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Rahman F, Bhat V, Ozair A, Detchou DKE, Ahluwalia MS. Financial barriers and inequity in medical education in India: challenges to training a diverse and representative healthcare workforce. MEDICAL EDUCATION ONLINE 2024; 29:2302232. [PMID: 38194431 PMCID: PMC10778416 DOI: 10.1080/10872981.2024.2302232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Abstract
India has been historically challenged by an insufficient and heterogeneously clustered distribution of healthcare infrastructure. While resource-limited healthcare settings, such as major parts of India, require multidisciplinary approaches for improvement, one key approach is the recruitment and training of a healthcare workforce representative of its population. This requires overcoming barriers to equity and representation in Indian medical education that are multi-faceted, historical, and rooted in inequality. However, literature is lacking regarding the financial or economic barriers, and their implications on equity and representation in the Indian allopathic physician workforce, which this review sought to describe. Keyword-based searches were carried out in PubMed, Google Scholar, and Scopus in order to identify relevant literature published till November 2023. This state-of-the-art narrative review describes the existing multi-pronged economic barriers, recent and forthcoming changes deepening these barriers, and how these may limit opportunities for having a diverse workforce. Three sets of major economic barriers exist to becoming a specialized medical practitioner in India - resources required to get selected into an Indian medical school, resources required to pursue medical school, and resources required to get a residency position. The resources in this endeavor have historically included substantial efforts, finances, and privilege, but rising barriers in the medical education system have worsened the state of inequity. Preparation costs for medical school and residency entrance tests have risen steadily, which may be further exacerbated by recent major policy changes regarding licensing and residency selection. Additionally, considerable increases in direct and indirect costs of medical education have recently occurred. Urgent action in these areas may help the Indian population get access to a diverse and representative healthcare workforce and also help alleviate the shortage of primary care physicians in the country. Discussed are the reasons for rural healthcare disparities in India and potential solutions related to medical education.
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Affiliation(s)
- Faique Rahman
- Faculty of Medicine, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University (AMU), Aligarh, UP, India
| | - Vivek Bhat
- St. John’s Medical College, Bangalore, KA, India
| | - Ahmad Ozair
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Faculty of Medicine, King George’s Medical University, Lucknow, UP, India
| | - Donald K. E. Detchou
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Manmeet S. Ahluwalia
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
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Ritsema TS, Herring JR, Straker HO, Salsberg E. Assessing the Racial and Ethnic Diversity of Physician Assistant/Associate Program Graduates from 2010 to 2012 and 2019 to 2021. J Physician Assist Educ 2024; 35:252-261. [PMID: 38838288 DOI: 10.1097/jpa.0000000000000602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
INTRODUCTION To assess the racial/ethnic diversity of graduates of US Physician Assistant/Associate (PA) programs compared with the diversity of the populations from which they draw students and to assess diversity changes over time among PA graduates. METHODS We calculated proportion of Black or Hispanic PA graduates nationally and by school between 2010 to 2012 and 2019 to 2021 using the Integrated Postsecondary Education Data System (IPEDS) and compared it with the diversity of the 20 to 35-year-old population using the American Community Survey. We created benchmark populations for each school based on whether the school was public or private, with in-state/out-of-state proportions provided by the Physician Assistant Education Association. A diversity index (DI) was calculated for each program. A DI of 0.5 means that the representation of Black/Hispanic graduates is half their representation in the benchmark population. RESULTS Although the numbers of Black/Hispanic graduates increased from 2010 to 2012 to 2019 to 2021, the percentage of Black graduates decreased. Nationally, the DI for Black graduates decreased from 0.28 to 0.23 and the Hispanic DI increased from 0.28 to 0.37 between 2010 to 2012 and 2019 to 2021. Among 213 PA programs included in the 2019 to 2021 dataset, 5 schools had a DI >1.0 for Black graduates and 7 schools had a DI >1.0 for Hispanic graduates. DISCUSSION Using the IPEDS data, we found that Black and Hispanic graduates are underrepresented among PA program graduates. The PA education community needs to develop new strategies for diversifying the profession consistent with the new US Supreme Court decision banning race-conscious admissions.
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Affiliation(s)
- Tamara S Ritsema
- Tamara S. Ritsema, PhD, MPH, PA-C/R, is an associate professor, Department of Physician Assistant Studies, School of Medicine and Health Sciences at George Washington University, Washington, District of Columbia; She is also an adjunct reader, Physician Assistant Programme at St. George's University of London, London, United Kingdom
- Jordan R. Herring, MS, is a program associate, Fitzhugh Mullan Institute for Health Workforce Equity, and also a PhD student, Trachtenberg School of Public Policy and Public Administration at George Washington University, Washington, District of Columbia
- Howard O. Straker, EdD, MPH, PA-C, is an associate professor, director, Joint Degree PA/MPH Program, Department of Physician Assistant Studies, School of Medicine and Health Sciences; Department of Prevention and Community Health, Milken Institute School of Public Health at George Washington University, Washington, District of Columbia
- Edward Salsberg, MPA, FAAN, is a lead research scientist, Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health at George Washington University, Washington, District of Columbia
| | - Jordan R Herring
- Tamara S. Ritsema, PhD, MPH, PA-C/R, is an associate professor, Department of Physician Assistant Studies, School of Medicine and Health Sciences at George Washington University, Washington, District of Columbia; She is also an adjunct reader, Physician Assistant Programme at St. George's University of London, London, United Kingdom
- Jordan R. Herring, MS, is a program associate, Fitzhugh Mullan Institute for Health Workforce Equity, and also a PhD student, Trachtenberg School of Public Policy and Public Administration at George Washington University, Washington, District of Columbia
- Howard O. Straker, EdD, MPH, PA-C, is an associate professor, director, Joint Degree PA/MPH Program, Department of Physician Assistant Studies, School of Medicine and Health Sciences; Department of Prevention and Community Health, Milken Institute School of Public Health at George Washington University, Washington, District of Columbia
- Edward Salsberg, MPA, FAAN, is a lead research scientist, Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health at George Washington University, Washington, District of Columbia
| | - Howard O Straker
- Tamara S. Ritsema, PhD, MPH, PA-C/R, is an associate professor, Department of Physician Assistant Studies, School of Medicine and Health Sciences at George Washington University, Washington, District of Columbia; She is also an adjunct reader, Physician Assistant Programme at St. George's University of London, London, United Kingdom
- Jordan R. Herring, MS, is a program associate, Fitzhugh Mullan Institute for Health Workforce Equity, and also a PhD student, Trachtenberg School of Public Policy and Public Administration at George Washington University, Washington, District of Columbia
- Howard O. Straker, EdD, MPH, PA-C, is an associate professor, director, Joint Degree PA/MPH Program, Department of Physician Assistant Studies, School of Medicine and Health Sciences; Department of Prevention and Community Health, Milken Institute School of Public Health at George Washington University, Washington, District of Columbia
- Edward Salsberg, MPA, FAAN, is a lead research scientist, Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health at George Washington University, Washington, District of Columbia
| | - Edward Salsberg
- Tamara S. Ritsema, PhD, MPH, PA-C/R, is an associate professor, Department of Physician Assistant Studies, School of Medicine and Health Sciences at George Washington University, Washington, District of Columbia; She is also an adjunct reader, Physician Assistant Programme at St. George's University of London, London, United Kingdom
- Jordan R. Herring, MS, is a program associate, Fitzhugh Mullan Institute for Health Workforce Equity, and also a PhD student, Trachtenberg School of Public Policy and Public Administration at George Washington University, Washington, District of Columbia
- Howard O. Straker, EdD, MPH, PA-C, is an associate professor, director, Joint Degree PA/MPH Program, Department of Physician Assistant Studies, School of Medicine and Health Sciences; Department of Prevention and Community Health, Milken Institute School of Public Health at George Washington University, Washington, District of Columbia
- Edward Salsberg, MPA, FAAN, is a lead research scientist, Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health at George Washington University, Washington, District of Columbia
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Gregorio VR, Mantri S. Portals to the past and bridges to the future: exploring the impact of doulas on the birthing experiences of black and Latinx women. MEDICAL HUMANITIES 2024; 50:306-311. [PMID: 38604656 DOI: 10.1136/medhum-2023-012840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION In the USA, maternal morbidity and mortality is markedly higher for women of colour than for white women. The presence of a doula has been associated with positive birthing outcomes for white individuals, but the experiences of women of colour remain underexplored. The purpose of this qualitative paper is to understand the attitudes of black and Latinx communities towards doula-supported birthing practices. METHODS The perspectives of people of colour, both birthing women and doulas, were investigated through popular media sources, including blogs, magazine articles, podcasts and video interviews. Of 108 popular media sources identified in the initial search, 27 included direct accounts from birthing women or doulas and were therefore included in this paper. Thematic analysis was conducted by the grounded theory method. RESULTS Emerging themes reveal that doula presence allows for the experience of ancestral power, connection to the granny midwives, cultural translation in medical settings and physical protection of the birthing woman. When labouring with the support of a doula, women report the emotional and physical presence of their ancestors. Similarly, doulas recognise an ancestral presence within the birthing woman, and doulas experience their occupation as carrying on ancestral tradition and feel a strong vocational tie to the granny midwives of the American South. Lastly, doulas mediate communication between birthing women, their families and medical providers by emphasising the need for consent and patient autonomy. CONCLUSION By connecting women of colour to historic and ancient spaces as well as providing comfort and familiarity in the birthing space, doulas grant their clients the self-advocacy and empowerment needed to survive the present. Doulas serve as protectors of women of colour and have become an important piece to bridging society from the current maternal health crisis to a more equitable future.
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Affiliation(s)
- Victoria Rose Gregorio
- Trent Center for Bioethics, Humanities, and History of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sneha Mantri
- Trent Center for Bioethics, Humanities, and History of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Neurology, Duke University School of Medicine, Durham, North Carolina, USA
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Silvestre J, Ahn J, Dehghan N, Gitajn IL, Slobogean GP, Harris MB. Analysis of the diversity pipeline for the orthopedic trauma surgeon workforce in the United States. Injury 2024; 55:111695. [PMID: 38959676 DOI: 10.1016/j.injury.2024.111695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/23/2024] [Accepted: 06/19/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION There is a lack of research on the state of racial, ethnic, and gender diversity in the emerging orthopedic trauma workforce. The purpose of this study was to analyze the training pathway for diverse candidates in orthopedic trauma as it relates to race, ethnicity, and sex. METHODS Self-reported demographic data were compared among allopathic medical students, orthopedic surgery residents, orthopedic trauma fellows, and the general population in the United States (2013-2022). Race categories consisted of White, Asian, Black, and Native American/Alaskan Native (NA/AN), and Native Hawaiian/Pacific Islander (NH/PI). Ethnicity categories were Hispanic/Latino or non-Hispanic/Latino. Sex categories were male and female. Representation was calculated at each stage of accredited training. Participation-to-prevalence ratios (PPRs) quantified the equitable representation of demographic groups in the emerging orthopedic trauma workforce relative to the US population. PPR thresholds were used to classify representation as overrepresented (PPR > 1.2), equitable (PPR = 0.8-1.2), and underrepresented (PPR < 0.8). RESULTS Relative to medical school and orthopedic surgery residency, fewer female (48.5 % vs 16.7 % vs 18.7 %, P < 0.001), Hispanic (6.1 % vs 4.5 % vs 2.6 %, P < 0.001), Black (6.9 % vs 5.0 % vs 3.1 %, P < 0.001), and Asian (24.0 % vs 14.3 % vs 12.2 %, P < 0.001) trainees existed in orthopedic trauma fellowship training. In contrast, more male (51.5 % vs 83.3 % vs 81.3 %, P < 0.001) and White (62.8 % vs 79.1 % vs 84.0 %, P < 0.001) trainees existed in orthopedic trauma fellowship relative to earlier training stages. There were zero NA/AN or NH/PI trainees in orthopedic trauma (PPR = 0). Relative to the US population, Hispanic (PPR = 0.14), Black (PPR = 0.25), and female (PPR = 0.37) trainees were underrepresented in orthopedic trauma. In contrast, Asian (PPR = 2.04), male (PPR = 1.64), and White (PPR = 1.36) trainees were overrepresented in orthopedic trauma. CONCLUSION Women, racial, and ethnic minorities are underrepresented in the emerging orthopedic trauma workforce relative to the US population, and earlier stages of training. Targeted recruitment and guided mentorship of these groups may lead to greater interest, engagement, and diversity in orthopedic trauma.
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Affiliation(s)
- Jason Silvestre
- Medical University of South Carolina, Charleston, SC, United States.
| | - Jaimo Ahn
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Niloofar Dehghan
- University of Arizona College of Medicine Phoenix, Phoenix, AZ, United States
| | - Ida L Gitajn
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
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Atunah-Jay SJ, Phelan S, Anderson AT, Behl S, McTate EA, Gorfine MC, Sood G, Taylor KK, Brockman J, Salinas M, Biggs BK, Wieland ML, Asiedu GB. Promoting Safe and Supportive Health Care Spaces for Youth Experiencing Racism. Acad Pediatr 2024; 24:963-972. [PMID: 38244857 DOI: 10.1016/j.acap.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 11/23/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE This qualitative study applies a community-based participatory research approach to elicit formative data on pediatric patient experiences of racism in the health care setting and to explore clinic-based opportunities for supporting pediatric patients experiencing racism. METHODS The study is situated within the outpatient practice of a large tertiary academic medical center in a midsize Midwestern city. Community partners were involved in all aspects of the research, including research protocol design, recruitment, data analysis, community dissemination, and manuscript preparation. Participants were youth between 11 and 18 years, in middle or high school, self-identifying as a person of color, Latinx or Indigenous who answered yes to the question "have you ever experienced race-related prejudice and discrimination?" Parent/guardians of youth meeting inclusion criteria participated in separate focus groups. Data were analyzed using an interpretative phenomenological analysis approach. RESULTS Major findings were divided into 2 categories: 1) racism-related experiences in the health care setting; and 2) patient and parent/guardian recommendations to support pediatric patients experiencing racism. Among health care setting experiences, primary emerging themes included racism experienced in the health care setting, patient-clinician communication around racism, patient-clinician concordance, and high-quality clinical care. Recommendations were presented within the 4 domains of racism: intrapersonal, interpersonal, structural, and institutional. CONCLUSIONS Racism experiences worsen child biological, psychological, and behavioral functioning, yet research is lacking on how health care professionals may best support pediatric patients experiencing racism. Study findings suggest opportunities for providing safer and more supportive health care spaces for youth experiencing racism.
