Background: Worldwide, the number of refugees continues to increase. By the end of 2017, there were an estimated 68.5 million individuals forcibly displaced worldwide due to persecution, conflict, or generalized violence. Refugees have unique and complex health care conditions and needs. Most physicians receive limited, if any, training on providing medical care to refugees. The aim of our study was to survey faculty hospitalists who care for refugee patients to identify general and specific educational needs of trainees who plan to care for this unique patient population.
Methods: In June 2019, we invited a cross-section of health care clinicians who care for refugee patients to complete a 40-question survey using REDCap. Invitation emails sent to the clinicians contained a link to the REDCap survey and up to two reminder emails were sent to promote survey completion. Participation was voluntary and there was no compensation for participating in the survey. All analyses were performed using SAS Enterprise Guide 8.1 (SAS Institute, Inc., Cary, North Carolina).
Results: Of the 180 clinicians that completed the survey, 58% were female and most were physicians (84%). Seventy six (42%) were hospitalists, and 8 percent of these were born outside of the US or Canada. Interestingly, 38% of the hospitalist responders reported prior education or training in global or refugee health. Sixty-four percent of all responders reported that they felt unprepared to take care of refugee patients after residency while 63% of responders reported feeling unprepared to take care of refugee patients now. Cultural challenges, lack of knowledge, language barrier, lack of resources, and lack of training were the most cited reasons for feeling unprepared to care for refugee patients.Prior education or training in refugee health or global health strongly predicted respondents feeling prepared to care for refugee patients both during residency and now (p <.0001 and p = 0.02). Furthermore, there was a strong correlation between the percentage of refugee patients encountered during residency and respondents feeling “usually” or “always” prepared to care for refugee patients both during residency and now (rho = 0.4477, p <.0001 and rho = 0.2098, p = 0.01 respectively). Respondents identified the following five topics as very important in caring for refugees: use of interpreters (97%), effective ways to deliver health care needs that meet the social and cultural needs of this unique patient population (83%), availability and referral of social services resources (79%), addressing mental health (70%), and appropriate screening and treatment of HIV/AIDS (58%).
Conclusions: The majority of health care clinicians surveyed feel unprepared to take care of refugee patients. Our findings suggest that training in refugee and immigrant health during medical and residency training can improve how prepared clinicians feel, providing a starting point for developing a curricular intervention to improve clinician confidence, competence, and ultimately the well-being of their refugee patients.