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Thomas M, Balbo J, Nottingham K, Forster L, Chavan B. Student Journal Club to Improve Cultural Humility with LGBTQ Patients. J Prim Care Community Health 2020; 11:2150132720963686. [PMID: 33048001 PMCID: PMC7557682 DOI: 10.1177/2150132720963686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Health degree programs provide opportunities to reduce disparities in care for LGBTQ patients by exposing students to LGBTQ communities and current health issues. However, LGBTQ content is mostly absent from medical school curricula. This mixed method assessment study, conducted during the 2018 to 2019 academic year, examined the feasibility of implementing a medical student journal club focused specifically on LGBTQ health issues as a complementary training tool to support efforts to create an inclusive educational environment. Compared to the pre-test, mean response scores increased for most of the parameters including familiarity with LGBTQ healthcare issues, confidence in the ability to identify harmful medical provider practices, and reading and assessing scientific literature. Qualitative data showed increased confidence, comfort and knowledge about LGBTQ health barriers. This study offers a framework for using a journal club to provide an effective platform for enhancing students' LGBTQ cultural humility and research literacy.
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Affiliation(s)
- Melissa Thomas
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Jane Balbo
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | | | - Lisa Forster
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Bhakti Chavan
- Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, USA
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52
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Paschen-Wolff MM, Greene MZ, Hughes TL. Sexual Minority Women's Sexual and Reproductive Health Literacy: A Qualitative Descriptive Study. HEALTH EDUCATION & BEHAVIOR 2020; 47:728-739. [PMID: 32506954 PMCID: PMC7568910 DOI: 10.1177/1090198120925747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although sexual minority women (SMW) are at risk for cervical cancer and sexually transmitted infections (STIs), they may not seek preventative sexual and reproductive health care at the same rates as their heterosexual peers. We conducted a qualitative descriptive study of 22 adult SMW, a subsample of participants enrolled in the Chicago Health and Life Experiences of Women study. The aim was to describe the sexual and reproductive health literacy of this community sample based on qualitative themes, using an integrated model of health literacy. This model considers not only access to information but also understanding, appraisal, and application of information. We found that family of origin, health care providers, and school-based sexual education were the most important sources of sexual and reproductive health information. Participants described their understanding, appraisal, and application of sexual and reproductive health information as interdependent concepts. Pap test literacy and decision making were strongly independent, with SMW seeking various sources of information, or were driven by health care providers, with SMW following instructions and trusting provider advice. STI-related literacy hinged on whether the participant perceived SMW as at risk for STIs. Our findings reinforce that simply having access to information is insufficient to enact health behaviors that reflect full literacy. Findings have implications for health care providers, who should provide evidence-based recommendations for their SMW clients, and for public health practitioners and educators, who could make sexual health education more inclusive of and specific to the needs of SMW.
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Affiliation(s)
- Margaret M. Paschen-Wolff
- Columbia University Irving Medical Center at New York State Psychiatric Institute, New York, NY, USA
| | - Madelyne Z. Greene
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
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53
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Baugh RF. The Evolution of Social Beliefs 1960-2016 in the United States and Its Influence on Empathy and Prosocial Expression in Medicine. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:437-446. [PMID: 32636695 PMCID: PMC7334402 DOI: 10.2147/amep.s246658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/08/2020] [Indexed: 06/11/2023]
Abstract
This perspective surveys healthcare's response to the increased prominence of racial, ethnic, religious and sexual minorities as well as females in American culture. It argues for understanding physicians both as products of the broader society and its changes. Starting in the 1960s, empiric evidence for the rise of reactionary viewpoints in response to major social movements is outlined. Structural reasons for the prevalence of such ideologies within medicine are highlighted. Its negative consequences for minority health are addressed. Finally, the author turns to compensatory strategies to improve the social environment within healthcare. Alternative selection strategies for medical school are proposed, with a stronger focus on empathetic candidates.
