1
|
Mukhopadhyay B, Thambinathan V, Kinsella EA. Towards anti-racist futures: a scoping review exploring educational interventions that address systemic racism in post graduate medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10343-1. [PMID: 38874647 DOI: 10.1007/s10459-024-10343-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/19/2024] [Indexed: 06/15/2024]
Abstract
Since 2020, brought to the forefront by movements such as Black Lives Matter and Idle No More, it has been widely acknowledged that systemic racism contributes to racially differentiated health outcomes. Health professional educators have been called to address such disparities within healthcare, policy, and practice. To tackle structural racism within healthcare, one avenue that has emerged is the creation of medical education interventions within postgraduate residency medical programming. The objective of this scoping review is to examine the current literature on anti-racist educational interventions, that integrate a systemic or structural view of racism, within postgraduate medical education. Through the identification and analysis of 23 papers, this review identified three major components of interest across medical interventions, including (a) conceptualization, (b) pedagogical issues, and (c) outcomes & evaluation. There were overlapping points of discussion and analysis within each of these components. Conceptualization addressed how researchers conceptualized racism in different ways, the range of curricular content educators chose to challenge racism, and the absence of community's role in curricular development. Pedagogical issues addressed knowledge vs. skills-based teaching, and tensions between one-time workshops and integrative curriculum. Outcomes and evaluation highlighted self-reported Likert scales as dominant types of evaluation, self-evaluation in educational interventions, and misalignments between intervention outcomes and learning objectives. The findings are unique in their in-depth exploration of anti-racist medical interventions within postgraduate medical education programming, specifically in relation to efforts to address systemic and structural racism. The findings contribute a meaningful review of the current state of the field of medical education and generate new conversations about future possibilities for a broader anti-racist health professions curriculum.
Collapse
Affiliation(s)
- Baijayanta Mukhopadhyay
- Office of Social Accountability and Community Engagement, Faculty of Medicine and Health Sciences, Institute of Health Sciences Education, McGill University, Montreal, QC, Canada.
| | - Vivetha Thambinathan
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
| | - Elizabeth Anne Kinsella
- Department of Equity, Ethics and Policy, Faculty of Medicine and Health Sciences, Institute of Health Sciences Education, McGill University, Montreal, QC, Canada
| |
Collapse
|
2
|
Ng SH, Kaur S, Cheah PY, Ong ZL, Lim J, Voo TC. Migration health ethics in Southeast Asia: a scoping review. Wellcome Open Res 2024; 8:391. [PMID: 38595706 PMCID: PMC11002524 DOI: 10.12688/wellcomeopenres.19572.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 04/11/2024] Open
Abstract
Background Asia hosts the second-largest international migrant population in the world. In Southeast Asia (SEA), key types of migration are labour migration, forced migration, and environmental migration. This scoping review seeks to identify key themes and gaps in current research on the ethics of healthcare for mobile and marginalised populations in SEA, and the ethics of research involving these populations. Methods We performed a scoping review using three broad concepts: population (stateless population, migrants, refugees, asylum seekers, internally displaced people), issues (healthcare and ethics), and context (11 countries in SEA). Three databases (PubMed, CINAHL, and Web of Science) were searched from 2000 until May 2023 over a period of four months (February 2023 to May 2023). Other relevant publications were identified through citation searches, and six bioethics journals were hand searched. All searches were conducted in English, and relevant publications were screened against the inclusion and exclusion criteria. Data were subsequently imported into NVivo 14, and thematic analysis was conducted. Results We identified 18 papers with substantial bioethical analysis. Ethical concepts that guide the analysis were 'capability, agency, dignity', 'vulnerability', 'precarity, complicity, and structural violence' (n=7). Ethical issues were discussed from the perspective of research ethics (n=9), clinical ethics (n=1) and public health ethics (n=1). All publications are from researchers based in Singapore, Thailand, and Malaysia. Research gaps identified include the need for more research involving migrant children, research from migrant-sending countries, studies on quality of migrant healthcare, participatory health research, and research with internal migrants. Conclusions More empirical research is necessary to better understand the ethical issues that exist in the domains of research, clinical care, and public health. Critical examination of the interplay between migration, health and ethics with consideration of the diverse factors and contexts involved is crucial for the advancement of migration health ethics in SEA.
