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Wengryn MI, Hester EJ. Pragmatic Skills Used by Older Adults in Social Communication Health Care Contexts: Precursors to Health Literacy. ACTA ACUST UNITED AC 2011. [DOI: 10.1044/cicsd_38_s_41] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Hines AB. Asthma: a health disparity among African American children: the impact and implications for pediatric nurses. J Pediatr Nurs 2011; 26:25-33. [PMID: 21256409 DOI: 10.1016/j.pedn.2009.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Revised: 09/02/2009] [Accepted: 10/19/2009] [Indexed: 12/16/2022]
Abstract
Asthma is the most common chronic illness among children and is a significant health disparity for African American children and their families. This article provides current statistics that clearly define the problem of asthma and explains the relevance of this health problem for pediatric nurses. The Healthy People 2010 objectives for pediatric asthma care are discussed as outcome measures. The individual, sociocultural, and environmental characteristics of asthma are described. The impact and implications for pediatric nurses in the roles of (a) coordinator of care, (b) child/family advocate, and (c) evaluator of care are explained.
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Rosenfeld L, Rudd R, Emmons KM, Acevedo-García D, Martin L, Buka S. Beyond reading alone: the relationship between aural literacy and asthma management. PATIENT EDUCATION AND COUNSELING 2011; 82:110-6. [PMID: 20399060 PMCID: PMC2944911 DOI: 10.1016/j.pec.2010.02.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 02/19/2010] [Accepted: 02/24/2010] [Indexed: 05/03/2023]
Abstract
OBJECTIVES to examine the relationship between literacy and asthma management with a focus on the oral exchange. METHODS study participants, all of whom reported asthma, were drawn from the New England Family Study (NEFS), an examination of links between education and health. NEFS data included reading, oral (speaking), and aural (listening) literacy measures. An additional survey was conducted with this group of study participants related to asthma issues, particularly asthma management. Data analysis focused on bivariate and multivariable logistic regression. RESULTS in bivariate logistic regression models exploring aural literacy, there was a statistically significant association between those participants with lower aural literacy skills and less successful asthma management (OR: 4.37, 95%CI: 1.11, 17.32). In multivariable logistic regression analyses, controlling for gender, income, and race in separate models (one-at-a-time), there remained a statistically significant association between those participants with lower aural literacy skills and less successful asthma management. CONCLUSION lower aural literacy skills seem to complicate asthma management capabilities. PRACTICE IMPLICATIONS greater attention to the oral exchange, in particular the listening skills highlighted by aural literacy, as well as other related literacy skills may help us develop strategies for clear communication related to asthma management.
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Affiliation(s)
- Lindsay Rosenfeld
- Northeastern University, Institute on Urban Health Research, Boston, MA 02115, USA.
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Hardie G, Liu R, Darden J, Gold WM. Ethnic differences in methacholine responsiveness and word descriptors in African Americans, Hispanic-Mexican Americans, Asian-Pacific Islanders, and Whites with mild asthma. J Asthma 2010; 47:388-96. [PMID: 20528591 DOI: 10.3109/02770903.2010.481341] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE There is little asthma research that compares ethnic differences in airway responsiveness and word descriptors among African Americans, Hispanic-Mexican Americans, Asian-Pacific Islanders, and Whites. Thus, identifying ethnic differences in symptom descriptors and airway responsiveness may improve health outcomes by educating health professionals about treatment decisions that are culturally and ethnically sensitive. METHODS Specific Inclusion criteria-forced expiratory volume in one second (FEV(1)) >or= 70% predicted normal; provocative concentration causing a 30% fall in FEV(1) (PC(30)) <or= 8 mg/ml for methacholine (MCh), using only a beta(2)- inhaler, and self-reported ethnicity of African American, Hispanic-Mexican American, Asian-Pacific Islander, or White. Serial pulmonary function test (PFT) and Borg, Visual Analogue Scale (VAS), and Ethnic Word Descriptors (EWDs) were collected. RESULTS One hundred eighteen consented, 106 completed procedures, and 90 had a positive PC(30) and were enrolled. Asian-Pacific Islanders had significantly greater airway responsiveness (p <.02). Baseline FEV(1), MCh dose, and PC(30) correlated with race (p <.001); baseline FEV(1) and ethnicity predicted airway responsiveness (p <.001). EWDs differed significantly by ethnicity. Upper airway EWDs for Asian-Pacific Islanders: itchy throat (p < .04), itchy (p <.02), itchy back throat (p <.04), voice tight, tight throat (p <.001), and cough (p <.04). Upper airway EWDs for African Americans: add itchy throat (p <.002), itchy neck (p <.001), tight throat (p <.003), voice tight (p <.02), and cough (p <.04). Hispanic-Mexican Americans used both upper and lower airway EWDs; Whites used only lower airway EWDs. CONCLUSION This study provides new insights about ethnic differences in airway responsiveness and EWDs. Asian-Pacific Islanders required a significantly smaller dose of MCh to achieve a PC(30) compared to the other three ethnic groups. The upper airway EWDs used by African Americans, Asian-Pacific Islanders, and Hispanic-Mexican Americans indicate a shared language of symptoms. A new language of breathlessness that incorporates both cultural and ethnic differences is needed to address the present disparity in the management of asthma symptoms.