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Affiliation(s)
- Reginald F Baugh
- University of Toledo College of Medicine and Life Sciences, Toledo, OH43623, USA
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54
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Tsai JW, Michelson CD. Attitudes Toward Implicit Bias and Implicit Bias Training Among Pediatric Residency Program Directors: A National Survey. J Pediatr 2020; 221:4-6.e1. [PMID: 32446492 DOI: 10.1016/j.jpeds.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/02/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Jessica W Tsai
- Boston Combined Residency Program in Pediatrics, Boston, MA; Department of Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Boston Medical Center, Boston, MA.
| | - Catherine D Michelson
- Boston Combined Residency Program in Pediatrics, Boston, MA; Department of Medicine, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Boston Medical Center, Boston, MA
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55
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Macias Gil R, Hardy WD. Spectrum of Diversity in Today's Infectious Diseases Workforce: It's Much Broader and Brighter Than You Think. J Infect Dis 2020; 220:S42-S49. [PMID: 31430383 DOI: 10.1093/infdis/jiz242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The spectrum of inclusion, diversity, access, and equity among the Infectious Diseases (ID) workforce is ever-growing, ever-evolving, and continuously benefiting from the contributions made by the unique differences among our workforce which make us stronger, smarter, and better prepared to respond to whatever emerging ID challenge we will encounter next.
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Affiliation(s)
- Raul Macias Gil
- Alpert Medical School of Brown University, Providence, Rhode Island
| | - W David Hardy
- Johns Hopkins University School of Medicine, Baltimore, Maryland.,Board of Directors, HIV Medicine Association, Arlington, Virginia
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56
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Pratt-Chapman ML. Implementation of sexual and gender minority health curricula in health care professional schools: a qualitative study. BMC MEDICAL EDUCATION 2020; 20:138. [PMID: 32375760 PMCID: PMC7201690 DOI: 10.1186/s12909-020-02045-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/20/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, queer, and intersex people-inclusively termed "sexual and gender minorities"-have unique health and health care needs that are not being met by most healthcare providers due to lack of training in health care professional schools. The purpose of this qualitative study was to examine implementation factors for advancing sexual and gender minority health professional student curricula in academic settings. METHODS Semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR) were conducted with sixteen curricular champions to identify factors relevant to curricular adoption, integration, and sustainment. Themes were coded using a hybrid of deductive and inductive approaches and reported using major CFIR domains. RESULTS Facilitators supporting implementation of sexual and gender minority health curricula included collaboration among multiple stakeholders, alignment of formal and hidden curricula, fostering an organizational culture that valued inclusion and diversity, engagement with external subject matter experts or faculty with content expertise, and thoughtful and inclusive planning. CONCLUSION This study contributes to health care professional education research as well as to implementation science. Facilitators that were identified in this study can be used to increase the adoption, integration, and sustainment of sexual and gender minority health curricula in diverse academic settings.
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Affiliation(s)
- Mandi L Pratt-Chapman
- The George Washington University, GW Cancer Center, 2600 Virginia Ave, #324, Washington, DC, 20037, USA.
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57
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Hill KA, Samuels EA, Gross CP, Desai MM, Sitkin Zelin N, Latimore D, Huot SJ, Cramer LD, Wong AH, Boatright D. Assessment of the Prevalence of Medical Student Mistreatment by Sex, Race/Ethnicity, and Sexual Orientation. JAMA Intern Med 2020; 180:653-665. [PMID: 32091540 PMCID: PMC7042809 DOI: 10.1001/jamainternmed.2020.0030] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE Previous studies have shown that medical student mistreatment is common. However, few data exist to date describing how the prevalence of medical student mistreatment varies by student sex, race/ethnicity, and sexual orientation. OBJECTIVE To examine the association between mistreatment and medical student sex, race/ethnicity, and sexual orientation. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed data from the 2016 and 2017 Association of American Medical Colleges Graduation Questionnaire. The questionnaire annually surveys graduating students at all 140 accredited allopathic US medical schools. Participants were graduates from allopathic US medical schools in 2016 and 2017. Data were analyzed between April 1 and December 31, 2019. MAIN OUTCOMES AND MEASURES Prevalence of self-reported medical student mistreatment by sex, race/ethnicity, and sexual orientation. RESULTS A total of 27 504 unique student surveys were analyzed, representing 72.1% of graduating US medical students in 2016 and 2017. The sample included the following: 13 351 female respondents (48.5%), 16 521 white (60.1%), 5641 Asian (20.5%), 2433 underrepresented minority (URM) (8.8%), and 2376 multiracial respondents (8.6%); and 25 763 heterosexual (93.7%) and 1463 lesbian, gay, or bisexual (LGB) respondents (5.3%). At least 1 episode of mistreatment was reported by a greater proportion of female students compared with male students (40.9% vs 25.2%, P < .001); Asian, URM, and multiracial students compared with white students (31.9%, 38.0%, 32.9%, and 24.0%, respectively; P < .001); and LGB students compared with heterosexual students (43.5% vs 23.6%, P < .001). A higher percentage of female students compared with male students reported discrimination based on gender (28.2% vs 9.4%, P < .001); a greater proportion of Asian, URM, and multiracial students compared with white students reported discrimination based on race/ethnicity (15.7%, 23.3%, 11.8%, and 3.8%, respectively; P < .001), and LGB students reported a higher prevalence of discrimination based on sexual orientation than heterosexual students (23.1% vs 1.0%, P < .001). Moreover, higher proportions of female (17.8% vs 7.0%), URM, Asian, and multiracial (4.9% white, 10.7% Asian, 16.3% URM, and 11.3% multiracial), and LGB (16.4% vs 3.6%) students reported 2 or more types of mistreatment compared with their male, white, and heterosexual counterparts (P < .001). CONCLUSIONS AND RELEVANCE Female, URM, Asian, multiracial, and LGB students seem to bear a disproportionate burden of the mistreatment reported in medical schools. It appears that addressing the disparate mistreatment reported will be an important step to promote diversity, equity, and inclusion in medical education.