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Affiliation(s)
- Sarah J Atunah-Jay
- Mayo Clinic Alix School of Medicine (SJ Atunah-Jay), Mayo Clinic College of Medicine and Science, Rochester, Minn.
| | - Sean Phelan
- Division of Health Care Delivery Research (S Phelan and GB Asiedu), Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minn
| | - Ashaunta T Anderson
- Department of Pediatrics (AT Anderson), Keck School of Medicine of the University of Southern California, Children's Hospital Los Angeles
| | - Supriya Behl
- Department of Pediatric and Adolescent Medicine (S Behl), Mayo Clinic, Rochester, Minn
| | - Emily A McTate
- Department of Pediatric and Adolescent Medicine (EA McTate), Mayo Clinic College of Medicine and Science, Rochester, Minn; Department of Psychology (EA McTate and BK Biggs), Mayo Clinic College of Medicine and Science, Rochester, Minn
| | - Mary Conboy Gorfine
- Rochester-Olmsted Youth Commission and Rochester Community Engaged Research Advisory Board (Mayo Clinic) (MC Gorfine), Minn
| | - Gauri Sood
- Rochester-Olmsted Youth Commission (G Sood and KK Taylor), Minn
| | - Kashanti K Taylor
- Rochester-Olmsted Youth Commission (G Sood and KK Taylor), Minn; Howard University (KK Taylor), Washington, DC
| | - Jack Brockman
- Pediatric Advisory Board (J Brockman), Mayo Clinic, Rochester, Minn
| | - Manisha Salinas
- Center for Health Equity and Community Engagement Research (M Salinas), Mayo Clinic College of Medicine and Science, Jacksonville, Fla
| | - Bridget K Biggs
- Department of Psychology (EA McTate and BK Biggs), Mayo Clinic College of Medicine and Science, Rochester, Minn
| | - Mark L Wieland
- Division of Community Internal Medicine (ML Wieland), Mayo Clinic College of Medicine and Science, Rochester, Minn
| | - Gladys B Asiedu
- Division of Health Care Delivery Research (S Phelan and GB Asiedu), Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minn
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Shaw NM, Hills N, Holler J, Fernandez A, Davis D, Palmer NR, Sliwka D, Breyer BN. The Impact of Patient-Physician Racial and Gender Concordance on Patient Satisfaction with Outpatient Clinic Visits. J Racial Ethn Health Disparities 2024; 11:2083-2092. [PMID: 37341950 DOI: 10.1007/s40615-023-01676-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/10/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Patient and provider race and gender concordance (patient and physician identify as the same race/ethnicity or gender) may impact patient experience and satisfaction. OBJECTIVE We sought to examine how patient and physician racial and gender concordance effect patient satisfaction with outpatient clinical encounters. Furthermore, we examined factors that changed satisfaction among concordant and discordant dyads. DESIGN Consumer Assessment of Healthcare Provider and Systems (CAHPS) Patient Satisfaction Survey Scores were collected from outpatient clinical encounters between January 2017 and January 2019 at the University of California, San Francisco. PARTICIPANTS Patients who were seen in the eligible time period, who voluntarily provided physician satisfaction scores. Providers with fewer than 30 reviews and encounters with missing data were excluded. MAIN MEASURES Primary outcome was rate of top satisfaction score. The provider score (1-10 scale) was dichotomized as "top score (9-10)" and "low scores (<9)." KEY RESULTS A total of 77,543 evaluations met inclusion criteria. Most patients identified as White (73.5%) and female (55.4%) with a median age of 60 (IQR 45, 70). Compared to White patients, Asian patients were less likely to give a top score even when controlling for racial concordance (OR: 0.67; CI 0.63-0.714). Telehealth was associated with increased odds of a top score relative to in-person visits (OR 1.25; CI 1.07-1.48). The odds of a top score decreased by 11% in racially discordant dyads. CONCLUSIONS Racial concordance, particularly among older, White, male patients, is a nonmodifiable predictor of patient satisfaction. Physicians of color are at a disadvantage, as they receive lower patient satisfaction scores, even in race concordant pairs, with Asian physicians seeing Asian patients receiving the lowest scores. Patient satisfaction data is likely an inappropriate means of determining physician incentives as such may perpetuate racial and gender disadvantages.
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Affiliation(s)
- Nathan M Shaw
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Nancy Hills
- Department of Epidemiology and Biostatistics, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Jordan Holler
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alicia Fernandez
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division on General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Denise Davis
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nynikka R Palmer
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division on General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Diane Sliwka
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA, USA.
- Department of Epidemiology and Biostatistics, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA.
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Melro CM, Pack R, MacLeod A, Rideout A, Watson-Creed G, Burm S. Front row seat: The role MMI assessors play in widening access to medical school. MEDICAL TEACHER 2024; 46:1052-1059. [PMID: 38100759 DOI: 10.1080/0142159x.2023.2289851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND While many medical schools utilize the Multiple Mini-Interview (MMI) to help select a diverse student body, we know little about MMI assessors' roles. Do MMI assessors carry unique insights on widening access (WA) to medical school? Herein we discuss the hidden expertise and insights that assessors contribute to the conversation around WA. METHODS Ten MMI assessors (1-10 years' experience) participated in semi-structured interviews exploring factors influencing equitable medical school recruitment. Given their thoughtfulness during initial interviews, we invited them for follow-up interviews to gain further insight into their perceived role in WA. Fourteen interviews were conducted and analyzed using a thematic analysis approach. RESULTS Assessors expressed concerns with diversity in medicine; dissatisfaction with the status quo fueled their contributions to the selection process. Assessors advocated for greater diversity among the assessor pool, citing benefits for all students, not only those from underrepresented groups. They noted that good intentions were not enough and that medical schools can do more to include underrepresented groups' perspectives in the admissions process. CONCLUSION Our analysis reveals that MMI assessors are committed to WA and make thoughtful contributions to the selection process. A medical school selection process, inclusive of assessors' expertise is an important step in WA.
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Affiliation(s)
- Carolyn M Melro
- Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rachael Pack
- Centre for Education Research & Innovation, Western University, London, Ontario, Canada
| | - Anna MacLeod
- Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrea Rideout
- Admissions, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gaynor Watson-Creed
- Serving and Engaging Society, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sarah Burm
- Continuing Professional Development and Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
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Akuffo-Addo E, Dalson J, Agyei K, Mohsen S, Yusuf S, Juando-Prats C, Simpson JS. Barriers to Black Medical Students and Residents Pursuing and Completing Surgical Residency in Canada: A Qualitative Analysis. J Am Coll Surg 2024; 239:151-160. [PMID: 38470049 DOI: 10.1097/xcs.0000000000001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND The limited available data suggest that the Canadian surgical workforce does not reflect the racial diversity of the patient population it serves, despite the well-established benefits of patient-provider race concordance. There have been no studies to date that characterize the systemic and individual challenges faced by Black medical students in matching to and successfully finishing training in a surgical specialty within a Canadian context that can explain this underrepresentation. STUDY DESIGN Using critical qualitative inquiry and purposive sampling to ensure sex, geographical, and student or trainee year heterogeneity, we recruited self-identifying Black medical students and surgical residents across Canada. Online in-depth semistructured interviews were conducted and transcribed verbatim. Transcripts were analyzed through an inductive reflexive narrative thematic process by 4 analysts. RESULTS Twenty-seven participants including 18 medical students and 9 residents, were interviewed. The results showed 3 major themes that characterized their experiences: journey to and through medicine, perceptions of the surgical culture, and recommendations to improve the student experience. Medical students identified lack of mentorship and representation as well as experiences with racism as the main barriers to pursuing surgical training. Surgical trainees cited systemic racism, lack of representation, and insufficient safe spaces as the key deterrents to program completion. The intersection with sex exponentially increased these identified barriers. CONCLUSIONS Except for a few surgical programs, medical schools across Canada do not offer a safe space for Black students and trainees to access and complete surgical training. An urgent change is needed to provide diverse mentorship that is transparent, acknowledges the real challenges related to systemic racism and biases, and is inclusive of different racial and ethnic backgrounds.
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Affiliation(s)
- Edgar Akuffo-Addo
- From the Temerty Faculty of Medicine (Akuffo-Addo, Dalson, Agyei, Mohsen, Yusuf, Simpson)
| | - Jaycie Dalson
- From the Temerty Faculty of Medicine (Akuffo-Addo, Dalson, Agyei, Mohsen, Yusuf, Simpson)
| | - Kwame Agyei
- From the Temerty Faculty of Medicine (Akuffo-Addo, Dalson, Agyei, Mohsen, Yusuf, Simpson)
| | - Samiha Mohsen
- From the Temerty Faculty of Medicine (Akuffo-Addo, Dalson, Agyei, Mohsen, Yusuf, Simpson)
| | - Safia Yusuf
- From the Temerty Faculty of Medicine (Akuffo-Addo, Dalson, Agyei, Mohsen, Yusuf, Simpson)
| | - Clara Juando-Prats
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada (Juando-Prats)
- Division of General Surgery, St Michael's Hospital, Toronto, ON, Canada (Juando-Prats, Simpson)
| | - Jory S Simpson
- From the Temerty Faculty of Medicine (Akuffo-Addo, Dalson, Agyei, Mohsen, Yusuf, Simpson)
- Division of General Surgery, St Michael's Hospital, Toronto, ON, Canada (Juando-Prats, Simpson)
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Hascher K, Jaiswal J, LoSchiavo C, Ezell J, Duffalo D, Greene RE, Cox A, Burton WM, Griffin M, John T, Grin B, Halkitis PN. Lack of Informed and Affirming Healthcare for Sexual Minority Men: A Call for Patient-Centered Care. J Gen Intern Med 2024; 39:2023-2032. [PMID: 38308157 PMCID: PMC11306825 DOI: 10.1007/s11606-024-08635-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 01/16/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Sexual minority men (SMM) face severe health inequities alongside negative experiences that drive avoidance of medical care. Understanding how SMM experience healthcare is paramount to improving this population's health. Patient-centered care, which emphasizes mutual respect and collaboration between patients and providers, may alleviate the disparaging effects of the homophobia that SMM face in healthcare settings. OBJECTIVE To explore how SMM perceive their experiences with healthcare providers and how care can most effectively meet their needs. DESIGN Semi-structured qualitative interviews focused on healthcare experiences, pre-exposure prophylaxis (PrEP), and HIV-related beliefs were conducted between July and November 2018. PARTICIPANTS The study included a sample of 43 young adult SMM (ages 25-27), representing diverse socioeconomic, racial, and ethnic backgrounds, in New York City. APPROACH Researchers utilized a multiphase, systematic coding method to identify salient themes in the interview transcripts. KEY RESULTS Analyses revealed three main themes: (1) SMM perceived that their clinicians often lack adequate skills and knowledge required to provide care that considers participants' identities and behaviors; (2) SMM desired patient-centered care as a way to regain agency and actively participate in making decisions about their health; and (3) SMM felt that patient-centered care was more common with providers who were LGBTQ-affirming, including many who felt that this was especially true for LGBTQ-identified providers. CONCLUSIONS SMM expressed a clear and strong desire for patient-centered approaches to care, often informed by experiences with healthcare providers who were unable to adequately meet their needs. However, widespread adoption of patient-centered care will require improving education and training for clinicians, with a focus on LGBTQ-specific clinical care and cultural humility. Through centering patients' preferences and experiences in the construction of care, patient-centered care can reduce health inequities among SMM and empower healthcare utilization in a population burdened by historic and ongoing stigmatization.
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Affiliation(s)
- Kevin Hascher
- Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Jessica Jaiswal
- Department of Family and Community Medicine, University of Alabama, Birmingham School of Medicine, Birmingham, AL, 35294, USA.
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, 06510, USA.
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA.
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
| | - Caleb LoSchiavo
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, 08854, USA
| | - Jerel Ezell
- Department of Community Health Sciences, UC Berkeley, Berkeley, CA, 94720, USA
- Center for Cultural Humility, UC Berkeley, Berkeley, CA, 94720, USA
| | - Danika Duffalo
- School of Medicine, Creighton University, Phoenix, AZ, USA
| | - Richard E Greene
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, 10001, USA
| | - Amanda Cox
- Culverhouse College of Business, University of Alabama, Tuscaloosa, AL, USA
| | - Wanda M Burton
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, 35401, USA
| | - Marybec Griffin
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, 08854, USA
| | - Tejossy John
- Department of Family and Community Medicine, University of Alabama, Birmingham School of Medicine, Birmingham, AL, 35294, USA
| | - Benjamin Grin
- Department of Primary Care, Kansas City University College of Osteopathic Medicine, Kansas City, MO, 64106, USA
| | - Perry N Halkitis
- Center for Health, Identity, Behavior and Prevention Studies (CHIBPS), Rutgers School of Public Health, Newark, NJ, 07102, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, 08854, USA
- Department of Urban-Global Public Health, Rutgers School of Public Health, Newark, NJ, 07102, USA
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10
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Bondok MS, Bondok M, Martel L, Kherani IZ, Pur DR, Bakshi N, Law C. Evaluation of commitment to equity, diversity, and inclusion on Canadian ophthalmology residency program websites. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e350-e356. [PMID: 37369355 DOI: 10.1016/j.jcjo.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE Program websites play a crucial role in providing information to prospective residency applicants. This research assesses the extent to which Canadian ophthalmology residency programs demonstrate their commitment to equity, diversity, and inclusion (EDI) through their websites and identifies areas for potential improvement. METHODS A cross-sectional analysis of websites affiliated with 15 accredited Canadian ophthalmology residency training programs was performed. A score was assigned based on 16 EDI elements derived from recent literature. The relationship between program website EDI elements with language, geography, and regional population diversity was explored. RESULTS Of the 15 Canadian ophthalmology residency programs, 12 (80%) met at least 1 of 16 EDI elements, with a mean program score of 2.4 (SD = 1.92). The program that attained the highest score met 7 of 16 EDI elements. Anglophone programs had a higher mean score (2.92; SD = 1.78) when compared with their Francophone counterparts (0.33; SD = 0.58; p = 0.023). No significant difference was found between programs in western, central, and eastern Canada (p = 0.86). The regional minorities proportion associated with each program was not found to influence scores (p = 0.088). CONCLUSIONS EDI elements were seldom addressed on Canadian ophthalmology residency program affiliated websites. We propose recommendations in 4 domains: showcasing team diversity, clear discourse in recruitment, inclusive resources, and program organization. Improving EDI visibility on program websites through revisions of existing websites or through creation of new promotional websites may foster recruitment of a diverse resident body.