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Affiliation(s)
- Grace Hardie
- San Francisco State University, School of Nursing, San Francisco, California 94132, USA.
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Diedhiou A, Probst JC, Hardin JW, Martin AB, Xirasagar S. Relationship between presence of a reported medical home and emergency department use among children with asthma. Med Care Res Rev 2010; 67:450-75. [PMID: 20442339 DOI: 10.1177/1077558710367735] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined data from the 2005-2006 National Survey of Children with Special Health Care Needs to assess the relationship among children with asthma between a reported medical home and emergency department (ED) use. The authors used 21 questions to measure 6 medical home components: personal doctor/nurse, family-centered, compassionate, culturally effective and comprehensive care, and effective care coordination. Weighted zero-inflated Poisson regression analyses assessed the independent effects of having a medical home on annual number of child ED visits while controlling for child and parental characteristics, and the differential likelihood of securing a medical home. Nearly half (49.9%) of asthmatic children had a medical home. Receiving primary care in a medical home was associated with fewer ED visits (incidence rate ratio = 0.93; 95% confidence interval = 0.89-0.97). A medical home in which physicians and parents share responsibility for ensuring that children have access to needed services may improve child and family outcomes for children with asthma.
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Affiliation(s)
- Abdoulaye Diedhiou
- South Carolina Public Health Consortium, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Suite 309, Columbia, SC 29208, USA.
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Manfredi C, Kaiser K, Matthews AK, Johnson TP. Are racial differences in patient-physician cancer communication and information explained by background, predisposing, and enabling factors? JOURNAL OF HEALTH COMMUNICATION 2010; 15:272-92. [PMID: 20432108 PMCID: PMC2862581 DOI: 10.1080/10810731003686598] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Research shows that African Americans tend to have poorer and less informative patient-physician communication than Whites. We analyzed survey data from 248 African American and 244 White cancer patients to examine whether this disadvantage could be explained by race variability on several other variables commonly reported to affect communication. These variables were organized into background, enabling, and predisposing factors, based on the Precede-Proceed Model. Multivariate regressions were used to test whether race differences in communication and information variables persisted after successively controlling for background, enabling, and predisposing factors. African American patients had higher interpersonal communication barriers than Whites, but this difference did not persist after controlling for background factors. African Americans also had higher unmet information needs and were less likely to receive the name of a cancer expert. These differences persisted after controlling for all other factors. Future research should focus on the informational disadvantages of African American patients and how such disadvantages may affect cancer treatment decisions.
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Affiliation(s)
- Clara Manfredi
- Program for Cancer Control and Population Science, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA.
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Houle CR, Caldwell CH, Conrad FG, Joiner TA, Parker EA, Clark NM. Blowing the whistle: what do African American adolescents with asthma and their caregivers understand by "wheeze?". J Asthma 2010; 47:26-32. [PMID: 20100017 DOI: 10.3109/02770900903395218] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS To investigate what African American adolescents with asthma and their caregivers understand by "wheeze". METHODS Caregivers (n = 35) and adolescents (n = 35) were each asked to describe what they understood by "wheeze". Respondents were also shown a video clip of an adolescent wheezing and asked: a) to describe the breathing of the adolescent in the video; and, b) whether the adolescent respondent's breathing had ever been similar to the video-presented symptoms. RESULTS Most caregivers described wheeze in terms of sound alone (61.8%) while the majority of adolescents described wheeze as something that is felt (55.8%). Few caregivers and adolescents (5.8% each) included "whistling" in their descriptions of "wheeze". Most caregivers and adolescents used the word "wheeze" when describing the video clip, but nearly one-quarter of the caregivers and one-third of the adolescents felt that the adolescent's breathing was never similar to the video. CONCLUSION Caregiver and adolescents descriptions of wheeze are different from each other and both may be different from clinical definitions of the term. Study findings have implications for the ways in which questions about "wheeze" are framed and interpreted.
