Equity, Diversity, Advocacy, and Cultural Safety (EDACS) education has become an increasingly important component of emergency medicine (EM) training. As a critical access point for marginalized and structurally disadvantaged patients, the emergency department requires physicians to have the skills and understanding necessary to recognize how social determinants of health shape patient outcomes and how to advocate effectively within healthcare systems. In response to this need, Equity, Diversity, and Inclusion (EDI) curricula have been increasingly integrated into EM training programs across Canada. However, despite widespread implementation, many of these curricula have not undergone formal evaluation to assess their underlying principles, implementation, or impact.
The EDACS curriculum was developed and implemented within the University of Toronto Emergency Medicine training program in 2019. Grounded in Metzl and Hansen’s Structural Competency Framework, the curriculum aims to equip EM trainees with the knowledge, skills, and perspectives required to address healthcare inequities in clinical practice. The curriculum includes experiential learning opportunities, such as guided visits to community-based organizations including overdose prevention sites, detoxification centres, and shelters, as well as didactic sessions led by medical experts focused on systems-level advocacy. While learner feedback to date has been generally positive, a comprehensive and formal evaluation of the EDACS curriculum has not yet been complete.
To address this gap, our team is conducting a formal Principles-Focused Evaluation (PFE) of the EDACS curriculum. PFE, developed by Michael Quinn Patton, offers an alternative and complementary approach to traditional outcome-based evaluation by focusing on the guiding principles—or actionable values—that inform program design and implementation. This approach is particularly well suited to equity- and justice-oriented curricula, where desired outcomes are often complex, contextual, and system-level, and where understanding how and why a program functions is as important as measuring discrete outcomes.
The evaluation will be conducted in three phases. Phase I aims to identify the core guiding principles of the EDACS curriculum through cross-sectional surveys and focus groups with curriculum founders and leads. Phase II assesses the extent to which the curriculum adheres to these identified principles through semi-structured interviews with curriculum end-users, including learners, recent graduates, and faculty leadership. Phase III focuses on analysis and knowledge translation, including abstract submissions to national conferences and manuscript preparation for publication, with the goal of informing future iterations of the EDACS curriculum and contributing to broader conversations around the evaluation of equity-focused medical education initiatives.