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Affiliation(s)
| | - Mostafa Bondok
- UBC Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - Liana Martel
- Faculty of Medicine, University of Ottawa, Ottawa, ON
| | - Imaan Z Kherani
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON
| | - Daiana R Pur
- Schulich School of Medicine and Dentistry, Western University, London, ON
| | - Nupura Bakshi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Christine Law
- Department of Ophthalmology, School of Medicine, Queen's University, Kingston, ON.
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11
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Santen SA, Gonzalez-Flores A, Coe CL, Partin M, Brenner JM, Nalin PM, Macerollo AA, Cangiarella J, Saavedra A, Leong SL. Return on Investment of Three-Year Accelerated Programs for Students, Medical Schools, Departments, and Community. MEDICAL SCIENCE EDUCATOR 2024; 34:919-925. [PMID: 39099855 PMCID: PMC11297223 DOI: 10.1007/s40670-024-02043-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 08/06/2024]
Abstract
Building on the initial accelerated pathway programs in the 1970s to increase workforce, nearly 30 schools have launched accelerated 3-year pathways (A3YP) during the past decade. The authors based on their educational roles, experiences, and scholarship with A3YP provide this perspective of the argument for A3YP and potential disadvantages for each group-students, schools, residencies, departments, and community. When schools consider innovations, they might consider A3YPs for multiple reasons; this perspective helps provide justification for the program and broadly considers return on investment (ROI). The ROI for students includes decreased debt, reduced costs and stress associated with the fourth-year residency applications, and a directed pathway with facilitated transition into a residency program with accompanying professional identity development. Disadvantages for students include early specialty commitment, risk of deceleration, and condensed curriculum. The ROI for schools includes recruiting and retaining students, who will then transition more easily into residency and stimulating innovation. Residency programs gain residents with known skills, who have been a part of the department for 3 years. In addition, fewer residency slots for interviewing leads to saving recruitment administrative costs and time. Finally, many programs are intended to increase the workforce, since students who come to the region for medical school and transition directly into residency are likely to stay in the region. Disadvantages include increased curricular complexity for the medical school, increased administrative support, and advising resources. Finally, several of the accelerated programs attract matriculants from diverse backgrounds contributing to the diversity of the medical school, residency program, and community workforce.
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Affiliation(s)
- Sally A. Santen
- Department of Emergency Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0769, Cincinnati, OH 45267-0769 USA
- Virginia Commonwealth University School of Medicine, Richmond, VA USA
| | - Alicia Gonzalez-Flores
- Department of Internal Medicine, University of California Davis School of Medicine, Davis, CA USA
| | - Catherine L. Coe
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC USA
| | - Michael Partin
- Department of Family and Community Medicine, Pennsylvania State University College of Medicine, Hershey, PA USA
| | - Judith M. Brenner
- New York University Grossman Long Island School of Medicine, Mineola, NY USA
| | - Peter M. Nalin
- University of Minnesota School of Medicine, Minneapolis, MN USA
| | - Allison A. Macerollo
- Department of Family and Community Medicine, The Ohio State University College of Medicine, Columbus, OH USA
| | - Joan Cangiarella
- Department of Pathology, NYU Grossman School of Medicine, New York, NY USA
| | | | - Shou Ling Leong
- Department of Family and Community Medicine, Pennsylvania State University College of Medicine, Hershey, PA USA
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12
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Sehgal NKR, Rader B, Brownstein JS. Examining the Role of Physician Characteristics in Web-Based Verified Primary Care Physician Reviews: Observational Study. J Med Internet Res 2024; 26:e51672. [PMID: 39074363 PMCID: PMC11319894 DOI: 10.2196/51672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/17/2023] [Accepted: 06/12/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Doctor review websites have become increasingly popular as a source of information for patients looking to select a primary care provider. Zocdoc is one such platform that allows patients to not only rate and review their experiences with doctors but also directly schedule appointments. This study examines how several physician characteristics including gender, age, race, languages spoken in a physician's office, education, and facial attractiveness impact the average numerical rating of primary care doctors on Zocdoc. OBJECTIVE The aim of this study was to investigate the association between physician characteristics and patient satisfaction ratings on Zocdoc. METHODS A data set of 1455 primary care doctor profiles across 30 cities was scraped from Zocdoc. The profiles contained information on the physician's gender, education, and languages spoken in their office. Age, facial attractiveness, and race were imputed from profile pictures using commercial facial analysis software. Each doctor profile listed an average overall satisfaction rating, bedside manner rating, and wait time rating from verified patients. Descriptive statistics, the Wilcoxon rank sum test, and multivariate logistic regression were used to analyze the data. RESULTS The average overall rating on Zocdoc was highly positive, with older age, lower facial attractiveness, foreign degrees, allopathic degrees, and speaking more languages negatively associated with the average rating. However, the effect sizes of these factors were relatively small. For example, graduates of Latin American medical schools had a mean overall rating of 4.63 compared to a 4.77 rating for US graduates (P<.001), a difference roughly equivalent to a 2.8% decrease in appointments. On multivariate analysis, being Asian and having a doctor of osteopathic medicine degree were positively associated with higher overall ratings, while attending a South Asian medical school and speaking more European and Middle Eastern languages in the office were negatively associated with higher overall ratings. CONCLUSIONS Overall, the findings suggest that age, facial attractiveness, education, and multilingualism do have some impact on web-based doctor reviews, but the numerical effect is small. Notably, bias may play out in many forms. For example, a physician's appearance or accent may impact a patient's trust, confidence, or satisfaction with their physician, which could in turn influence their take-up of preventative services and lead to either better or worse health outcomes. The study highlights the need for further research in how physician characteristics influence patient ratings of care.
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Affiliation(s)
- Neil K R Sehgal
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, United States
- Computational Epidemiology Group, Boston Children's Hospital, Boston, MA, United States
| | - Benjamin Rader
- Computational Epidemiology Group, Boston Children's Hospital, Boston, MA, United States
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - John S Brownstein
- Computational Epidemiology Group, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
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13
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Zabat MA, Johnson ME, Hammouri Q, Fischer CR. What is the impact of DEI on spine care? Does it matter if my doctor looks like me? Spine J 2024:S1529-9430(24)00888-X. [PMID: 39053736 DOI: 10.1016/j.spinee.2024.06.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/27/2024] [Accepted: 06/29/2024] [Indexed: 07/27/2024]
Abstract
Though the United States population has rapidly diversified in recent decades, the American physician workforce has been slow to follow. Orthopedic surgery and neurosurgery are 2 specialties which remain particularly homogenous, and the subset of orthopedic surgeons and neurosurgeons who pursue spine surgery is even less diverse, along many different demographic axes. To provide effective, innovative, and accessible care to the changing population, greater diversity in spine surgery is essential. This is achieved in part by recruitment, retention, and leadership sponsorship of a new generation of trainees and faculty who reflect the diversity of the patient population they will care for. For surgeons, workforce diversity means improved learning, innovation, and organizational performance. For patients, it means greater ability to access respectful, quality care. Investing in the future of spine surgery means creating a more diverse and inclusive field, 1 in which patients from all walks of life can say, "My doctor is different-like me."
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Affiliation(s)
- Michelle A Zabat
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York City, NY, 10010, USA
| | - Megan E Johnson
- Texas Scottish Rite for Children, 2222 Welborn Street, Dallas, TX, 75219, USA
| | - Qusai Hammouri
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York City, NY, 10010, USA
| | - Charla R Fischer
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York City, NY, 10010, USA.
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14
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Amakiri IC, Enchill Z, Ukogu C, Mukorombindo T, Morcos MM, Le HV, Lipa SA. You say you want to be "diverse": what are the practical steps towards increasing diversity of spine surgeons? Spine J 2024:S1529-9430(24)00884-2. [PMID: 39053737 DOI: 10.1016/j.spinee.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/05/2024] [Accepted: 07/07/2024] [Indexed: 07/27/2024]
Abstract
This article explores the critical issue of underrepresentation in spine surgery, specifically addressing racial/ethnic diversity. The paper proposes actionable strategies to enhance diversity within spine surgery through early education and outreach, intentional mentorship and sponsorship, and addressing biases in recruitment and promotion processes. It emphasizes the importance of a supportive culture within spine surgery divisions and practices, advocating for a top-down approach to inclusivity, while underscoring the necessity of continuous evaluation and adaptation of diversity initiatives. By leveraging diverse perspectives, the field of spine surgery can better serve an increasingly heterogeneous population, ultimately improving patient care and healthcare outcomes.
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Affiliation(s)
- Ikechukwu C Amakiri
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, 55 Fruit St. Boston, Massachusetts, 02114, USA
| | - Zenaida Enchill
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, 55 Fruit St. Boston, Massachusetts, 02114, USA
| | - Chierika Ukogu
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, 55 Fruit St. Boston, Massachusetts, 02114, USA
| | - Tino Mukorombindo
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, 55 Fruit St. Boston, Massachusetts, 02114, USA
| | - Mary M Morcos
- Harvard Medical School, 25 Shattuck St, Boston, Massachusetts, 02115, USA
| | - Hai V Le
- Department of Orthopaedic Surgery, University of California Davis Medical Center, University of California Davis School of Medicine, 3301 C St, Sacramento, CA 95816
| | - Shaina A Lipa
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
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15
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Takagi MA, Rhodes ST, Kim JH, King M, Soukar S, Martin C, Sasaki Cole A, Chan A, Brennan C, Zyzanski S, Kissoondial B, Ragina N. Evaluating Two Educational Interventions for Enhancing COVID-19 Knowledge and Attitudes in a Sample American Indian/Alaska Native Population. Vaccines (Basel) 2024; 12:787. [PMID: 39066425 PMCID: PMC11281502 DOI: 10.3390/vaccines12070787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 07/15/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has exacerbated existing healthcare disparities among American Indian/Alaska Native (AI/AN) populations rooted in historical traumas and systemic marginalization. METHODS This study conducted at a single Indian Health Service (IHS) clinic in central Michigan evaluates two educational interventions for enhancing COVID-19 knowledge and attitudes in a sample AI/AN population. Utilizing a pre/post-intervention prospective study design, participants received either a video or infographic educational intervention, followed by a survey assessing their COVID-19 knowledge and attitudes. RESULTS The results indicate significant improvements in knowledge and attitudes post-intervention, with both modalities proving effective. However, specific factors such as gender, political affiliation, and place of residence influenced COVID-19 attitudes and knowledge, emphasizing the importance of tailored interventions. CONCLUSIONS Despite limitations, this study highlights the critical role of educational interventions in addressing vaccine hesitancy and promoting health equity within AI/AN communities. Moving forward, comprehensive strategies involving increased Indian Health Service funding, culturally relevant interventions, and policy advocacy are crucial in mitigating healthcare disparities and promoting health equity within AI/AN communities.
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Affiliation(s)
- Maya Asami Takagi
- College of Medicine, Central Michigan University, Mount Pleasant, MI 48858, USA; (S.T.R.); (J.H.K.); (M.K.); (S.S.); (C.M.); (A.S.C.); (A.C.); (C.B.); (N.R.)
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA 95817, USA
| | - Simone T. Rhodes
- College of Medicine, Central Michigan University, Mount Pleasant, MI 48858, USA; (S.T.R.); (J.H.K.); (M.K.); (S.S.); (C.M.); (A.S.C.); (A.C.); (C.B.); (N.R.)
| | - Jun Hwan Kim
- College of Medicine, Central Michigan University, Mount Pleasant, MI 48858, USA; (S.T.R.); (J.H.K.); (M.K.); (S.S.); (C.M.); (A.S.C.); (A.C.); (C.B.); (N.R.)
| | - Maxwell King
- College of Medicine, Central Michigan University, Mount Pleasant, MI 48858, USA; (S.T.R.); (J.H.K.); (M.K.); (S.S.); (C.M.); (A.S.C.); (A.C.); (C.B.); (N.R.)
| | - Stephanie Soukar
- College of Medicine, Central Michigan University, Mount Pleasant, MI 48858, USA; (S.T.R.); (J.H.K.); (M.K.); (S.S.); (C.M.); (A.S.C.); (A.C.); (C.B.); (N.R.)
| | - Chad Martin
- College of Medicine, Central Michigan University, Mount Pleasant, MI 48858, USA; (S.T.R.); (J.H.K.); (M.K.); (S.S.); (C.M.); (A.S.C.); (A.C.); (C.B.); (N.R.)
| | - Angela Sasaki Cole
- College of Medicine, Central Michigan University, Mount Pleasant, MI 48858, USA; (S.T.R.); (J.H.K.); (M.K.); (S.S.); (C.M.); (A.S.C.); (A.C.); (C.B.); (N.R.)
| | - Arlene Chan
- College of Medicine, Central Michigan University, Mount Pleasant, MI 48858, USA; (S.T.R.); (J.H.K.); (M.K.); (S.S.); (C.M.); (A.S.C.); (A.C.); (C.B.); (N.R.)
| | - Ciara Brennan
- College of Medicine, Central Michigan University, Mount Pleasant, MI 48858, USA; (S.T.R.); (J.H.K.); (M.K.); (S.S.); (C.M.); (A.S.C.); (A.C.); (C.B.); (N.R.)
| | - Stephen Zyzanski
- Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Barry Kissoondial
- College of Medicine Affiliated Community Clinic, Central Michigan University, Mount Pleasant, MI 48858, USA;
| | - Neli Ragina
- College of Medicine, Central Michigan University, Mount Pleasant, MI 48858, USA; (S.T.R.); (J.H.K.); (M.K.); (S.S.); (C.M.); (A.S.C.); (A.C.); (C.B.); (N.R.)