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Affiliation(s)
| | - Elizabeth A Samuels
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cary P Gross
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut.,National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Mayur M Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Nicole Sitkin Zelin
- Department of Psychiatry and Behavioral Sciences, Stanford Medicine, Stanford, California
| | - Darin Latimore
- Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Stephen J Huot
- Section of Nephrology, Yale School of Medicine, New Haven, Connecticut
| | - Laura D Cramer
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Ambrose H Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Najor AJ, Kling JM, Imhof RL, Sussman JD, Nippoldt TB, Davidge-Pitts CJ. Transgender Health Care Curriculum Development: A Dual-Site Medical School Campus Pilot. Health Equity 2020; 4:102-113. [PMID: 32258962 PMCID: PMC7133436 DOI: 10.1089/heq.2019.0106] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Lack of physician training contributes to health care disparities for transgender people. The limited generalizability and feasibility of published training approaches lessen their utility in lowering barriers for other institutions to adopt similar training. Methods: All first-year medical students at the Mayo Clinic Alix School of Medicine (MCASOM) in Minnesota and Arizona received a 1-h lecture introducing key concepts related to transgender people and their health disparities. Students completed a 21-question survey before and after the lecture, and 1 year later. Chi-square likelihood coefficients were used to compare responses between the three time points. Results: Eighty-six of 100 students answered the prelecture survey (86% response rate); 70 the postlecture survey; and 44 the 1-year follow-up survey. Twenty-five (29%) students had prior education in any lesbian, gay, bisexual, and transgender (LGBT+) health disparities, but this did not correlate with more favorable attitudes or knowledge. LGBT+ students and those with close LGBT+ friends had the most favorable attitudes and knowledge. The proportion of students comfortable with caring for transgender people changed significantly (76% self-reported very comfortable prelecture vs. 91% postlecture, p=0.0073) and remained at 89% 1 year later. The proportion of students comfortable with a transgender patient scenario significantly increased (67% self-reported very comfortable prelecture vs. 87% postlecture, p=0.032) even when surveyed 1 year later (95% very comfortable, p<0.0001). Conclusion: This study demonstrates that a 1-h lecture can increase the proportion of medical students who demonstrate positive attitudes and correct knowledge on transgender patient care for at least a year, and how a survey can gather essential information on student learning needs to guide training development.