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Affiliation(s)
- Christy R Houle
- Center for Managing Chronic Disease, The University of Michigan, Ann Arbor, Michigan, USA.
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The effect of patient race and blood pressure control on patient-physician communication. J Gen Intern Med 2009; 24:1057-64. [PMID: 19575270 PMCID: PMC2726885 DOI: 10.1007/s11606-009-1051-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 05/21/2009] [Accepted: 06/04/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Racial disparities in hypertension control contribute to higher rates of cardiovascular mortality among blacks. Patient-physician communication quality is associated with better health outcomes, including blood pressure (BP) control. Both race/ethnicity and BP control may adversely affect communication. OBJECTIVE To determine whether being black and having poor BP control interact to adversely affect patient-physician communication more than either condition alone, a situation referred to as "double jeopardy." DESIGN, SETTINGS, AND PATIENTS Cross-sectional study of enrollment data from a randomized controlled trial of interventions to enhance patient adherence to therapy for hypertension. Participants included 226 hypertensive patients and 39 physicians from 15 primary care practices in Baltimore, MD. MEASUREMENTS Communication behaviors and visit length from coding of audiotapes. RESULTS After controlling for patient and physician characteristics, blacks with uncontrolled BP have shorter visits (B = -3.9 min, p < 0.01) with less biomedical (B = -24.0, p = 0.05), psychosocial (B = -19.4, p < 0.01), and rapport-building (B = -19.5, p = 0.01) statements than whites with controlled BP. Of all communication outcomes, blacks with uncontrolled BP are only in "double jeopardy" for a patient positive affect-coders give them lower ratings than all other patients. Blacks with controlled BP also experience shorter visits and less communication with physicians than whites with controlled BP. There are no significant communication differences between the visits of whites with uncontrolled versus controlled BP. CONCLUSIONS This study reveals that patient race is associated with the quality of patient-physician communication to a greater extent than BP control. Interventions that improve patient-physician communication should be tested as a strategy to reduce racial disparities in hypertension care and outcomes.
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Frampton GK, Shepherd J, Dorne JLCM. Demographic data in asthma clinical trials: a systematic review with implications for generalizing trial findings and tackling health disparities. Soc Sci Med 2009; 69:1147-54. [PMID: 19592148 DOI: 10.1016/j.socscimed.2009.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Indexed: 01/18/2023]
Abstract
The prevalence of asthma, and the morbidity, adverse events, mortality and healthcare utilisation of asthmatic patients vary widely among racial/ethnic and other socio-demographic groups. Debates over the meanings of race and ethnicity and the strategic need to resolve health inequalities have prompted extensive recommendations for reporting and analyzing racial/ethnic and demographic information in clinical trials. We conducted a systematic review to determine the extent to which race/ethnicity, socio-economic status and other demographic variables are analyzed and reported in publications from randomized controlled trials of asthma interventions. Randomized controlled trials of inhaled corticosteroids and long-acting beta-agonists in asthmatic patients were identified by systematically searching 12 electronic bibliographic databases. We identified peer-reviewed papers reporting 87 relevant trials published during 1985-2006, from which we extracted data on patients' race/ethnicity, ancestry, gender, socio-economic variables and geographical attributes. The proportion of the papers reporting the race/ethnicity of their participants was lower than would be expected by chance and has recently declined. None of the papers included race/ethnicity or gender in statistical analyses or reported socio-economic variables, ancestry, or genetic data for their participants, and few discussed the generalizability of their findings. The frequency of reporting race/ethnicity was statistically significantly lower in trials conducted in the UK than in the US, but 23 of the 87 papers did not identify countries. Despite extensive recommendations in the literature, guidance from health agencies on analyzing and reporting demographic data in clinical trials still appears inconsistent and vague. There remains a need to improve guidance on the representation and analysis of minority populations in asthma clinical trials, in order to encourage transparent reporting of population selection, analysis approaches, and trial generalizability. To assist this process, asthma clinical trials should be based on clear hypotheses that link both to existing demographic evidence and to demographic healthcare goals.