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16
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Sivakumar A, Rana S, Rofaiel D, Ahmad T, Hari S, Yu CH. "The straw that broke the camel's back": An analysis of racialized women clinicians' experiences providing diabetes care. PLoS One 2024; 19:e0305473. [PMID: 38990933 PMCID: PMC11239002 DOI: 10.1371/journal.pone.0305473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/30/2024] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION Racialized women clinicians (RWCs) experience the brunt of unfair racial and gendered expectations, which is a direct result of their visible identity. Our study sought to understand how these experiences intersect to impact the personal and professional well-being of RWCs, and their approach to diabetes care. METHODS Data were collected from 24 RWCs working within Canadian diabetes care settings, who participated in semi-structured, one-on-one interviews conducted from April 2021 to September 2021. The data were qualitatively analyzed using thematic analysis to develop emergent themes, and interactions were explored using the socioecological model (SEM), adapted to our study context. RESULTS We identified three themes: (1) Discordance between self-identity and relational identity impacted how RWCs interacted with others, and how others interacted with them; (2) Tokenistic, "inclusive" organizational policies/practices and inherently racist and sexist social norms permitted acts of discrimination and led to the systematic othering and exclusion of RWCs within the workplace; and (3) Differential treatment of RWCs had both positive and negative impacts on participants' relational, workplace and self-identity. Using the SEM, we also found that differential treatment of RWCs stems from upstream policies, structures, and social norms, percolating through different levels of the SEM, including work environments and communities, which eventually impacts one's relational identity, as well as one's perception of oneself. CONCLUSION The differential treatment of RWCs arises predominantly from macro systems of the work environment. The burden to address these disparities must be shifted to the source (i.e., namely systems) by implementing interventions that equitably value diversity efforts, institute policies of accountability and correction of implicit biases, and prioritize an inclusive culture broadly across faculty and leadership.
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Affiliation(s)
- Arani Sivakumar
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Simrit Rana
- McMaster University, Hamilton, Ontario, Canada
| | | | - Tehmina Ahmad
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shriya Hari
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
| | - Catherine H. Yu
- Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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17
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Vance SR, Venegas L, Johnson J, Sinha A, Chaphekar AV, Sevelius J. Community-Derived Recommendations for Improving Gender Affirmation of Black and Latine Transgender/Nonbinary Youth. Ann Behav Med 2024; 58:517-526. [PMID: 38963074 PMCID: PMC11237890 DOI: 10.1093/abm/kaae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Gender affirmation is a process by which gender-diverse individuals are supported in their gender identity. Parents are critical in how gender-diverse youth, including Black and Latine transgender/nonbinary youth (BLTY), access various forms of gender affirmation-for example, social and medical transition. Culturally relevant supports are needed to bolster how BLTY and their parents navigate gender affirmation. PURPOSE This study aimed to explore recommendations for aiding BLTY and parents in navigating the youth's gender journey. METHODS Semi-structured interviews were conducted with parents of BLTY, BLTY, and BLT young adults (BLTYAs) recruited from clinics, community organizations, and social media. Interviews focused on gender affirmation and recommendations to promote BLTY's gender affirmation. Primary and secondary analysts coded transcripts using a priori and emergent codes. For this analysis, excerpts pertaining to recommended supports were analyzed to identify themes. RESULTS Ten parents of BLTY, 10 BLTY (14-18 years), and 23 BLTYAs (18-30 years) participated. Participants provided recommendations at different socio-ecological levels. On the societal level, participants recommended improvements in media representation of racial and ethnic minority gender-diverse individuals. For organizations, participants recommended more clinicians who shared minoritized identities, clinicians knowledgeable in gender-affirming care, affordability of gender-affirming services, and school-based education regarding gender diversity. On interpersonal/individual levels, they suggested culturally informed peer support among BLTY and parents, including support groups, peer mentors, and camps with individuals who share their minoritized identities. CONCLUSIONS Participants provided salient insights to supporting gender affirmation of BLTY, which can inform intervention development for BLTY and their families.
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Affiliation(s)
- Stanley R Vance
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Luz Venegas
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Jack Johnson
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Anoushka Sinha
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Anita V Chaphekar
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Jae Sevelius
- Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
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18
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Myint MT, Yue H, Zalpuri I, Sharma N, Stewart C. Workforce Initiatives to Advance Health Equity and Diverse Representation. Child Adolesc Psychiatr Clin N Am 2024; 33:437-445. [PMID: 38823815 DOI: 10.1016/j.chc.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
The persistence of health inequity and the need for workforce diverse representation within child and adolescent psychiatry require systemic solutions. There are recommendations and strategies particularly for the training programs with "all of the above" approach to tackle these complex systemic issues. One of the ways is to think through existing and innovative training pipelines by making them less leaky, enhancing quality, expanding the type and size, and connecting them to reach children and adolescents in need.
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Affiliation(s)
- Myo Thwin Myint
- Tulane University, Children's Hospital New Orleans, 1430 Tulane Avenue, #8055, New Orleans, LA 70112, USA.
| | - Han Yue
- Tufts University, 800 Washington Street Pratt Building 2nd Floor, Boston, MA 02111, USA
| | - Isheeta Zalpuri
- Stanford University, 401 Quarry Road, Palo Alto, CA 94304, USA
| | - Neha Sharma
- Tufts University, 800 Washington Street Pratt Building 2nd Floor, Boston, MA 02111, USA
| | - Colin Stewart
- Georgetown University, 2115 Wisconsin Avenue Northwest, Washington, DC 20016, USA
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Margaretten ME, Yazdany J, Mandal J. Rheum at the Table for Everyone: A Call to Expand Rheumatology Knowledge for Primary Care Providers. Arthritis Rheumatol 2024; 76:993-995. [PMID: 38221722 DOI: 10.1002/art.42800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 01/16/2024]
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Gawel EM, DiNardo LA, Corbin AF, Friedel JE, Carr MM. Second opinions: Do otolaryngologist demographics matter? Am J Otolaryngol 2024; 45:104322. [PMID: 38692073 DOI: 10.1016/j.amjoto.2024.104322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Pediatric patients and their caregivers may receive information from their primary care physician (PCP) that does not match current American Academy of Otolaryngology (AAO) guidelines. The purpose of this study is to evaluate the frequency of parents deciding to seek a second opinion based on the demographics of pediatric otolaryngologists who deliver guideline supported advice, contrary to advice from their child's PCP. METHODS A survey was distributed to parents in a pediatric otolaryngology clinic between June 2021 and July 2023. Demographics included parent age category, gender, race, and age of youngest child. The survey included a scenario depicting recurrent otitis media with clear ears and a suggestion to defer tympanostomy tube insertion per AAO guidelines after their child's PCP recommended tubes. Thirteen variations of otolaryngologist photos were used in the case, including a control case with no picture. RESULTS Of the 658 participants, 460 (69.9 %) were female. 551 (83.7 %) were aged 30-49 years, 70 (10.7 %) were younger, and 37 (5.6 %) were older. 545 (82.8 %) were White, 30 (4.6 %) were Black, 20 (3.0 %) were Asian, and 31 (4.7 %) were Hispanic. 39.9 % of parents would seek a second opinion if an otolaryngologist recommended watchful waiting following evaluation of their child's otitis media. Participants given the control case were 2.23 times more likely to listen to the otolaryngologist's advice (p = .025). If a picture was provided, respondents were more likely to follow advice given if the pictured otolaryngologist was female (p = .025, OR = 1.47) or Asian (p = .042, OR = 1.53). CONCLUSION In this group, there is evidence that physician race and gender may influence decision making when considering action versus monitoring in the context of recurrent otitis media.
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Affiliation(s)
- Erin M Gawel
- Jacobs School Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Lauren A DiNardo
- Jacobs School Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Alexandra F Corbin
- Jacobs School Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
| | - Jonathan E Friedel
- Department of Psychology, Georgia Southern University, Statesboro, GA, USA.
| | - Michele M Carr
- Department of Otolaryngology, Jacobs School Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
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Galvan E, Ahn CE, Hansen M, Evoh V, Gebreyohanns Y, Estelle C, Cryer B, Yin H, Harris TB, Collins CA, Okorodudu DO. Increasing Diversity in Academic Medicine Via a Strategic Intermural Housestaff Leadership Development Program. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:745-749. [PMID: 38568839 DOI: 10.1097/acm.0000000000005723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PROBLEM By 2055, the United States will no longer have a single race or ethnic majority. As the nation's demographics change, the field of medicine must also change to meet the needs of diverse patients. APPROACH In 2013, UT Southwestern Medical Center implemented the Housestaff Emerging Academy of Leaders (HEAL) program, which provides leadership development skills and training to underrepresented in medicine physician residents in preparation for academic medicine careers. Program leaders hypothesized that by providing housestaff with structured mentorship, career coaching, and individualized development plans, HEAL would increase interest in pursuing academic careers and prepare residents for faculty positions. HEAL has since expanded to graduate medical education programs nationwide. OUTCOMES From 2013 to 2018, HEAL included housestaff at UT Southwestern and other Texas medical centers, totaling 392 enrollees. In 2019, the program increased to include housestaff from around the country. The first HEAL USA program had 39 housestaff, which increased to 173 in 2019, including 60 faculty from 31 U.S. academic medical centers. The 2019 HEAL USA preassessment survey (32 trainee responses) revealed that 10 (31%) of the housestaff were "extremely interested" in academic medicine, but only 1 (3%) felt "extremely confident" to pursue an academic medicine career. Postassessment responses to these same items (5 trainee responses) were 3 (60%) and 1 (20%), respectively, with 3 (60%) also feeling "extremely prepared" (1 [20%]) or "very prepared" (2 [40%]) to pursue an academic medicine career. Of 70 evaluable participants who attended at least 2 sessions and have graduated from residency, 47 (67%) have attained academic faculty positions, whereas 23 (33%) have pursued positions at nonacademic centers. NEXT STEPS The next steps for HEAL USA will be continued expansion to additional medical centers and effective delivery of career development and leadership training to encourage participants to pursue academic medical careers.
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Yang A, Rodriguez F, Woo JP. Sex, Age, and Patient Experience in Cardiologist Reviews: A Large-Scale Artificial Intelligence-Enabled Analysis. JACC. ADVANCES 2024; 3:101046. [PMID: 39129993 PMCID: PMC11312787 DOI: 10.1016/j.jacadv.2024.101046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/09/2024] [Accepted: 05/16/2024] [Indexed: 08/13/2024]
Abstract
Background Patients are increasingly using online reviews to evaluate cardiologists. Online reviews can provide insights into factors driving patient satisfaction. Little is known about the effects of age and sex on the patient experience with cardiologists. Objectives The purpose of this study was to apply natural language processing techniques on online reviews to determine the factors underlying positive and negative patient experiences and the effects of age and sex on the patient experience with cardiologists. Methods Mixed effects logistic regression and sentiment analysis were applied to online cardiologist reviews from Healthgrades between 1998 and 2023. The results were then analyzed by sex and age to show trends with respect to rating statistics, sentiment analysis, and frequency of 2-word phrases. Results There were 100,334 online reviews of 9,461 cardiologists. Female cardiologists received lower average ratings compared to male cardiologists and were 34.5% less likely to receive a positive review (OR: 0.655; 95% CI: 0.481-0.893; P = 0.015). Older cardiologists received lower average ratings compared to younger cardiologists (4.145 ± 0.908 vs 4.348 ± 0.795; P < 0.01). Positive reviews were associated with time spent with patients (OR: 1.383; 95% CI: 1.251-1.528; P < 0.01), answering questions (OR: 2.622; 95% CI: 2.324-2.959; P < 0.01), and patients feeling they could trust their providers' decisions (OR: 2.285; 95% CI: 2.053-2.543; P < 0.01). Conclusions Positive reviews were associated with cardiologists being comprehensive and patients feeling a sense of trust in the relationship. There was a difference in ratings based on age and sex with female and older cardiologists receiving lower ratings.
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Affiliation(s)
- Andrew Yang
- Department of Medicine, Division of Cardiology, Stanford University, Palo Alto, California, USA
| | - Fatima Rodriguez
- Department of Medicine, Division of Cardiology, Stanford University, Palo Alto, California, USA
| | - Jennifer P. Woo
- Department of Medicine, Division of Cardiology, Stanford University, Palo Alto, California, USA
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Rambachan A, Joshi M, Auerbach AD, Fang MC. Sex concordance between physicians and patients and discharge opioid prescribing. J Hosp Med 2024; 19:605-609. [PMID: 38721898 PMCID: PMC11222022 DOI: 10.1002/jhm.13389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 07/04/2024]
Abstract
Inpatient pain management is challenging for clinicians and inequities are prevalent. We examined sex concordance between physicians and patients to determine if discordance was associated with disparate opioid prescribing on hospital discharge. We examined 15,339 hospitalizations from 2013 to 2021. Adjusting for patient, clinical, and hospitalization-level characteristics, we calculated the odds of a patient receiving an opioid on discharge and the days of opioids prescribed across all hospitalizations and for patients admitted with a common pain diagnosis. We did not find an overall association between physician-patient sex concordance and discharge opioid prescriptions. Compared to concordant sex pairs, patients in discordant pairs were not significantly less likely to receive an opioid prescription (odds ratio: 1.04; 95% confidence interval [CI]: 0.95, 1.15) and did not receive significantly fewer days of opioids (2.1 fewer days of opioids; 95% CI: -4.4, 0.4). Better understanding relationships between physician and patient characteristics is essential to achieve more equitable prescribing.