Collapse
Affiliation(s)
- Shu Hui Ng
- School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, 47500, Malaysia
| | - Sharon Kaur
- Faculty of Law, University Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, 50603, Malaysia
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Oxford, OX3 7LG, UK
| | - Zhen Ling Ong
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, University Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, 50603, Malaysia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Jane Lim
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
| | - Teck Chuan Voo
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
| |
Collapse
|
3
|
Thompson CM, Bishop MJ, Dillard TC, Maurice JM, Rollins DD, Pulido MD, Salas MJ, Mendelson EA, Yan J, Gerlikovski ER, Benevento SV, Zeinstra C, Kesavadas T. Healing Health Care Disparities: Development and Pilot Testing of a Virtual Reality Implicit Bias Training Module for Physicians in the Context of Black Maternal Health. HEALTH COMMUNICATION 2024:1-12. [PMID: 38711251 DOI: 10.1080/10410236.2024.2347000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Grounded in communication models of cultural competence, this study reports on the development and testing of the first module in a larger virtual reality (VR) implicit bias training for physicians to help them better: (a) recognize implicit bias and its effects on communication, patients, and patient care; (b) identify their own implicit biases and exercise strategies for managing them; and (c) learn and practice communicating with BIPOC patients in a culture-centered manner that demonstrates respect and builds trust. Led by communication faculty, a large, interdisciplinary team of researchers, clinicians, and engineers developed the first module tested herein focused on training goal (a). Within the module, participants observe five scenes between patient Marilyn Hayes (a Black woman) and Dr. Richard Flynn (her obstetrician, a White man) during a postpartum visit. The interaction contains examples of implicit bias, and participants are asked to both identify and consider how implicit bias impacts communication, the patient, and patient care. The team recruited 30 medical students and resident physicians to participate in a lab-based study that included a pretest, a training experience of the module using a head-mounted VR display, and a posttest. Following the training, participants reported improved attitudes toward implicit bias instruction, greater importance of determining patients' beliefs and perspectives for history-taking, treatment, and providing quality health care; and greater communication efficacy. Participants' agreement with the importance of assessing patients' perspectives, opinions, and psychosocial and cultural contexts did not significantly change. Implications for medical education about cultural competency and implicit bias are discussed.
Collapse
Affiliation(s)
- Charee M Thompson
- Department of Communication, University of Illinois Urbana-Champaign
| | - Mardia J Bishop
- Department of Communication, University of Illinois Urbana-Champaign
| | | | - Joseph M Maurice
- Department of Obstetrics & Gynecology, Creighton University School of Medicine
| | - Déjà D Rollins
- Department of Communication, University of Illinois Urbana-Champaign
| | - Manuel D Pulido
- Department of Communication Studies, California State University, Long Beach
| | - M J Salas
- School of Communication and Information, Rutgers University
| | - Emily A Mendelson
- Department of Communication, University of Illinois Urbana-Champaign
| | - Jia Yan
- Department of Communication, University of Illinois Urbana-Champaign
| | | | - Sarah V Benevento
- Department of Communication, University of Illinois Urbana-Champaign
| | | | - Thenkurussi Kesavadas
- Division of Research and Economic Development, University at Albany, The State University of New York
| |
Collapse
|
4
|
Jecke L, Zepf FD. Delivering transgender-specific knowledge and skills into health and allied health studies and training: a systematic review. Eur Child Adolesc Psychiatry 2024; 33:1327-1354. [PMID: 37115277 PMCID: PMC11098887 DOI: 10.1007/s00787-023-02195-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/11/2023] [Indexed: 04/29/2023]
Abstract
Many transgender individuals face inequities, discrimination, and sometimes even a lack of transgender-specific knowledge in health care settings. Educational curricula can address such disparities and help future health professionals to become more knowledgeable, confident, and well-prepared for addressing the needs of transgender individuals. This systematic review aims to summarize current training interventions about care of transgender individuals for health and allied health students, and to analyse the effects of the respective intervention. A total of six databases (Pubmed, MEDLINE, Scopus, Web of Science, Embase and SciSearch) were screened for original articles published between 2017 and June 2021. Search terms and eligibility criteria were pre-specified, and after a structured selection process 21 studies were included into further analysis. Extracted data contained information on general study properties, population, design, program format and outcomes of interest. A narrative synthesis was used to summarize detected results. Study quality was assessed for each individual study. A self-developed 18-item checklist combining criteria of two prior published tools was used to assess overall quality of quantitative studies. For qualitative studies a 10-item checklist by Kmet et al. [HTA Initiat, 2004] was applied. Eligible studies were designed for multiple health or allied health profession students, and varied widely regarding program format, duration, content, and assessed outcomes. Almost all (N = 19) interventions indicated improvements in knowledge, attitude, confidence and comfort levels or practical skills concerning care for transgender clients. Major limitations included the lack of long-term data, validated assessment tools, control groups and comparative studies. Training interventions contribute to prepare future health professionals to deliver competent and sensitive care and which may improve the prospective experienced health care reality of transgender individuals. However, currently there is no common consensus about best practice of education. Additionally, little is known about whether detected effects of training interventions translate into noticeable improvements for transgender clients. Further studies are warranted to assess the direct impact of specific interventions in the light of the respective target populations.