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Affiliation(s)
- Anna J Najor
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | - Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Reese L Imhof
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | - Jon D Sussman
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | - Todd B Nippoldt
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota.,Division of Endocrinology, Diabetes, Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Caroline J Davidge-Pitts
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota.,Division of Endocrinology, Diabetes, Nutrition, Mayo Clinic, Rochester, Minnesota
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Hequembourg AL, Blayney JA, Bostwick W, Van Ryzin M. Concurrent Daily Alcohol and Tobacco Use among Sexual Minority and Heterosexual Women. Subst Use Misuse 2020; 55:66-78. [PMID: 31446825 DOI: 10.1080/10826084.2019.1656252] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Studies show that sexual minority women (SMW) report more hazardous alcohol use patterns and higher rates of tobacco use than exclusively heterosexual women. Despite the public health implications of drinking and smoking, especially when they co-occur, little is known about SMW's daily use patterns or the factors that may facilitate concurrent use. Objectives: The present study seeks to identify patterns of daily concurrent alcohol and tobacco use among SMW and heterosexual women, including socio-environmental drinking contexts of concurrent use. Methods: Data come from a community sample of lesbian, bisexual, and heterosexual women (N = 246) who completed up to 84 consecutive days of web-based reports about substance use. Results: Participants reported 4,012 drinking days (24%), 2,019 smoking days (12%), and 769 concurrent drinking and smoking days (5%). No differences were found between SMW and heterosexual women in the proportion of drinking days; however, SMW consumed more drinks on drinking days. SMW also reported a greater proportion of smoking days, more cigarettes smoked on smoking days, and a greater proportion of concurrent drinking and smoking days. Reciprocal daily relationships between alcohol and tobacco use were identified, and these relationships were strongest for bisexual women. Socio-environmental factors-including certain locations, situations, and companions-increased the likelihood of concurrent use for all women; however, few sexual identity differences were found in concurrent use contexts. Importance: Results expand our understanding about daily concurrent alcohol and tobacco use risk among SMW, and potentially inform treatment research to better address the unique experiences of this vulnerable group.
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Affiliation(s)
- Amy L Hequembourg
- Research Institute on Addictions, University at Buffalo, The State University of New York, Buffalo, New York, USA.,School of Nursing, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Jessica A Blayney
- Department of Psychology, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Wendy Bostwick
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
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Abstract
Sexual and gender minority (SGM) individuals include, but are not limited to, those who identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ). LGBTQ individuals are considered a marginalized and at-risk population, facing significant health care inequities when compared with heterosexual and cisgendered (ie, "gender-conforming") populations. They are more likely than heterosexual and cisgendered individuals to experience discrimination, bias, and dissatisfaction with the medical system. This article provides a broad overview of systemic inequalities confronting SGM patients.
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Affiliation(s)
- Erica Arnold
- Spring Street Dermatology, 73 Spring Street, Suite 303, New York, NY 10012, USA; University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Nikhil Dhingra
- Spring Street Dermatology, 73 Spring Street, Suite 303, New York, NY 10012, USA; Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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61
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Ko M, Dorri A. Primary Care Clinician and Clinic Director Experiences of Professional Bias, Harassment, and Discrimination in an Underserved Agricultural Region of California. JAMA Netw Open 2019; 2:e1913535. [PMID: 31642925 PMCID: PMC6820031 DOI: 10.1001/jamanetworkopen.2019.13535] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Many rural and agricultural communities experience hardship from a shortage of clinicians. The aging of the clinician population threatens future supply in these areas. Developing policies to build a sustainable workforce requires the understanding of experiences from those currently in medical practice. Previous research about rural clinicians has primarily sampled non-Latinx white men, and to a lesser extent, non-Latinx white women; to date, no study has examined differences by race/ethnicity, sexual orientation, or gender identity. OBJECTIVE To describe the professional experiences of a diverse group of primary care clinicians and clinic directors in an underserved rural and agricultural region of California. DESIGN, SETTING, AND PARTICIPANTS In this qualitative study, semistructured in-depth qualitative interviews were performed with clinicians and clinic directors from December 1, 2017, to December 31, 2018, with a present or recent medical practice in the central San Joaquin Valley region of California. Participants (N = 26) consisted of physicians, nurse practitioners, and clinic directors practicing in primary care settings. Settings included solo and group private practice, academic training programs, community health centers, and rural health clinics. MAIN OUTCOMES AND MEASURES Personal experiences as primary care clinicians and clinic directors, and perceived associations with gender, race/ethnicity, sexual orientation, and gender identity. RESULTS Of 26 primary care clinicians and clinic directors interviewed, 16 (62%) identified as female, 12 (46%) identified as non-Latinx white, and 3 (12%) identified as a member of a sexual and gender minority group. Participants who self-identified as female, nonwhite, and of certain sexual orientation and gender identity minority groups described burnout from bias, harassment, and hostility in their professional relationships with colleagues and health care staff. These experiences intensified their feelings of community isolation and professional isolation. Harassment and institutional discrimination were factors in the decision of participants to change practices or exit the region entirely. Discriminatory acts against members of sexual and gender minority groups were the most severe, including threats to licensure and denial of hospital admitting privileges. In contrast to the minority group participants, the remaining participants expressed little to no awareness of these negative experiences, or the association between these experiences and retention. CONCLUSIONS AND RELEVANCE Professional harassment and discrimination may hamper efforts to improve clinician and clinic director recruitment and retention in underserved rural and agricultural areas and may pose barriers to addressing health disparities within those communities. Additional investigation appears to be needed to assess the extent to which professional harassment and discrimination affect clinicians and clinic directors in similar communities across the United States.