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Affiliation(s)
- Aksharananda Rambachan
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, California
| | - Mihir Joshi
- Santa Clara Valley Medical Center, San Jose, California
| | - Andrew D. Auerbach
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, California
| | - Margaret C. Fang
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, California
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Liu M, Patel VR, Sandhu S, Reisner S, Keuroghlian AS. Health Care Discrimination and Care Avoidance Due to Patient-Clinician Identity Discordance Among Sexual and Gender Minority Adults. Ann Fam Med 2024; 22:329-332. [PMID: 39038968 PMCID: PMC11268683 DOI: 10.1370/afm.3130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 03/18/2024] [Accepted: 04/12/2024] [Indexed: 07/24/2024] Open
Abstract
Sexual and gender minority (SGM) adults experience poor health outcomes, in part due to frequent avoidance of necessary health care. Little is known, however, about factors contributing to patterns of health care utilization in this population. Using national data from the All of Us Research Program, this study evaluated the prevalence of care avoidance due to patient-clinician identity discordance (PCID) and its association with health care discrimination among SGM adults. Sexual minority (20.0% vs 9.4%; adjusted rate ratio [aRR] = 1.58; 95% CI, 1.49-1.67, P <0.001) and gender minority adults (34.4% vs 10.3%; aRR = 2.00; 95% CI, 1.79-2.21, P <0.001) were significantly more likely than their non-SGM counterparts to report care avoidance due to PCID. Exposure to health care discrimination was also more prevalent in this population and was dose-dependently associated with significantly higher rates of PCID-based care avoidance. Study findings highlight the importance of diversifying the health care workforce, expanding SGM-related clinical training, and preventing health care discrimination against SGM patients.
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Affiliation(s)
- Michael Liu
- Harvard Medical School, Boston, Massachusetts
| | - Vishal R Patel
- Harvard Medical School, Boston, Massachusetts
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Sari Reisner
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Alex S Keuroghlian
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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Aminpour N, Phan V, Wang H, McDermott J, Valentin M, Mishra A, DeLia D, Noel M, Al-Refaie W. Clinician-to-clinician connectedness and access to gastric cancer surgery at National Cancer Institute-designated cancer centers. J Gastrointest Surg 2024:S1091-255X(24)00480-3. [PMID: 38910084 DOI: 10.1016/j.gassur.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/16/2024] [Accepted: 05/26/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND For patients with gastric cancer, the pathway from primary care (PC) clinician to gastroenterologist to cancer specialist (medical oncologist or surgeons) is referral dependent. The impact of clinician connectedness on disparities in quality gastric cancer care, such as at National Cancer Institute-designated cancer centers (NCI-CC), remains underexplored. This study evaluated how clinician connectedness influences access to gastrectomy at NCI-CC. METHODS Maryland's All-Payer Claims Database was used to evaluate 667 patients who underwent gastrectomy for cancer from 2013 to 2018. Two separate referral linkages, defined as ≥9 shared patients, were examined: (1) PC clinicians to gastroenterologists at NCI-CC and (2) gastroenterologists to cancer specialists at NCI-CC. Multiple logistic regression models determined associations between referral linkages and odds of undergoing gastrectomy at NCI-CC. RESULTS Only 15% of gastrectomies were performed at NCI-CC. Patients of gastroenterologists with referral links to cancer specialists at NCI-CC were more likely to be <65 years, male, White, and privately insured. Every additional referral link between PC clinician and gastroenterologist at NCI-CC and between gastroenterologist and cancer specialist at NCI-CC increased the odds of gastrectomy at NCI-CC by 71% and 26%, respectively. Black patients had half the odds as White patients in receiving gastrectomy at NCI-CC; however, adjusting for covariates including clinician-to-clinician connectedness attenuated this observation. CONCLUSION Patients of clinicians with low connectedness and Black patients are less likely to receive gastrectomy at NCI-CC. Enhancing clinician connectedness is necessary to address disparities in cancer care. These results are relevant to policy makers, clinicians, and patient advocates striving for health equity.
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Affiliation(s)
- Nathan Aminpour
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, United States
| | - Vy Phan
- Georgetown University School of Medicine, Washington, DC, United States
| | - Haijun Wang
- MedStar Health Research Institute, Hyattsville, MD, United States
| | - James McDermott
- Department of Surgery, Stanford University, Stanford, CA, United States
| | - Michelle Valentin
- Georgetown University School of Medicine, Washington, DC, United States
| | - Ankit Mishra
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Derek DeLia
- Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, United States
| | - Marcus Noel
- Department of Medicine, MedStar-Georgetown University Hospital, Washington, DC, United States
| | - Waddah Al-Refaie
- Department of Surgery, Creighton University School of Medicine and CHI Health, Omaha, NE, United States.
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Truong OH, Wang JY, Cronholm PF. Holistic Review in Family Medicine Residency Programs: A CERA Study. Fam Med 2024; 56:367-372. [PMID: 38652848 PMCID: PMC11229850 DOI: 10.22454/fammed.2024.515525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND OBJECTIVES Interest in using holistic review for residency recruitment as a strategy to improve the diversity of the physician workforce has increased. However, no data are published on the prevalence of holistic review in the selection process for family medicine residency programs. We designed this study to assess programs' knowledge, skills, and attitudes; prevalence; barriers to implementation; and program characteristics associated with the use of holistic review. METHODS Data for this study were elicited as part of a 2023 survey conducted by the Council of Academic Family Medicine Educational Research Alliance. The nationwide, web-based survey was sent to 739 family medicine residency program directors. RESULTS A total of 309 program directors completed the holistic review portion of the survey. Programs that understood and agreed with holistic review used it more in their selection process. Holistic review was more common in programs with higher rates of residents, faculty, and patients that are underrepresented in medicine. Barriers to holistic review utilization were increased number of applicants, increased resources associated with holistic review, and lack of consensus on the holistic review approach. CONCLUSIONS The holistic review process is an area of growing interest to diversify the physician workforce, especially among residencies caring for underresourced communities. Further discussions on the specific scoring rubrics of family medicine residency programs that use holistic review are needed and could help programs that are facing barriers. Widespread use of holistic review to diversify the physician workforce has the potential to improve patient care access and health.
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Affiliation(s)
- Oanh H Truong
- Baton Rouge General Family Medicine Residency Program, Baton Rouge, LA
- School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Jenny Y Wang
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA
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Ezell JM. The Health Disparities Research Industrial Complex. Soc Sci Med 2024; 351:116251. [PMID: 37865583 DOI: 10.1016/j.socscimed.2023.116251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/14/2023] [Indexed: 10/23/2023]
Abstract
Research focused on health disparities-whether relating to one's race/ethnicity, gender expression, sexual orientation, citizenship status, income level, etc.-constitutes a large, generative, and highly profitable portion of scholarship in academic, clinical, and government settings. Health disparities research is expressed as a means of bringing greater attention to, and ultimately addressing via evidence-based implementation science, acts of devaluation and oppression that have continually contributed to these inequities. Philosophies underlying health disparities research's expansive and growing presence mirror the formal logic and ethos of the Military Industrial Complex and the Prison Industrial Complex. The "Health Disparities Research Industrial Complex," operationalized in this article, represents a novel mutation and extension of these complexes, primarily being enacted through these three mechanisms: 1) The construction and maintenance of beliefs, behaviors, and policies in healthcare, and society more broadly, that create and sustain disadvantages in minority health; 2) the creation and funding of research positions that inordinately provide non-minoritized people and those without relevant lived experiences the ability to study health disparities as "health equity tourists"; and 3) the production of health disparities research that, due to factors one and two, is incapable of fully addressing the disparities. In this piece, these and other core elements of the Health Disparities Research Industrial Complex, and the research bubble that it has produced, are discussed. Additionally, strategies for reducing the footprint and impact of the Health Disparities Research Industrial Complex and better facilitating opportunities for meaningful implementation in the field are presented.
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Affiliation(s)
- Jerel M Ezell
- Community Health Sciences, School of Public Health, University of California Berkeley, Berkeley, CA, USA; Berkeley Center for Cultural Humility, University of California Berkeley, Berkeley, CA, USA.
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Wang CH, Bryant BL, Cogen FR, Marks BE, Monaghan M. Preferences for Health Care Professional Interactions Among Adolescents and Young Adults with Type 1 Diabetes. Clin Pediatr (Phila) 2024; 63:620-624. [PMID: 37497925 DOI: 10.1177/00099228231189649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Affiliation(s)
- Christine H Wang
- Center for Translational Research, Children's National Hospital, Washington, DC, USA
| | - Breana L Bryant
- Center for Translational Research, Children's National Hospital, Washington, DC, USA
| | - Fran R Cogen
- Division of Endocrinology and Diabetes, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Brynn E Marks
- Division of Endocrinology and Diabetes, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Maureen Monaghan
- Division of Endocrinology and Diabetes, Children's National Hospital, Washington, DC, USA
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Smith LB, O'Brien C, Kenney GM, Waidmann TA. Black-White Disparities in Asthma Hospitalizations and ED Visits Among Medicaid-Enrolled Children. Hosp Pediatr 2024; 14:490-498. [PMID: 38752291 DOI: 10.1542/hpeds.2023-007477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/17/2024] [Accepted: 01/25/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Asthma is a common, potentially serious childhood chronic condition that disproportionately afflicts Black children. Hospitalizations and emergency department (ED) visits for asthma can often be prevented. Nearly half of children with asthma are covered by Medicaid, which should facilitate access to care to manage and treat symptoms. We provide new evidence on racial disparities in asthma hospitalizations and ED visits among Medicaid-enrolled children. METHODS We used comprehensive Medicaid claims data from the Transformed Medicaid Statistical Information System. Our study population included 279 985 Medicaid-enrolled children with diagnosed asthma. We identified asthma hospitalizations and ED visits occurring in 2019. We estimated differences in the odds of asthma hospitalizations and ED visits for non-Hispanic Black versus non-Hispanic white children, adjusting for sex, age, Medicaid eligibility group, Medicaid plan type, state, and rurality. RESULTS In 2019, among Black children with asthma, 1.2% had an asthma hospitalization and 8.0% had an asthma ED visit compared with 0.5% and 3.4% of white children with a hospitalization and ED visit, respectively. After adjusting for other characteristics, the rates for Black children were more than twice the rates for white children (hospitalization adjusted odds ratio 2.45, 95% confidence interval 2.23-2.69; ED adjusted odds ratio 2.42; 95% confidence interval 2.33-2.51). CONCLUSIONS There are stark racial disparities in asthma hospitalizations and ED visits among Medicaid-enrolled children with asthma. To diminish these disparities, it will be important to implement solutions that address poor quality care, discriminatory treatment in health care settings, and the structural factors that disproportionately expose Black children to asthma triggers and access barriers.
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Lattimore CM, Meneveau MO, Desai R, Camacho TF, Squeo GC, Showalter SL. Are There Disparities in Breast Reconstruction After Contralateral Prophylactic Mastectomy? J Surg Res 2024; 298:277-290. [PMID: 38636184 PMCID: PMC11144118 DOI: 10.1016/j.jss.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/26/2023] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Despite national guidelines against contralateral prophylactic mastectomy (CPM) in low- to moderate-risk breast cancer, CPM use continues to rise. Breast reconstruction improves health-related quality of life and satisfaction among women undergoing mastectomy. Given the lack of data regarding factors associated with reconstruction after CPM and the known benefits of reconstruction, we sought to investigate whether disparities exist in receipt of reconstruction after CPM. METHODS The 2004-2017 National Cancer Database was queried to identify women diagnosed with breast cancer who underwent unilateral mastectomy with CPM. Patients were divided into two groups: those who underwent planned reconstruction at any timepoint and those who did not. A secondary analysis comparing types of reconstruction (tissue, implant, combined) was conducted. Patient, tumor, and demographic characteristics were analyzed using chi-square test and odds ratios were calculated using generalized estimating equations. RESULTS The cohort included 1,73,249 women: 95,818 (55.3%) underwent reconstruction and 77,431 (45.7%) did not. Both the rate CPM and the proportion of women undergoing reconstruction after CPM increased between 2004 and 2017. Of the women who had reconstruction, 40,840 (51.7%) received implants, 29,807 (37.7%) had tissue, and 8352 (10.6%) had combined reconstruction. After adjusted analysis, factors associated with reconstruction were young age, Hispanic ethnicity, private insurance, and living in an area with the highest education and median income (P < 0.01). Patients who underwent reconstruction were less likely to have radiation (P < 0.01) and chemotherapy (P < 0.01), more likely to have stage I disease (P < 0.01), and to be treated at an integrated cancer center (P < 0.01). CONCLUSIONS Reconstruction after CPM is disproportionately received by younger women, Hispanics, those with private insurance, and higher socioeconomic status and education. While the rate of reconstruction after CPM is increasing, there remain significant disparities. Conscious efforts must be made to eliminate these disparities, especially given the known benefits of reconstruction after mastectomy.