Collapse
Affiliation(s)
- L Jecke
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - F D Zepf
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany.
- German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Jena, Germany.
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, Jena, Germany.
| |
Collapse
|
5
|
O'Brien L, Wassall N, Cadoret D, Petrović A, O'Donnell P, Neville S. Perceptions of and preparedness for cross-cultural care: a survey of final-year medical students in Ireland. BMC MEDICAL EDUCATION 2024; 24:472. [PMID: 38685005 PMCID: PMC11059656 DOI: 10.1186/s12909-024-05392-4] [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: 08/20/2023] [Accepted: 04/04/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Migration is increasing globally, and societies are becoming more diverse and multi-ethnic. Medical school curricula should prepare students to provide high-quality care to all individuals in the communities they serve. Previous research from North America and Asia has assessed the effectiveness of medical cultural competency training, and student preparedness for delivery of cross-cultural care. However, student preparedness has not been explored in the European context. The aim of this study was to investigate how prepared final-year medical students in the Republic of Ireland (ROI) feel to provide care to patients from other countries, cultures, and ethnicities. In addition, this study aims to explore students' experiences and perceptions of cross-cultural care. METHODS Final-year medical students attending all six medical schools within the ROI were invited to participate in this study. A modified version of the Harvard Cross-Cultural Care Survey (CCCS) was used to assess their preparedness, skill, training/education, and attitudes. The data were analysed using IBM SPSS Statistics 28.0, and Fisher's Exact Test was employed to compare differences within self-identified ethnicity groups and gender. RESULTS Whilst most respondents felt prepared to care for patients in general (80.5%), many felt unprepared to care for specific ethnic patient cohorts, including patients from a minority ethnic background (50.7%) and the Irish Traveller Community (46.8%). Only 20.8% of final-year students felt they had received training in cross-cultural care during their time in medical school. Most respondents agreed that they should be assessed specifically on skills in cultural competence whilst in medical school (83.2%). CONCLUSIONS A large proportion of final-year medical students surveyed in Ireland feel inadequately prepared to care for ethnically diverse patients. Similarly, they report feeling unskilled in core areas of cross-cultural care, and a majority agree that they should be assessed on aspects of cultural competency. This study explores shortcomings in cultural competency training and confidence amongst Irish medical students. These findings have implications for future research and curricular change, with opportunities for the development of relevant educational initiatives in Irish medical schools.
Collapse
Affiliation(s)
- Lesley O'Brien
- School of Medicine, University of Limerick, Limerick, Republic of Ireland.
| | - Nicola Wassall
- School of Medicine, University of Limerick, Limerick, Republic of Ireland
| | - Danielle Cadoret
- School of Medicine, University of Limerick, Limerick, Republic of Ireland
| | | | - Patrick O'Donnell
- School of Medicine, University of Limerick, Limerick, Republic of Ireland
| | - Siobhán Neville
- School of Medicine, University of Limerick, Limerick, Republic of Ireland
| |
Collapse
|
6
|
Dickson CA, Ergun-Longmire B, Greydanus DE, Eke R, Giedeman B, Nickson NM, Hoang LN, Adabanya U, Payares DVP, Chahin S, McCrary J, White K, Moon JH, Haitova N, Deleon J, Apple RW. Health equity in pediatrics: Current concepts for the care of children in the 21st century (Dis Mon). Dis Mon 2024; 70:101631. [PMID: 37739834 DOI: 10.1016/j.disamonth.2023.101631] [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] [Indexed: 09/24/2023]
Abstract
This is an analysis of important aspects of health equity in caring for children and adolescents written by a multidisciplinary team from different medical centers. In this discussion for clinicians, we look at definitions of pediatric health equity and the enormous impact of social determinants of health in this area. Factors involved with pediatric healthcare disparities that are considered include race, ethnicity, gender, age, poverty, socioeconomic status, LGBT status, living in rural communities, housing instability, food insecurity, access to transportation, availability of healthcare professionals, the status of education, and employment as well as immigration. Additional issues involved with health equity in pediatrics that are reviewed will include the impact of the COVID-19 pandemic, behavioral health concepts, and the negative health effects of climate change. Recommendations that are presented include reflection of one's own attitudes on as well as an understanding of these topics, consideration of the role of various healthcare providers (i.e., community health workers, peer health navigators, others), the impact of behavioral health integration, and the need for well-conceived curricula as well as multi-faceted training programs in pediatric health equity at the undergraduate and postgraduate medical education levels. Furthermore, ongoing research in pediatric health equity is needed to scrutinize current concepts and stimulate the development of ideas with an ever-greater positive influence on the health of our beloved children. Clinicians caring for children can serve as champions for the optimal health of children and their families; in addition, these healthcare professionals are uniquely positioned in their daily work to understand the drivers of health inequities and to be advocates for optimal health equity in the 21st century for all children and adolescents.