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Affiliation(s)
- Michelle Ko
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis
| | - Armin Dorri
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis
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Boos MD, Yeung H, Inwards-Breland D. Dermatologic care of sexual and gender minority/LGBTQIA youth, Part I: An update for the dermatologist on providing inclusive care. Pediatr Dermatol 2019; 36:581-586. [PMID: 31259437 PMCID: PMC6750998 DOI: 10.1111/pde.13896] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sexual and gender minority (SGM) persons, including lesbian, gay, bisexual, transgender/gender diverse, questioning/queer, intersex, and asexual (LGBTQIA) individuals, represent a historically underserved population within the field of medicine, though their unique health needs are increasingly recognized. Unfortunately, our understanding of these needs as they relate to dermatology is still nascent, particularly with respect to children and adolescents. This two-part review will discuss the dermatologic care of SGM youth, with Part 1 providing practical advice for dermatologists seeking to provide more culturally mindful and accessible care for SGM children and adolescents. A more comprehensive understanding of the psychosocial and physical needs of SGM youth will allow dermatologists to more actively and compassionately care for this health disparity population.
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Affiliation(s)
- Markus D Boos
- Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - David Inwards-Breland
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
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63
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Marcelin JR, Siraj DS, Victor R, Kotadia S, Maldonado YA. The Impact of Unconscious Bias in Healthcare: How to Recognize and Mitigate It. J Infect Dis 2019; 220:S62-S73. [DOI: 10.1093/infdis/jiz214] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AbstractThe increasing diversity in the US population is reflected in the patients who healthcare professionals treat. Unfortunately, this diversity is not always represented by the demographic characteristics of healthcare professionals themselves. Patients from underrepresented groups in the United States can experience the effects of unintentional cognitive (unconscious) biases that derive from cultural stereotypes in ways that perpetuate health inequities. Unconscious bias can also affect healthcare professionals in many ways, including patient-clinician interactions, hiring and promotion, and their own interprofessional interactions. The strategies described in this article can help us recognize and mitigate unconscious bias and can help create an equitable environment in healthcare, including the field of infectious diseases.
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Wittlin NM, Dovidio JF, Burke SE, Przedworski JM, Herrin J, Dyrbye L, Onyeador IN, Phelan SM, van Ryn M. Contact and role modeling predict bias against lesbian and gay individuals among early-career physicians: A longitudinal study. Soc Sci Med 2019; 238:112422. [PMID: 31391147 DOI: 10.1016/j.socscimed.2019.112422] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 07/05/2019] [Accepted: 07/13/2019] [Indexed: 12/30/2022]
Abstract
RATIONALE Physician bias against sexual minorities can hinder the delivery of high-quality health care and thus contribute to the disproportionate prevalence of negative health outcomes within this population. Medical students' interpersonal experiences within the context of medical school may contribute to this bias. OBJECTIVE The goal of the current research was to examine the relationship between these interpersonal experiences, reported by heterosexual, cisgender medical students, and explicit and implicit bias against lesbians and gay individuals, reported two years later during second year of medical residency. METHOD Data were collected by surveying students (n = 2940) from a stratified sample of U.S. medical schools in fall 2010 (first semester of medical school), spring 2014 (final semester of medical school), and spring 2016 (second year of medical residency). RESULTS Amount and favorability of contact with LGBT individuals, reported during the final semester of medical school, predicted lower levels of explicit bias against lesbian and gay individuals during second year of medical residency. Additionally, exposure to negative role modeling, also reported during the final semester of medical school, predicted higher levels of explicit bias against lesbian and gay individuals during second year of medical residency. Amount of contact with LGBT individuals - and in particular, with LGBT medical students - predicted lower levels of implicit bias against lesbian and gay individuals during second year of medical residency. Neither favorability of contact with LGBT individuals nor exposure to negative role modeling predicted implicit bias against lesbian and gay individuals during second year of medical residency. CONCLUSION These results suggest that interpersonal experiences during medical school can systematically shape heterosexual, cisgender physicians' subsequent explicit and implicit bias against lesbian and gay individuals.