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Affiliation(s)
- Courtney M Lattimore
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Max O Meneveau
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Raj Desai
- Division of Translational Research & Applied Statistics, Department of Public Health Sciences, University of Virginia Health System, Charlottesville, Virginia
| | - T Fabian Camacho
- Division of Translational Research & Applied Statistics, Department of Public Health Sciences, University of Virginia Health System, Charlottesville, Virginia
| | - Gabriella C Squeo
- Department of Plastic and Maxillofacial Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Shayna L Showalter
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
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Sechrist S, Margol V, Martinez A. Redefining the term "Disadvantaged student": A post baccalaureate program's role in underrepresented students' success and reclaiming of narratives. J Natl Med Assoc 2024; 116:309-319. [PMID: 38816265 DOI: 10.1016/j.jnma.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/31/2024] [Accepted: 05/08/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Racial/ethnic minority groups and low-income students continue to be underrepresented in medicine (URiM) despite years of diversity and inclusion efforts. Post baccalaureate programs (PBP) are shown to prepare underrepresented students to successfully matriculate to medical school. However, identification of the aspects of a PBP that are key to future success in medicine from the student perspective is lacking. Therefore, this study was designed to answer the question, "What aspects of a post baccalaureate program do URiM students see as valuable to their future success?" METHODS This is a qualitative analysis of semi-structured interviews with alumni of the UCSF PBP who completed the program between 2015-2020. Interviews were conducted via phone or video call, audio recorded, and transcribed verbatim. Names and years of attendance were removed from the transcripts prior to review to protect confidentiality. Transcripts were coded following an inductive qualitative approach using methodology rooted in grounded theory. Demographic data was collected upon enrollment in the program. RESULTS Forty study participants were interviewed (58% of eligible subjects). Participants self-identified as Latinx (70%), African American (8%), Southeast Asian (10%), Native American (2%), Multiethnic (10%), and 60% female. The average age at enrollment was 24 years. Most participants (75%) were first-generation college students and 85% grew up with a family income <$49,999. Qualitative findings were categorized into five main themes: (1) Academic, Professional, and Personal Skills Development, (2) Supportive Student Cohort, (3) Resources, Personalized Advising, and Mentorship, (4) Gaining Confidence and a Sense of Belonging in Medicine, and (5) Redefining "Disadvantaged" Status. A novel finding was the importance of redefining the narrative of belonging to a "disadvantaged" community. During the program, the study participants reported gaining confidence and a sense of belonging in medicine as they recognized the unique qualifications and advantages they bring to medicine. CONCLUSIONS Our findings suggest that in addition to academic preparation, PBPs for students who are underrepresented in medicine should empower students to recognize their strengths and qualifications in the field of medicine. Our study participants rejected the term "disadvantaged" as they celebrated the value of their backgrounds and what they bring to medicine.
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Affiliation(s)
- Samantha Sechrist
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Valerie Margol
- Post Baccalaureate & Outreach Programs, University of California San Francisco, San Francisco, California, USA
| | - Alma Martinez
- Post Baccalaureate & Outreach Programs, University of California San Francisco, San Francisco, California, USA; Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.
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Yu YL. Disparities by Race/Ethnicity and Immigration Status in Perceived Importance of and Access to Culturally Competent Health Care in the United States. J Racial Ethn Health Disparities 2024; 11:1829-1841. [PMID: 37314687 DOI: 10.1007/s40615-023-01655-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/15/2023]
Abstract
While cultural competence has been proposed as an important framework for enhancing health care equity, how members of different racial/ethnic groups consider the importance of cultural competence and their access to culturally competent health care are insufficiently understood. Despite continuously increasing immigrants into the US, it is unclear how immigration status intersects with race/ethnicity to shape individuals' perception of and access to culturally competent care in the US health care system. To fill this research gap, this study examined how the intersection of race/ethnicity and immigration status is associated with people's perception of and access to culturally competent health care and among immigrants, whether their length of stay matters, using data from the 2017 National Health Interview Survey. The results show that while racial and ethnic minority members reported greater importance of culturally competent care than non-Hispanic whites, Asian, black and other-race immigrants reported even greater importance than their US-born counterparts. Additionally, although racial/ethnic minorities reported greater limited access to culturally competent care than their white peers, this gap in access was observed primarily among US-born racial/ethnic minorities. Shorter length of residence (fewer than 15 years) was associated with greater perceived importance than residence of at least 15 years among immigrants, but access to culturally competent care did not differ by length of residence. The findings speak to racial/ethnic minorities' greater desire for culturally competent care and their unmet needs.
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Affiliation(s)
- Yan-Liang Yu
- Department of Sociology and Criminology, Howard University, 2419 6th St. NW Bldg. 23, Washington, DC, 20059, USA.
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Coisy F, Olivier G, Ageron FX, Guillermou H, Roussel M, Balen F, Grau-Mercier L, Bobbia X. Do emergency medicine health care workers rate triage level of chest pain differently based upon appearance in simulated patients? Eur J Emerg Med 2024; 31:188-194. [PMID: 38100643 DOI: 10.1097/mej.0000000000001113] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
BACKGROUND AND IMPORTANCE There seems to be evidence of gender and ethnic bias in the early management of acute coronary syndrome. However, whether these differences are related to less severe severity assessment or to less intensive management despite the same severity assessment has not yet been established. OBJECTIVE To show whether viewing an image with characters of different gender appearance or ethnic background changes the prioritization decision in the emergency triage area. METHODS The responders were offered a standardized clinical case in an emergency triage area. The associated image was randomized among eight standardized images of people presenting with chest pain and differing in gender and ethnic appearance (White, Black, North African and southeast Asian appearance). OUTCOME MEASURES AND ANALYSIS Each person was asked to respond to a single clinical case, in which the priority level [from 1 (requiring immediate treatment) to 5 (able to wait up to 2 h)] was assessed visually. Priority classes 1 and 2 for vital emergencies and classes 3-5 for nonvital emergencies were grouped together for analysis. RESULTS Among the 1563 respondents [mean age, 36 ± 10 years; 867 (55%) women], 777 (50%) were emergency physicians, 180 (11%) emergency medicine residents and 606 (39%) nurses. The priority levels for all responses were 1-5 : 180 (11%), 686 (44%), 539 (34%), 131 (9%) and 27 (2%). There was a higher reported priority in male compared to female [62% vs. 49%, difference 13% (95% confidence interval; CI 8-18%)]. Compared to White people, there was a lower reported priority for Black simulated patients [47% vs. 58%, difference -11% (95% CI -18% to -4%)] but not people of southeast Asian [55% vs. 58%, difference -3% (95% CI -10-5%)] and North African [61% vs. 58%, difference 3% (95% CI -4-10%)] appearance. CONCLUSION In this study, the visualization of simulated patients with different characteristics modified the prioritization decision. Compared to White patients, Black patients were less likely to receive emergency treatment. The same was true for women compared with men.
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Affiliation(s)
- Fabien Coisy
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, CHU de Nimes, University of Montpellier, Nimes, France
| | - Guillaume Olivier
- Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
| | | | - Hugo Guillermou
- IDESP, University of Montpellier and INSERM, Montpellier, France
| | - Mélanie Roussel
- Emergency Department, Rouen University Hospital, Rouen, France
| | - Frédéric Balen
- Emergency Department, Toulouse University Hospital, Toulouse, France
| | - Laura Grau-Mercier
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, CHU de Nimes, University of Montpellier, Nimes, France
| | - Xavier Bobbia
- Montpellier University, UR UM 103 (IMAGINE), Department of Emergency Medicine, Montpellier University Hospital, Montpellier, France
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Chary AN, Hernandez N, Rivera AP, Santangelo I, Ritchie C, Ouchi K, Liu SW, Naik AD, Kennedy M. Emergency department communication with diverse caregivers and persons living with dementia: A qualitative study. J Am Geriatr Soc 2024; 72:1687-1696. [PMID: 38553011 DOI: 10.1111/jgs.18897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/24/2024] [Accepted: 03/07/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND Research to date has detailed numerous challenges in emergency department (ED) communication with persons living with dementia (PLWD) and their caregivers. However, little is known about communication experiences of individuals belonging to minoritized racial and ethnic groups, who are disproportionately impacted by dementia and less likely to be included in dementia research. METHODS We conducted semi-structured interviews with 29 caregivers of PLWD from two urban academic hospital EDs with distinct patient populations. The first site is an ED in the Northeast serving a majority White, English-speaking, and insured population. The second site is an ED in the South serving a majority Black and/or Hispanic, Spanish-speaking, and underinsured population. Interviews lasted an average of 25 min and were digitally recorded and transcribed. We used an inductive approach to analyze interview transcripts for dominant themes and compared themes between sites. RESULTS Our sample included caregivers of diverse racial and ethnic backgrounds. Caregivers cared for PLWD who spoke English, Spanish, Arabic, Chinese, and Vietnamese. We identified three themes. First, caregiver advocacy was central to experiences of ED communication, particularly when PLWD primarily spoke a non-English language. Second, routine care plans did not address what mattered most to participants and PLWD. Participants felt that care arose from protocols and did not address what mattered most to them. Third, White English-speaking caregivers in Site 1 more commonly expected ED staff to engage them in care decision-making than Black, Hispanic, Asian, and Middle Eastern caregivers in Site 2. CONCLUSION Language barriers amplify the higher intensity care needed by PLWD in the ED. Strategies should be developed for communicating with PLWD and caregivers about what matters most in their ED care.
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Affiliation(s)
- Anita N Chary
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Norvin Hernandez
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | - Ilianna Santangelo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christine Ritchie
- Division of Palliative Care and Geriatric Medicine, Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kei Ouchi
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Shan W Liu
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Aanand D Naik
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Consortium on Aging, University of Texas Health Science Center, Houston, Texas, USA
| | - Maura Kennedy
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Jones RL, Prusmetikul S, Whitehorn S. Differential attainment in assessment of postgraduate surgical trainees: a scoping review. BMC MEDICAL EDUCATION 2024; 24:597. [PMID: 38816822 PMCID: PMC11141033 DOI: 10.1186/s12909-024-05580-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/20/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Solving disparities in assessments is crucial to a successful surgical training programme. The first step in levelling these inequalities is recognising in what contexts they occur, and what protected characteristics are potentially implicated. METHODS This scoping review was based on Arksey & O'Malley's guiding principles. OVID and Embase were used to identify articles, which were then screened by three reviewers. RESULTS From an initial 358 articles, 53 reported on the presence of differential attainment in postgraduate surgical assessments. The majority were quantitative studies (77.4%), using retrospective designs. 11.3% were qualitative. Differential attainment affects a varied range of protected characteristics. The characteristics most likely to be investigated were gender (85%), ethnicity (37%) and socioeconomic background (7.5%). Evidence of inequalities are present in many types of assessment, including: academic achievements, assessments of progression in training, workplace-based assessments, logs of surgical experience and tests of technical skills. CONCLUSION Attainment gaps have been demonstrated in many types of assessment, including supposedly "objective" written assessments and at revalidation. Further research is necessary to delineate the most effective methods to eliminate bias in higher surgical training. Surgical curriculum providers should be informed by the available literature on inequalities in surgical training, as well as other neighbouring specialties such as medicine or general practice, when designing assessments and considering how to mitigate for potential causes of differential attainment.
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Affiliation(s)
- Rebecca L Jones
- Department of Surgery and Cancer, Imperial College London, London, UK.
- Department of Ophthalmology, Cheltenham General Hospital, Gloucestershire Hospitals NHS Foundation Trust, Alexandra House, Sandford Road, Cheltenham, GL53 7AN, UK.
| | - Suwimol Prusmetikul
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Orthopaedics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sarah Whitehorn
- Department of Surgery and Cancer, Imperial College London, London, UK
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Chen P, Siegler E, Siracuse JJ, O'Donnell TFX, Patel VI, Morrissey NJ. Association between Asian race and perioperative outcomes after carotid revascularization varies with Asian procedure density. J Vasc Surg 2024:S0741-5214(24)01226-6. [PMID: 38821432 DOI: 10.1016/j.jvs.2024.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 05/08/2024] [Accepted: 05/22/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE Postoperative outcomes following carotid revascularization are understudied in Asian patients. We aimed to assess whether disease severity and postoperative outcomes following carotid revascularization differ between Asian and White patients, and whether this varies with Asian procedure density. METHODS We analyzed the Vascular Quality Initiative Carotid Endarterectomy and Carotid Artery Stenting datasets from 2003 to 2021. Regions were divided into tertiles based on Asian procedure density. Propensity scores were used to match Asian and White patients based on patient factors and procedure type. The primary outcome variable was a collapsed composite of in-hospital ipsilateral stroke/death/myocardial infarction. χ2 tests were used to assess association between Asian race and disease severity, center and surgeon volume, and 1-year outcomes. Logistic and Cox regressions were performed between the matched cohorts. RESULTS A total of 1766 Asian and 159,608 White patients underwent carotid revascularization, and we identified 2704 patients (1352 Asian and 1352 White) in the matched cohorts. Among propensity matched patients, all-comer Asian patients more commonly had >80% ipsilateral stenosis (63% vs 52%; P < .001) and a moderate/severe preoperative Rankin score (7.6% vs 5.1%; P = .007). The rate of in-hospital stroke/death/myocardial infarction was higher in Asian patients (2.6% vs 1.3%; P = .012), and this disparity was more pronounced in the lowest tertile of Asian procedure density (4.3% vs 0.5%; P < .001). Logistic regression in the propensity-matched cohort demonstrated Asian race was associated with lower odds of intervention at highest volume centers (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.2-0.3; P < .001) and by highest volume surgeons (OR, 0.3; 95% CI, 0.3-0.4; P < .001). Asian race was associated with higher odds of in-hospital stroke/death/myocardial infarction (OR, 2.0; 95% CI, 1.1-3.8; P = .031), and there was a significant interaction between Asian procedure density and the relationship between Asian race and this outcome (interaction P = .001). After accounting for center and surgeon volume, the association of Asian race and the composite outcome was mitigated (OR, 1.5; 95% CI, 0.7-3.3; P = .300). Cox regression between the matched cohorts demonstrated that Asian race was associated with lower 1-year mortality (hazard ratio, 0.5; 95% CI, 0.3-0.7; P = .001) and higher risk of 1-year reintervention (hazard ratio, 16; 95% CI, 1.8-142; P = .013). CONCLUSIONS Asian patients are more likely to present with a higher degree of carotid stenosis, higher preoperative risk, and experience worse perioperative outcomes. The association of Asian race with perioperative stroke/death/myocardial infarction varies with Asian procedure density and is also confounded by center and surgeon volume. These results highlight the importance of understanding referral patterns and cultural effects on outcomes disparities in Asian patients.