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Affiliation(s)
- Geoff K Frampton
- School of Medicine, University of Southampton, Southampton, Hampshire SO16 7NS, UK.
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Bryant-Stephens T. Asthma disparities in urban environments. J Allergy Clin Immunol 2009; 123:1199-206; quiz 1207-8. [PMID: 19501229 DOI: 10.1016/j.jaci.2009.04.030] [Citation(s) in RCA: 143] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 03/26/2009] [Accepted: 04/14/2009] [Indexed: 11/26/2022]
Abstract
Asthma continues to disproportionately affect minority and low-income groups, with African American and Latino children who live in low-socioeconomic-status urban environments experiencing higher asthma morbidity and mortality than white children. This uneven burden in asthma morbidity has been ever increasing despite medical advancement. Many factors have contributed to these disparities in the areas of health care inequities, which result in inadequate treatment; poor housing, which leads to increased exposure to asthma allergens; and social and psychosocial stressors, which are often unappreciated. Interventions to reduce individual areas of disparities have had varying successes. Because asthma is a complex disease that affects millions of persons, multifaceted comprehensive interventions that combine all evidence-based successful strategies are essential to finally closing the gap in asthma morbidity.
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Affiliation(s)
- Tyra Bryant-Stephens
- Department of General Pediatrics, Community Asthma Prevention Program, the Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
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Canino G, McQuaid EL, Rand CS. Addressing asthma health disparities: a multilevel challenge. J Allergy Clin Immunol 2009; 123:1209-17; quiz 1218-9. [PMID: 19447484 DOI: 10.1016/j.jaci.2009.02.043] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 02/05/2009] [Accepted: 02/06/2009] [Indexed: 12/17/2022]
Abstract
Substantial research has documented pervasive disparities in the prevalence, severity, and morbidity of asthma among minority populations compared with non-Latino white subjects. The underlying causes of these disparities are not well understood, and as a result, the leverage points to address them remain unclear. A multilevel framework for integrating research in asthma health disparities is proposed to advance both future research and clinical practice. The components of the proposed model include health care policies and regulations, operation of the health care system, provider/clinician-level factors, social/environmental factors, and individual/family attitudes and behaviors. The body of research suggests that asthma disparities have multiple, complex, and interrelated sources. Disparities occur when individual, environmental, health system, and provider factors interact with one another over time. Given that the causes of asthma disparities are complex and multilevel, clinical strategies to address these disparities must therefore be comparably multilevel and target many aspects of asthma care. Several strategies that could be applied in clinical settings to reduce asthma disparities are described, including the need for routine assessment of the patient's beliefs, financial barriers to disease management, and health literacy and the provision of cultural competence training and communication skills to health care provider groups.
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Affiliation(s)
- Glorisa Canino
- Behavioral Sciences Research Institute and the Department of Pediatrics, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.
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Abstract
PURPOSE OF REVIEW In spite of numerous efforts, asthma rates in the United States remain historically high and disparities persist among low-income and minority populations. This review assesses the current status of asthma inequities from the perspective of disease development, progression, and outcomes. RECENT FINDINGS Recent findings highlight the complex and multifactorial nature of asthma. There is a clear line of emerging evidence suggestive of important hierarchical relationships between the predisposed or affected individual and his or her intrapersonal life, familial relationships, social networks, and broader community. SUMMARY Approaches in basic, clinical, and translational asthma research must be modified to account for the social construct of race and to detangle complex interactions of contributing factors at and across the individual and community level. However, there are a number of obvious opportunities to dramatically reduce asthma disparities at hand.