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Affiliation(s)
- Natalie M Wittlin
- Department of Psychology, Yale University, Kirtland Hall, 2 Hillhouse Ave., New Haven, CT 06511 United States.
| | - John F Dovidio
- Department of Psychology, Yale University, Kirtland Hall, 2 Hillhouse Ave., New Haven, CT 06511 United States.
| | - Sara E Burke
- Department of Psychology, Syracuse University, Huntington Hall, Syracuse, NY 13244, United States.
| | - Julia M Przedworski
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St. S.E., Minneapolis, MN 55455, United States; School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, United States.
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Yale School of Medicine, PO Box 2254, Charlottesville, VA 22902, United States.
| | - Liselotte Dyrbye
- Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, United States.
| | - Ivuoma N Onyeador
- Department of Psychology, Yale University, Kirtland Hall, 2 Hillhouse Ave., New Haven, CT 06511 United States.
| | - Sean M Phelan
- Division of Health Care Policy and Research, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States.
| | - Michelle van Ryn
- School of Nursing, Oregon Health & Science University, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, United States.
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65
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LGBT+ Health Teaching within the Undergraduate Medical Curriculum. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132305. [PMID: 31261831 PMCID: PMC6651354 DOI: 10.3390/ijerph16132305] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 11/16/2022]
Abstract
Introduction: The lesbian, gay, bisexual, and transgender (LGBT+) population experience health and social inequalities, including discrimination within healthcare services. There is a growing international awareness of the importance of providing healthcare professionals and students with dedicated training on LGBT+ health. Methods: We introduced a compulsory teaching programme in a large London-based medical school, including a visit from a transgender patient. Feedback was collected across four years, before (n = 433) and after (n = 541) the session. Student confidence in using appropriate terminology and performing a clinical assessment on LGBT+ people was assessed with five-point Likert scales. Fisher exact tests were used to compare the proportion responding “agree” or “strongly agree”. Results: Of the students, 95% (CI 93–97%) found the teaching useful with 97% (96–99%) finding the visitor’s input helpful. Confidence using appropriate terminology to describe sexual orientation increased from 62% (58–67%) to 93% (91–95%) (Fisher p < 0.001) and gender identity from 41% (36–46%) to 91% (88–93%) (p < 0.001). Confidence in the clinical assessment of a lesbian, gay or bisexual patient increased from 75% (71–79%) to 93% (90–95%) (p < 0.001), and of a transgender patient from 35% (31–40%) to 84% (80–87%) (p < 0.001). Discussion: This teaching programme, written and delivered in collaboration with the LGBT+ community, increases students’ confidence in using appropriate language related to sexual orientation and gender identity, and in the clinical assessment of LGBT+ patients.
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Part of the Solution to Address Sexual and Gender Minority Health and Health Care Disparities: Inclusive Professional Education. Dela J Public Health 2019; 5:56-62. [PMID: 34467041 PMCID: PMC8389761 DOI: 10.32481/djph.2019.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Teall AM, Graham M, Jenkins N, Ali A, Pryba J, Overcash J. Faculty Perceptions of Engaging Students in Active Learning to Address Implicit Bias Using Videos Exemplifying the Prenatal Visit of a Lesbian Couple. J Transcult Nurs 2019; 30:616-626. [DOI: 10.1177/1043659619828109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Implicit bias affects patient–nurse interactions and care management decisions. The purpose of this educational project was to explore faculty perceptions of engaging students in active learning to address implicit bias using videos vignettes. Method: Three videos were created with a corresponding instructor guide. The vignettes depicted insensitive behaviors, best practice clinical interactions, and a reflection about bias in health care. Faculty who implemented the active learning strategy were invited to complete an online, confidential survey regarding their perceptions. Results: Most faculty (83%) agreed that students benefit from discussing implicit bias using an active learning approach. All faculty ( N = 12) believed the videos and instructor guide to be effective tools in creating meaningful discussion. Discussion: Video vignettes illustrating insensitive behaviors and demonstrating best practice enable faculty to actively engage students in addressing the impact of implicit bias. Educational strategies intended to ensure equitable care are indicated to support positive patient outcomes.