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Affiliation(s)
- Panpan Chen
- Division of Vascular Surgery and Endovascular Interventions, New York Presbyterian-Columbia University Medical Center, New York, NY.
| | - Emily Siegler
- California Northstate University College of Medicine, Elk Grove, CA
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston, MA
| | - Thomas F X O'Donnell
- Division of Vascular Surgery and Endovascular Interventions, New York Presbyterian-Columbia University Medical Center, New York, NY
| | - Virendra I Patel
- Division of Vascular Surgery and Endovascular Interventions, New York Presbyterian-Columbia University Medical Center, New York, NY
| | - Nicholas J Morrissey
- Division of Vascular Surgery and Endovascular Interventions, New York Presbyterian-Columbia University Medical Center, New York, NY
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Zil-E-Ali A, Alamarie B, Paracha AW, Samaan F, Aziz F. Systematic review and meta-analysis to assess the racial disparities in the outcomes of carotid endarterectomy in the United States. J Vasc Surg 2024:S0741-5214(24)01213-8. [PMID: 38782214 DOI: 10.1016/j.jvs.2024.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/30/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE Race-based disparities in health care have been related to a myriad of prevailing factors among minorities in the United States. This study aims to study the race-based differences in the outcomes of carotid endarterectomy (CEA). METHODS The PROSPERO database registered the review protocol (CRD42023428253). A systematic English literature review was performed using literature databases PubMed and Scopus from inception till June 2023. The review was designed on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and included studies reporting mortality, stroke, or composite outcome of mortality and stroke after CEA for carotid artery disease, regardless of any degree of stenosis including both symptomatic and asymptomatic patients. The risk of bias was evaluated utilizing the Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) tool. A pooled odds ratio (OR) for the overall mortality was computed, and a P value of < .05 was designated as statistically significant. Interstudy heterogeneity was evaluated by Q-metric and quantified using Higgins I2 statistics. RESULTS Twelve studies were identified which included a total of 574,055 patients who underwent CEA from 1998 to 2022. Eleven of 12 studies reported 30-day mortality as an outcome for patients undergoing CEA in which 524,708 patients (92.5%) were White and 42,797 (7.5%) were non-White. The overall pooled OR indicated a statistical significance in 30-day mortality between White and non-White patients undergoing CEA (OR, 1.73; 95% confidence interval [CI], 1.37-2.18; P = .011) with substantial heterogeneity (I2 = 56.3%). Eleven of 12 studies reported stroke as an outcome for patients undergoing CEA in which 524,708 patients (92.5%) were White and 42,801 (7.5%) were non-White. The overall pooled OR indicated no statistical significance in stroke between White and non-White patients undergoing CEA (OR, 1.46; 95% CI, 1.28-1.65; P = .111) with moderate heterogeneity (I2 = 35.9%). Five of 12 studies reported composite mortality or stroke as an outcome for patients undergoing CEA. The overall pooled OR indicated no statistical significance in composite mortality or stroke between White and non-White patients undergoing CEA (OR, 1.40; 95% CI, 1.24-1.59; P = .467) with no heterogeneity (I2 = 0.0%). CONCLUSIONS Non-White patients have a relatively higher risk of mortality; however, no significant difference was observed between the racial groups in terms of stroke or a composite outcome of mortality or stroke. The odds of mortality in non-White patients have been persistent throughout recent studies.
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Affiliation(s)
- Ahsan Zil-E-Ali
- Division of Vascular Surgery, Penn State Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA.
| | - Billal Alamarie
- Office of Medical Education, Penn State College of Medicine, Penn State University, State College, PA
| | - Abdul Wasay Paracha
- Office of Medical Education, Penn State College of Medicine, Penn State University, State College, PA
| | - Fadi Samaan
- Office of Medical Education, Penn State College of Medicine, Penn State University, State College, PA
| | - Faisal Aziz
- Division of Vascular Surgery, Penn State Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA
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Sanchez J, Prabhu R, Guglielminotti J, Landau R. Racial and Ethnic Concordance Between the Patient and Anesthesia Team and Patients' Satisfaction With Pain Management During Cesarean Delivery. Anesth Analg 2024:00000539-990000000-00821. [PMID: 38768069 DOI: 10.1213/ane.0000000000006764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Racial and ethnic concordance between patients and health care providers increases patient satisfaction but has not been examined in obstetric anesthesia care. This study evaluated the association between racial and ethnic concordance and satisfaction with management of pain during cesarean delivery (PDCD). METHODS This was a secondary analysis on a cohort of patients undergoing cesarean deliveries under neuraxial anesthesia that examined PDCD. The outcome was satisfaction, recorded within 48 hours after delivery using the survey question, "Overall, how satisfied are you with the anesthesia care during the C-section as it relates to pain management?" Using a 5-point Likert scale, satisfaction was defined with the answer "very satisfied." Participants were also asked, "If you have another C-section, would you want the same anesthesia team?" The exposure was racial and ethnic concordance between the patient and anesthesia team members (attending with a resident, nurse anesthetist, or fellow) categorized into full concordance, partial concordance, discordance, and missing. Risk factors for satisfaction were identified using a multivariable analysis. RESULTS Among 403 participants, 305 (78.2%; 95% confidence interval [CI], 73.8-82.1) were "very satisfied," and 358 of 399 (89.7%; 95% CI, 86.3-92.5) "would want the same anesthesia team." Full concordance occurred in 18 (4.5%) cases, partial concordance in 117 (29.0%), discordance in 175 (43.4%), and missing in 93 (23.1%). Satisfaction rate was 88.9% for full concordance, 71.8% for partial concordance, 81.1% for discordance, and 78.5% for missing (P value = .202). In the multivariable analysis, there was insufficient evidence for an association of concordance with satisfaction. Compared to full concordance, partial concordance was associated with a nonsignificant 57% (95% CI, -113 to 91) decrease in the odds of being satisfied, discordance with a 29% (95% CI, -251 to 85) decrease, and missing with a 39% (95% CI, -210 to 88) decrease. Risk factors for not being "very satisfied" were PDCD, anxiety disorders, pregnancy resulting from in vitro fertilization, intravenous medication administration, intrapartum cesarean with extension of labor epidural, having 3 anesthesia team members (instead of 2), and a higher intraoperative blood loss. CONCLUSIONS Our inability to identify an association between concordance and satisfaction is likely due to the high satisfaction rate in our cohort (78.2%), combined with low proportion of full concordance (4.5%). Addressing elements such as PDCD, anxiety, intravenous medication administration, and use of epidural anesthesia for cesarean delivery, and a better understanding of the interplay between concordance and satisfaction are warranted.
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Affiliation(s)
- Jose Sanchez
- From the Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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Nimmon L. The complexity of physician power. Science 2024; 384:742-743. [PMID: 38753802 DOI: 10.1126/science.adp5154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Inequitable variation in physician effort and resource use is revealed.
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Affiliation(s)
- Laura Nimmon
- Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Canada
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40
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Xintong Z, Tao X, Shuying W, Huq KATME, Huiying G, Michiko M. An evaluation of outpatient satisfaction based on the national standard questionnaire: a satisfaction survey conducted in a tertiary hospital in Shenyang, China. Front Public Health 2024; 12:1348426. [PMID: 38784568 PMCID: PMC11111912 DOI: 10.3389/fpubh.2024.1348426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
Background Patient satisfaction survey serves as a pivotal tool in evaluating the quality of healthcare services. China's nationwide standard patient satisfaction measurement tool was introduced in 2019. This study aimed to assess the model fit of the national standard outpatient satisfaction questionnaire in a tertiary hospital and evaluate the outpatient satisfaction levels using this tool. Method A cross-sectional survey using the national outpatient satisfaction questionnaire was conducted via message links to all hospital outpatients who registered between April and July 2022. The data collected underwent descriptive analysis, comparative analysis, and confirmatory factor analysis (CFA). Results A total of 6,012 valid responses were received and analyzed during this period, with 52.9% of the participants being women. The confirmatory factor analysis (CFA) model showed a good fit and identified doctor communication as having a positive effect and environmental factors as having a negative effect on outpatients' satisfaction, with standardized regression weights of 0.46 and 0.42, respectively. Despite the remarkably high satisfaction levels, patients' recommendation for using the services of this hospital surpassed the overall evaluation and total satisfaction scores. Conclusion A disparity was identified between the expectations and real experiences of outpatients, leading to some extent of dissatisfaction. To enhance satisfaction levels, the hospital should improve the communication skills of all clinical staff, simplify the environment layout for first-time visitors, and manage patient overloads.
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Affiliation(s)
- Zhou Xintong
- Graduate School of Biomedical and Health Sciences, Division of Integrated Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Hospital Infection Management, Shenyang the Fourth People’s Hospital, Shenyang, China
| | - Xin Tao
- Department of Information, Shenyang the Fourth People’s Hospital, Shenyang, China
| | - Wang Shuying
- Department of Doctor-patient Communication, Shenyang the Fourth People’s Hospital, Shenyang, China
| | - K. A. T. M. Ehsanul Huq
- Graduate School of Biomedical and Health Sciences, Division of Integrated Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Gao Huiying
- Graduate School of Biomedical and Health Sciences, Division of Integrated Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Moriyama Michiko
- Graduate School of Biomedical and Health Sciences, Division of Integrated Health Sciences, Hiroshima University, Hiroshima, Japan
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Harik L, Yamamoto K, Kimura T, Rong LQ, Vogel B, Mehran R, Bairey-Merz CN, Gaudino M. Patient-physician sex concordance and outcomes in cardiovascular disease: a systematic review. Eur Heart J 2024; 45:1505-1511. [PMID: 38551446 PMCID: PMC11075930 DOI: 10.1093/eurheartj/ehae121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 05/09/2024] Open
Abstract
The sex disparity in outcomes of patients with cardiovascular disease is well-described and has persisted across recent decades. While there have been several proposed mechanisms to explain this disparity, there are limited data on female patient-physician sex concordance and its association with outcomes. The authors review the existing literature on the relationship between patient-physician sex concordance and clinical outcomes in patients with cardiovascular disease, the evidence of a benefit in clinical outcomes with female patient-physician sex concordance, and the possible drivers of such a benefit and highlight directions for future study.
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Affiliation(s)
- Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, USA
| | - Ko Yamamoto
- Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan
| | - Takeshi Kimura
- Department of Cardiology, Hirakata Kohsai Hospital, Osaka, Japan
| | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - Birgit Vogel
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - C Noel Bairey-Merz
- Barbara Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai, Los Angeles, CA, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065, USA
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Vandecasteele R, Schelfhout S, D'hondt F, De Maesschalck S, Derous E, Willems S. Intercultural effectiveness in GPs' communication and clinical assessment: An experimental study. PATIENT EDUCATION AND COUNSELING 2024; 122:108138. [PMID: 38237531 DOI: 10.1016/j.pec.2024.108138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/27/2023] [Accepted: 01/04/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE This study aimed to investigate potential disparities in general practitioners' overall communication and clinical assessments based on patient ethnicity, while examining the influence of intercultural effectiveness. METHODS Employing a 2 × 2 experimental study design, online video recorded consultations with simulated patients were conducted and analyzed using OSCEs. Each GP (N = 100) completed a consultation with both an ethnic majority and an ethnic minority patient. Additionally, a follow-up survey was administered to gather supplementary data. Paired sample t-tests explored ethnic disparities, correlation and regression analyses determined associations with intercultural attitudes, traits and capabilities. RESULTS No statistically significant differences in GPs' communication or clinical assessment were found based on patients' ethnic background. Positive associations were observed between all aspects of intercultural effectiveness and GPs' consultation behavior. Intercultural traits emerged as a strong and robust predictor of clinical assessment of ethnic minority patients. CONCLUSION Intercultural traits, such as ethnocultural empathy, may play a critical role in GPs' clinical assessment skills during intercultural consultations. PRACTICE IMPLICATIONS Findings provide valuable insights into the determinants of intercultural effectiveness in healthcare, fostering promising targets for interventions and training programs aiming to ensure higher-quality and more equitable care delivery.
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Affiliation(s)
- Robin Vandecasteele
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, University Hospital Campus entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium.
| | - Stijn Schelfhout
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Work, Organization and Society, Vocational and Personnel Psychology Lab, H. Dunantlaan 2, 9000 Ghent, Belgium; Ghent University, Faculty of Psychology and Educational Sciences, Department of Experimental Psychology, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Fanny D'hondt
- Department of Sociology, Faculty of Political and Social Sciences, Ghent University, Sint-Pietersnieuwstraat 41, 9000 Ghent, Belgium
| | - Stéphanie De Maesschalck
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, University Hospital Campus entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent University, Centre for the Social Study of Migration and Refugees, H. Dunantlaan 2, 9000 Ghent, Belgium
| | - Eva Derous
- Ghent University, Faculty of Psychology and Educational Sciences, Department of Work, Organization and Society, Vocational and Personnel Psychology Lab, H. Dunantlaan 2, 9000 Ghent, Belgium; Erasmus University Rotterdam, Erasmus School of Social and Behavioural Sciences, Burgemeester Oudlaan 50, 3062 Rotterdam, the Netherlands
| | - Sara Willems
- Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Research Group Equity in Health Care, University Hospital Campus entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium; Ghent University, Centre for the Social Study of Migration and Refugees, H. Dunantlaan 2, 9000 Ghent, Belgium; Ghent University, Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Quality & Safety Ghent, University Hospital Campus entrance 42, C. Heymanslaan 10, 9000 Ghent, Belgium
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Abella MKIL, Thorne T, Hayashi J, Finlay AK, Frick S, Amanatullah DF. An Inclusive Analysis of Racial and Ethnic Disparities in Orthopedic Surgery Outcomes. Orthopedics 2024; 47:e131-e138. [PMID: 38285555 DOI: 10.3928/01477447-20240122-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
BACKGROUND Despite increasing attention, disparities in outcomes for Black and Hispanic patients undergoing orthopedic surgery are widening. In other racial-ethnic minority groups, outcomes often go unreported. We sought to quantify disparities in surgical outcomes among Asian, American Indian or Alaskan Native, and Native Hawaiian or Pacific Islander patients across multiple orthopedic subspecialties. MATERIALS AND METHODS The National Surgical Quality Improvement Program was queried to identify all surgical procedures performed by an orthopedic surgeon from 2014 to 2020. Multivariable logistic regression models were used to investigate the impact of race and ethnicity on 30-day medical complications, readmission, reoperation, and mortality, while adjusting for orthopedic subspecialty and patient characteristics. RESULTS Across 1,512,480 orthopedic procedures, all patients who were not White were less likely to have arthroplasty-related procedures (P<.001), and Hispanic, Asian, and American Indian or Alaskan Native patients were more likely to have trauma-related procedures (P<.001). American Indian or Alaskan Native (adjusted odds ratio [AOR], 1.005; 95% CI, 1.001-1.009; P=.011) and Native Hawaiian or Pacific Islander (AOR, 1.009; 95% CI, 1.005-1.014; P<.001) patients had higher odds of major medical complications compared with White patients. American Indian or Alaskan Native patients had higher risk of reoperation (AOR, 1.005; 95% CI, 1.002-1.008; P=.002) and Native Hawaiian or Pacific Islander patients had higher odds of mortality (AOR, 1.003; 95% CI, 1.000-1.005; P=.019) compared with White patients. CONCLUSION Disparities regarding surgical outcome and utilization rates persist across orthopedic surgery. American Indian or Alaskan Native and Native Hawaiian or Pacific Islander patients, who are under-represented in research, have lower rates of arthroplasty but higher odds of medical complication, reoperation, and mortality. This study highlights the importance of including these patients in orthopedic research to affect policy-related discussions. [Orthopedics. 2024;47(3):e131-e138.].