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Patino CM, Okelo SO, Rand CS, Riekert KA, Krishnan JA, Thompson K, Quartey RI, Perez-Williams D, Bilderback A, Merriman B, Paulin L, Hansel N, Diette GB. The Asthma Control and Communication Instrument: a clinical tool developed for ethnically diverse populations. J Allergy Clin Immunol 2008; 122:936-943.e6. [PMID: 18848721 PMCID: PMC5516631 DOI: 10.1016/j.jaci.2008.08.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Revised: 08/22/2008] [Accepted: 08/25/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lower levels of quality asthma care among racially diverse populations might be due to inaccurate disease status assessments. The Asthma Control and Communication Instrument (ACCI) is a new tool that captures patient report of disease status during routine care. OBJECTIVE We sought to test the ACCI's psychometric properties in a racially diverse population. METHODS We performed a cross-sectional study. Subjects were recruited from specialist and generalist urban outpatient clinics. The ACCI and measures of asthma control, quality of life, lung function, and specialist rating of asthma status were collected. Four ACCI domains were separately validated: Acute Care, Bother, Control, and Direction. Principal component analysis, internal consistency, concurrent, discriminative, known-groups validity, and accuracy were evaluated. RESULTS Two hundred seventy asthmatic patients (77% female subjects, 55% black) participated. ACCI Control domain internal consistency was 0.80. ACCI Bother, Control, and Direction domains showed strong concurrent validity with asthma control and quality-of-life measures (all P < .001). ACCI Acute Care and Direction domains showed strong concurrent validity with individual validation items (all P < .001). The ACCI Control domain discriminated clinically important levels of disease status measured by asthma control, quality of life (both P < .001), and percent predicted peak expiratory flow rate (P = .005) and was associated with specialist rating of disease status (P < .001), confirming known-groups validity. The accuracy of the ACCI Control domain in classifying patients with uncontrolled asthma was very good (area under the curve, 0.851; 95% CI, 0.742-0.95870). Results were similar for both black and white subjects. CONCLUSION The ACCI is a promising clinical tool that measures asthma disease status during routine health care and is valid for use in both black and white populations.
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Affiliation(s)
- Cecilia M. Patino
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore
| | - Sande O. Okelo
- School of Medicine, University of Massachusetts, Worcester
| | - Cynthia S. Rand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore
| | - Kristin A. Riekert
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore
| | - Jerry A. Krishnan
- Section of Pulmonary and Critical Care Medicine, University of Chicago
| | - Kathy Thompson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore
| | | | | | - Andrew Bilderback
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore
| | - Barry Merriman
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore
| | - Laura Paulin
- Department of Pediatrics, Johns Hopkins University, Baltimore
| | - Nadia Hansel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore
| | - Gregory B. Diette
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore
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Rand CS, Apter AJ. Mind the widening gap: have improvements in asthma care increased asthma disparities? J Allergy Clin Immunol 2008; 122:319-21. [PMID: 18678342 PMCID: PMC4446570 DOI: 10.1016/j.jaci.2008.07.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 07/03/2008] [Accepted: 07/03/2008] [Indexed: 11/30/2022]
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Turner JL, Farquhar L. One medical school's effort to ready the workforce for the future: preparing medical students to care for populations who are publicly insured. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2008; 83:632-638. [PMID: 18580078 DOI: 10.1097/acm.0b013e31817836af] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This article describes the development, implementation, and evaluation of a curriculum project designed to prepare medical students to care for populations who have Medicaid or a low socioeconomic status (SES). The setting for the project was a community-based medical school, the College of Human Medicine (CHM) at Michigan State University. This article describes a four-year process of curriculum development and offers examples of specific changes that CHM made to courses and clerkships. CHM modified 25% of preclinical courses, five core clerkships of year three, and two clerkships (Senior Surgery and Senior Internal Medicine) of year four. The authors describe highlights of outcomes in student performance, course and clerkship ratings, attitudes, professional goals, student self-assessment of their skills, and feedback from residency program directors. The authors identified four items on the Association of American Medical Colleges (AAMC) Graduation Questionnaire as related to the project and tracked them as an outcome measure of student attitudes related to the social responsibility of physicians. Attitudes of the students who experienced the modified curriculum showed greater agreement with AAMC Graduation Questionnaire items than the previous class at CHM and than their classmates across the country. The majority of residency program directors rated CHM graduates as more skilled than their peers in applying cultural competence, working with patients who have Medicaid or a low SES, and using community resources. The authors discuss factors that contributed to the successful implementation of curricular changes as well as challenges to their implementation.
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Affiliation(s)
- Jane L Turner
- Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University, East Lansing, Michigan 48824, USA.
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Clancy CM, Kiley JP, Weiss KB. Eliminating asthma disparities through multistakeholder partnerships. Chest 2008; 132:1422-4. [PMID: 17998357 DOI: 10.1378/chest.07-1947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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