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Affiliation(s)
- Alice M. Teall
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - Margaret Graham
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - Nathan Jenkins
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - Awais Ali
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - John Pryba
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - Janine Overcash
- The Ohio State University College of Nursing, Columbus, OH, USA
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Colonnello V, Mattarozzi K, Russo PM. Emotion recognition in medical students: effects of facial appearance and care schema activation. MEDICAL EDUCATION 2019; 53:195-205. [PMID: 30467891 DOI: 10.1111/medu.13760] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/06/2018] [Accepted: 09/18/2018] [Indexed: 05/23/2023]
Abstract
CONTEXT Identifying the factors that may interfere with or sharpen the ability to recognise emotions when observing patients is a critical goal in medical education. This study addressed these issues by investigating the effects of facial appearance bias on medical students' emotion recognition (Experiment 1) and whether such bias is modulated by the activation of relational caregiving schema (Experiment 2). METHODS In Experiment 1, medical students were asked to recognise the emotions expressed by individuals differing in facial appearance (trustworthy, neutral and untrustworthy). In Experiment 2, they completed the same type of emotion recognition task after activating and anchoring themselves to the representation of the relational/human competences typical of a competent professional caregiver or after a control non-representation condition. RESULTS In both experiments, emotion recognition was affected by facial appearance bias: medical students were less accurate and slower in their recognition of emotions displayed by untrustworthy-looking individuals than in their recognition of emotions exhibited by individuals evoking more positive inferences. In Experiment 2, the activation of care schema enhanced medical students' emotion recognition ability regardless of facial appearance-based inferences. CONCLUSIONS Medical students' emotion recognition is affected by appearance-based bias, but such bias may be weakened by techniques that harness medical students' personal affective/relational and representational resources. Thus, the results provide a basis for designing curricula aimed at challenging implicit negative bias and promoting medical students' emotion recognition ability starting in the early stages of their education.
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Affiliation(s)
- Valentina Colonnello
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Katia Mattarozzi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Paolo M Russo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Improving Clinical Education and Training on Sexual and Gender Minority Health. CURRENT SEXUAL HEALTH REPORTS 2018. [DOI: 10.1007/s11930-018-0185-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Comparing medical, dental, and nursing students' preparedness to address lesbian, gay, bisexual, transgender, and queer health. PLoS One 2018; 13:e0204104. [PMID: 30235283 PMCID: PMC6147466 DOI: 10.1371/journal.pone.0204104] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 09/04/2018] [Indexed: 11/19/2022] Open
Abstract
Background Lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations face multiple health disparities including barriers to healthcare. Few studies have examined healthcare trainees’ perceptions of their preparedness to care for LGBTQ populations and none have compared perceptions of training across medicine, dental medicine, and nursing. We aimed to understand variations across disciplines in LGBTQ health by assessing medical, dental, and nursing students’ perceptions of preparedness across three domains: comfort levels, attitudes, and formal training. Methods We developed a 12-item survey with an interprofessional panel of LGBTQ students from the schools of medicine, dental medicine, and nursing at a top-tier private university in the United States. Any student enrolled full time in any of the three schools were eligible to respond. We performed descriptive statistical analyses and examined patterns in responses using Kruskal-Wallis tests and an ordered logistic regression model. Results 1,010 students from the Schools of Medicine, Dental Medicine, and Nursing responded to the survey for an overall response rate of 43%. While 70–74% of all student respondents felt comfortable treating LGBTQ patients, fewer than 50% agreed that their formal training had prepared them to do so. Overall, 71–81% of students reported interest in receiving formal LGBTQ health education, though dental students were significantly less likely than medical students to report this interest (OR 0.53, p<0.01). Respondents who identified as LGBQ were significantly less likely than heterosexual students to agree that training was effective (OR 0.55, p<0.01) and that their instructors were competent in LGBTQ health (OR 0.56, p<0.01). Conclusion Despite high comfort levels and positive attitudes towards LGBTQ health, most student respondents did not report adequate formal preparation. There were some significant differences between disciplines, but significant gaps in training exist across disciplines. Health professional schools should develop formal content on LGBTQ health and utilize this content as an opportunity for interprofessional training.