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Lima HK, Licata A, Mattos S. Assessing the Landscape of Lactation Education: Results of a Pilot Survey. J Hum Lact 2024; 40:276-285. [PMID: 38419567 DOI: 10.1177/08903344241232402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND The field of lactation currently uses breastfeeding rates to measure effectiveness. While monitoring breastfeeding outcomes can provide insight into the successes of lactation consulting as a profession, the improvement of breastfeeding outcomes is a multifactorial issue. In order to facilitate the growth of lactation education processes, understanding experiences during training and perceptions of readiness of current International Board Certified Lactation Consultants (IBCLC) for clinical practice is necessary. RESEARCH AIM The aim of this survey was to provide a baseline assessment of the current landscape of the lactation profession through data related to certification, job market, practice confidence after passing the International Board of Lactation Consultant Examiners (IBLCE) certifying examination, and perceptions of specializations. METHODS A cross-sectional study design was used to assess the experiences of practicing IBCLCs. Non-probability convenience sampling was implemented from December 2021 through January 2022. A total of 281 unique responses were recorded with complete data on variables of interest. RESULTS The majority of respondents were white females under age 50 located in the United States. The majority of respondents were certified through a Pathway 1. The largest barrier to certification was reported to be a lack of clinical/mentorship opportunities. Respondents were significantly more confident in providing entry-level support to dyads when mentored by four or more preceptors. CONCLUSION Diversification of the field of lactation is necessary to provide appropriate support to lactating families in the United States. Additionally, addressing the barrier of accessing clinical/mentorship opportunities is essential for continued growth of the field of lactation.
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Affiliation(s)
| | - Ashley Licata
- Department of Human Nutrition, Winthrop University, Rock Hill, SC, USA
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Umeh UO. Examining disparities in regional anaesthesia and pain medicine. Br J Anaesth 2024; 132:1033-1040. [PMID: 38508942 DOI: 10.1016/j.bja.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/20/2024] [Accepted: 02/24/2024] [Indexed: 03/22/2024] Open
Abstract
In high-resource countries, health disparities exist in both treatment approaches and health outcomes. Race and ethnicity can serve as proxies for other socioeconomic factors and social determinants of health such as income, education, social support, and residential neighbourhood, which strongly influence health outcomes and disparities. In regional anaesthesia and pain medicine, disparities exist across several surgical specialties including obstetrics, paediatrics, and orthopaedic surgery. Understanding these disparities will facilitate development of solutions aimed at eliminating disparities at the patient, physician/provider, and healthcare system levels.
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Affiliation(s)
- Uchenna O Umeh
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
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Kaldany A, Patel HV, Gore A, Ahmed H, Ghodoussipour S, Park JH, Leitner DV, Jang TL. Effect of United States Medical Licensing Examination Score Cutoffs on Recruitment of Underrepresented Applicants in the Urology Match. Urology 2024; 187:25-30. [PMID: 38342381 DOI: 10.1016/j.urology.2023.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 02/13/2024]
Abstract
OBJECTIVE To determine how the use of United States Medical Licensing Examination (USMLE) score cutoffs during the screening process of the Urology Residency Match Program may affect recruitment of applicants who are underrepresented in medicine (URM). MATERIALS AND METHODS Deidentified data from the Association of American Medical Colleges' (AAMC) Electronic Residency Application Service (ERAS) system was reviewed, representing all applicants to our institution's urology residency program from 2018 to 2022. We analyzed self-reported demographic variables including race/ethnicity, age, sex/gender, as well as USMLE Step 1 and Step 2 scores. Chi-square tests and ANOVA were used to determine the association between race/ethnicity and other sociodemographic factors and academic metrics. Applicants were stratified according to USMLE Step 1 cutoff scores and the distribution of applicants by race/ethnicity was assessed using a Gaussian nonlinear regression fit. RESULTS A total of 1258 applicants submitted applications to our program during the 5-year period, including 872 males (69.3%) and 386 females (30.7%). Most applicants were White (43.5%), followed by Asian (28.3%), Hispanic/Latino (11.7%), and Black (7.0%). There was an association between race/ethnicity and USMLE scores. Median USMLE Step 1 scores for White, Asian, Hispanic/Latino, and Black applicants were 242, 242, 237, and 232, respectively (P < .001). As cutoff score increases, percentage of URM applicants decreases. CONCLUSION The use of cutoffs based on USMLE scores disproportionately affects URM applicants. Transitioning from numeric scores to pass/fail may enhance holistic review processes and increase the representation of URM applicants offered interviews at urology residency programs.
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Affiliation(s)
- Alain Kaldany
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Hiren V Patel
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Aditi Gore
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Haris Ahmed
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Saum Ghodoussipour
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Ji Hae Park
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Thomas L Jang
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
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Brumbaugh JE, Bann CM, Bell EF, Travers CP, Vohr BR, McGowan EC, Harmon HM, Carlo WA, Hintz SR, Duncan AF. Social Determinants of Health and Redirection of Care for Infants Born Extremely Preterm. JAMA Pediatr 2024; 178:454-464. [PMID: 38466268 PMCID: PMC10928542 DOI: 10.1001/jamapediatrics.2024.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/17/2024] [Indexed: 03/12/2024]
Abstract
Importance Redirection of care refers to withdrawal, withholding, or limiting escalation of treatment. Whether maternal social determinants of health are associated with redirection of care discussions merits understanding. Objective To examine associations between maternal social determinants of health and redirection of care discussions for infants born extremely preterm. Design, Setting, and Participants This is a retrospective analysis of a prospective cohort of infants born at less than 29 weeks' gestation between April 2011 and December 2020 at 19 National Institute of Child Health and Human Development Neonatal Research Network centers in the US. Follow-up occurred between January 2013 and October 2023. Included infants received active treatment at birth and had mothers who identified as Black or White. Race was limited to Black and White based on service disparities between these groups and limited sample size for other races. Maternal social determinant of health exposures were education level (high school nongraduate or graduate), insurance type (public/none or private), race (Black or White), and ethnicity (Hispanic or non-Hispanic). Main Outcomes and Measures The primary outcome was documented discussion about redirection of infant care. Secondary outcomes included subsequent redirection of care occurrence and, for those born at less than 27 weeks' gestation, death and neurodevelopmental impairment at 22 to 26 months' corrected age. Results Of the 15 629 infants (mean [SD] gestational age, 26 [2] weeks; 7961 [51%] male) from 13 643 mothers, 2324 (15%) had documented redirection of care discussions. In unadjusted comparisons, there was no significant difference in the percentage of infants with redirection of care discussions by race (Black, 1004/6793 [15%]; White, 1320/8836 [15%]) or ethnicity (Hispanic, 291/2105 [14%]; non-Hispanic, 2020/13 408 [15%]). However, after controlling for maternal and neonatal factors, infants whose mothers identified as Black or as Hispanic were less likely to have documented redirection of care discussions than infants whose mothers identified as White (Black vs White adjusted odds ratio [aOR], 0.84; 95% CI, 0.75-0.96) or as non-Hispanic (Hispanic vs non-Hispanic aOR, 0.72; 95% CI, 0.60-0.87). Redirection of care discussion occurrence did not differ by maternal education level or insurance type. Conclusions and Relevance For infants born extremely preterm, redirection of care discussions occurred less often for Black and Hispanic infants than for White and non-Hispanic infants. It is important to explore the possible reasons underlying these differences.
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Affiliation(s)
- Jane E. Brumbaugh
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carla M. Bann
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina
| | | | - Colm P. Travers
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Betty R. Vohr
- Department of Pediatrics, Women & Infants Hospital of Rhode Island and Warren Albert Medical School of Brown University, Providence
| | - Elisabeth C. McGowan
- Department of Pediatrics, Women & Infants Hospital of Rhode Island and Warren Albert Medical School of Brown University, Providence
| | | | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Susan R. Hintz
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, California
| | - Andrea F. Duncan
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Beckman AL, Ryan AM, Figueroa JF. The Rise and Risks of Medicare Advantage "Affinity Plans". JAMA 2024; 331:1271-1272. [PMID: 38506818 DOI: 10.1001/jama.2024.1703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
This Viewpoint discusses the proliferation of Medicare Advantage plans targeting specific groups of individuals and whether these plans will improve quality of care for beneficiaries.
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Affiliation(s)
- Adam L Beckman
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew M Ryan
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Jose F Figueroa
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Megafu MN. Where are the Black men in osteopathic medical schools? J Osteopath Med 2024; 0:jom-2023-0091. [PMID: 38594971 DOI: 10.1515/jom-2023-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
Over the past decade, the American Association of Colleges of Osteopathic Medicine (AACOM) and the Association of American Medical Colleges (AAMC) have emphasized the need to enhance diversity within medical education. Despite concerted efforts, the representation of underrepresented populations in medicine (URiM), particularly Black men, remains alarmingly low. This commentary delves into the persisting challenges and potential solutions surrounding the lack of diversity of Black men in osteopathic schools. Black men, in particular, continue to be significantly underrepresented in osteopathic medical schools across the United States. Factors contributing to this disparity include limited access to resources, pervasive negative stereotypes, and biases within the medical community. Addressing these challenges necessitates multifaceted interventions such as mentorship programs, pipeline initiatives, and implicit bias training to enhance the recruitment and support for URiM applicants, particularly Black men. Institutions like Touro College of Osteopathic Medicine and A.T. Still University have underscored the importance of tailoring programs in fostering a sense of belonging and academic success among Black men aspiring to be osteopathic physicians. The creation of a supportive environment for Black men in osteopathic medical schools is not only crucial for promoting diversity but also crucial for improving patient health outcomes, because research consistently depicts enhanced patient outcomes and experiences with diverse healthcare teams. However, despite progress in some areas, Black men continue to face systemic barriers and biases that hinder the pursuit of a career in osteopathic medicine. Thus, increasing the representation of Black men in osteopathic medical schools requires a concerted effort from all stakeholders, including medical institutions, policymakers, and the broader medical community. By implementing targeted interventions, fostering a sense of belonging, and addressing systemic barriers, the medical community can work toward a more equitable and inclusive future in healthcare. Ultimately, promoting diversity is not only a matter of fairness but also essential for ensuring the delivery of high-quality, culturally competent care to all patients.
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Affiliation(s)
- Michael N Megafu
- 4270 A. T. Still University Kirksville College of Osteopathic Medicine , Kirksville, MO, USA
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Glover A, Holman C, Boise P. Patient-centered respectful maternity care: a factor analysis contextualizing marginalized identities, trust, and informed choice. BMC Pregnancy Childbirth 2024; 24:267. [PMID: 38605316 PMCID: PMC11010273 DOI: 10.1186/s12884-024-06491-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/07/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Increasing rates of maternal mortality and morbidity, coupled with ever-widening racial health disparities in maternal health outcomes, indicate that radical improvements need to be made in the delivery of maternity care. This study explored the provision of patient-centered maternity care from the perspective of pregnant and postpartum people; experiences of respect and autonomy were examined through the multi-dimensional contexts of identity, relational trust, and protection of informed choices. METHODS We conducted primary data collection among individuals who experienced a pregnancy in the five years preceding the survey (N = 484) using the validated Mothers on Respect Index (MORi) and Mothers Autonomy in Decision Making (MADM) scale. We conducted an exploratory factor analysis (EFA) which produced three factor variables: trust, informed choice, and identity. Using these factor variables as dependent variables, we conducted bivariate and multivariate analysis to examine the relationship between these factor variables and social marginalization, as measured by race, disability, justice-involvement, and other social risk factors, such as food and housing insecurity. RESULTS Results of our bivariate and multivariate models generally confirmed our hypothesis that increased social marginalization would be associated with decreased experiences of maternity care that was perceived as respectful and protective of individual autonomy. Most notably, AI/AN individuals, individuals who are disabled, and individuals who had at least one social risk factor were more likely to report experiencing identity-related disrespect and violations of their autonomy. CONCLUSIONS In light of the findings that emphasize the importance of patient identity in their experience in the healthcare system, patient-centered and respectful maternity care must be provided within a broader social context that recognizes unequal power dynamics between patient and provider, historical trauma, and marginalization. Provider- and facility-level interventions that improve patient experiences and health outcomes will be more effective if they are contextualized and informed by an understanding of how patients' identities and traumas shape their healthcare experience, health-seeking behaviors, and potential to benefit from clinical interventions and therapies.
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Affiliation(s)
- Annie Glover
- University of Montana Rural Institute for Inclusive Communities, Missoula, US.
- University of Montana School of Public & Community Health Sciences, Missoula, US.
| | - Carly Holman
- University of Montana Rural Institute for Inclusive Communities, Missoula, US
- University of Montana School of Public & Community Health Sciences, Missoula, US
| | - Patrick Boise
- University of Montana Rural Institute for Inclusive Communities, Missoula, US
- University of Montana School of Public & Community Health Sciences, Missoula, US
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