. Additionally, individual interviews with emergency medicine applicants were conducted in winter 2022. Participants were recruited from 45 medical schools across the U.S. using convenience sampling. The focus group discussions centered on participants' experiences and perceived gaps in their education related to caring for vulnerable patient populations. Thematic analysis was employed to identify key themes from the transcripts.
Results
Analysis revealed two major themes: (1) Multimodal instruction optimizes learning for caring for VPPs, with subthemes highlighting the importance of patient involvement, traditional didactic teaching, and self-directed learning; and (2) Learners require a growth mindset to effectively approach training for VPP care, emphasizing the roles of humility and adaptability. Participants expressed that clinical exposure to diverse patient populations was crucial but often insufficient, and they highlighted the challenges of integrating DEI topics into the fast-paced medical curriculum.
Conclusion
The findings suggest that current medical education inadequately prepares trainees to care for VPPs, highlighting the need for a DEI-related EPA. A proposed 14th EPA could guide medical schools in better integrating DEI principles into their curricula, thereby equipping future physicians with the competencies necessary to provide equitable care to all patient populations. The AAMC and other accrediting bodies should consider adopting this new EPA to address existing gaps and promote a more inclusive healthcare workforce. Future efforts will focus on collaboratively designing a DEI curriculum for medical schools and residency programs to better prepare incoming residents for the complexities of DEI in clinical practice.