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Aleshire ME, Ashford K, Fallin-Bennett A, Hatcher J. Primary Care Providers' Attitudes Related to LGBTQ People: A Narrative Literature Review. Health Promot Pract 2018; 20:173-187. [PMID: 29947564 DOI: 10.1177/1524839918778835] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this article is to review the current literature describing primary care providers' (PCPs) attitudes related to lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) people. LGBTQ individuals experience significant health disparities, and these inequities may be better understood via an ecological systems framework. PCPs' actual or perceived discriminatory attitudes can lead to suboptimal treatment or health outcomes for LGBTQ people. A review of the literature from 2005 through January 2017 was completed using the Cumulative Index for Nursing and Allied Health Literature and PubMed (Medline) databases. The purpose, sample, measure(s), design, findings, strengths, and weaknesses of each study were examined; and findings were synthesized, summarized, and critically appraised. Eight articles were eligible for review. There was significant heterogeneity in the studies' purposes, research questions, LGBTQ population(s) of focus, and findings. Many PCPs' attitudes toward LGBTQ people were positive, but a minority of each studies' participants had negative attitudes toward LGBTQ people. Stigma and health care barriers negatively affect LGBTQ health. Interventions must address LGBTQ health disparities at the individual, mesosytem, exosystem, and macrosystem levels. Research, education, and practice strategies all must be integrated across socioecological levels as components of a population-based approach to eliminate health disparities for LGBTQ persons.
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Affiliation(s)
| | - Kristin Ashford
- University of Kentucky College of Nursing, Lexington, KY, USA
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P Goddu A, O'Conor KJ, Lanzkron S, Saheed MO, Saha S, Peek ME, Haywood C, Beach MC. Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record. J Gen Intern Med 2018; 33:685-691. [PMID: 29374357 PMCID: PMC5910343 DOI: 10.1007/s11606-017-4289-2] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 11/13/2017] [Accepted: 12/13/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Clinician bias contributes to healthcare disparities, and the language used to describe a patient may reflect that bias. Although medical records are an integral method of communicating about patients, no studies have evaluated patient records as a means of transmitting bias from one clinician to another. OBJECTIVE To assess whether stigmatizing language written in a patient medical record is associated with a subsequent physician-in-training's attitudes towards the patient and clinical decision-making. DESIGN Randomized vignette study of two chart notes employing stigmatizing versus neutral language to describe the same hypothetical patient, a 28-year-old man with sickle cell disease. PARTICIPANTS A total of 413 physicians-in-training: medical students and residents in internal and emergency medicine programs at an urban academic medical center (54% response rate). MAIN MEASURES Attitudes towards the hypothetical patient using the previously validated Positive Attitudes towards Sickle Cell Patients Scale (range 7-35) and pain management decisions (residents only) using two multiple-choice questions (composite range 2-7 representing intensity of pain treatment). KEY RESULTS Exposure to the stigmatizing language note was associated with more negative attitudes towards the patient (20.6 stigmatizing vs. 25.6 neutral, p < 0.001). Furthermore, reading the stigmatizing language note was associated with less aggressive management of the patient's pain (5.56 stigmatizing vs. 6.22 neutral, p = 0.003). CONCLUSIONS Stigmatizing language used in medical records to describe patients can influence subsequent physicians-in-training in terms of their attitudes towards the patient and their medication prescribing behavior. This is an important and overlooked pathway by which bias can be propagated from one clinician to another. Attention to the language used in medical records may help to promote patient-centered care and to reduce healthcare disparities for stigmatized populations.
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Affiliation(s)
- Anna P Goddu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Katie J O'Conor
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sophie Lanzkron
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mustapha O Saheed
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Somnath Saha
- Section of General Internal Medicine, VA Portland Health Care System, Portland, OR, USA
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, OR, USA
| | - Monica E Peek
- Section of General Internal Medicine, The University of Chicago, Chicago, IL, USA
| | - Carlton Haywood
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Phelan SM, van Ryn M. Response to Capsule Commentary. J Gen Intern Med 2018; 33:403. [PMID: 29383549 PMCID: PMC5880783 DOI: 10.1007/s11606-018-4313-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Sean M Phelan
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA.
| | - Michelle van Ryn
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
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Capsule Commentary on Phelan et al., Medical School Factors Associated with Changes in Implicit and Explicit Bias Against Gay and Lesbian People among 3492 Graduating Medical Students. J Gen Intern Med 2017; 32:1248. [PMID: 28822044 PMCID: PMC5653564 DOI: 10.1007/s11606-017-4160-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Affiliation(s)
- Mitchell D Feldman
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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