Collapse
Affiliation(s)
- Cheryl A Dickson
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Berrin Ergun-Longmire
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Donald E Greydanus
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
| | - Ransome Eke
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Bethany Giedeman
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Nikoli M Nickson
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Linh-Nhu Hoang
- Department of Psychology, Western Michigan University, Kalamazoo, MI, United States
| | - Uzochukwu Adabanya
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Daniela V Pinto Payares
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Summer Chahin
- Department of Psychology, C.S. Mott Children's Hospital/Michigan Medicine, Ann Arbor, MI, United States
| | - Jerica McCrary
- Center for Rural Health and Health Disparities, Mercer University School of Medicine, Columbus, GA, United States
| | - Katie White
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Jin Hyung Moon
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Nizoramo Haitova
- Department of Educational Leadership, Research and Technology, Western Michigan University, Kalamazoo, MI, United States
| | - Jocelyn Deleon
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Roger W Apple
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| |
Collapse
|
7
|
Worku F, Bennett F, Wheeler S, Siddiqi A, Papadakos J. Exploring the COVID-19 Knowledge, Attitudes, and Practices (KAPs) in the Black Community: a Scoping Review. J Racial Ethn Health Disparities 2024; 11:273-299. [PMID: 36757610 PMCID: PMC9910259 DOI: 10.1007/s40615-023-01518-4] [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: 07/25/2022] [Revised: 01/06/2023] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION AND BACKGROUND Racial minorities have been the focal point of media coverage, attributing the disproportionate impact of COVID-19 to their individual actions; however, the ability to engage in preventative practices can also depend on one's social determinants of health. Individual actions can include knowledge, attitudes, and practices (KAPs). Since Black communities are among those disproportionately affected by COVID-19, this scoping review explores what is known about COVID-19 KAPs among Black populations. METHODS A comprehensive literature search was conducted in 2020 for articles written in English from the Medline, Embase, and PsycInfo databases. Reviews, experimental research, and observational studies were included if they investigated at least one of COVID-19 KAP in relation to the pandemic and Black communities in OECD peer countries including Canada, the United States, and the United Kingdom. RESULTS AND ANALYSIS Thirty-one articles were included for analysis, and all employed observational designs were from the United States. The following KAPs were examined: 6 (18.8%) knowledge, 21 (65.6%) attitudes, and 22 (68.8%) practices. Black communities demonstrated high levels of adherence to preventative measures (e.g., lockdowns) and practices (e.g., mask wearing), despite a strong proportion of participants believing they were less likely to become infected with the virus, and having lower levels of COVID-19 knowledge, than other racial groups. CONCLUSIONS AND IMPLICATIONS The findings from this review support that Black communities highly engage in COVID-19 preventative practices within their realm of control such as mask-wearing and hand washing and suggest that low knowledge does not predict low practice scores among this population.
Collapse
Affiliation(s)
- Fiqir Worku
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Avenue, Toronto, ON, M5T 3M7, Canada.
| | - Falan Bennett
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sarah Wheeler
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Avenue, Toronto, ON, M5T 3M7, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Janet Papadakos
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Avenue, Toronto, ON, M5T 3M7, Canada
- Cancer Health Literacy Research Centre, Princess Margaret Cancer Centre, Toronto, Canada
- The Institute for Education Research (TIER), University Health Network, Toronto, Canada
| |
Collapse
|
8
|
Jarrar R, Lim R, Richardson CL, Naqvi AA, Rathbone AP, Lau WM. How cultural competence is conceptualised, developed and delivered in pharmacy education: a systematic review. Int J Clin Pharm 2024; 46:40-55. [PMID: 37755644 PMCID: PMC10830822 DOI: 10.1007/s11096-023-01644-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND It is important to have a pharmacy workforce that is culturally competent to recognise a patient's health beliefs to improve medication adherence and reduce poor treatment outcomes. AIM This systematic review aimed to identify, critically appraise and summarise how cultural competency is conceptualised, developed and embedded in pre-qualification pharmacy education. METHOD Medline, Scopus, PsychInfo, Web of Knowledge, CINAHL, and Embase databases were searched for relevant papers published in English between January 2012 and December 2021, following PRISMA guidelines. Data from included papers were thematically analysed. Educational quality of papers was appraised using the GREET criteria. This systematic review was registered on PROSPERO, CRD42021295875. RESULTS The review included 47 papers (46 studies) with 18 papers meeting ≥ 9 points on the GREET criteria thus considered of good educational quality. Forty papers focused on educational interventions implemented to pharmacy students only, the remaining included students from different health disciplines. Half of the educational interventions focused on cultural competence in general. Most educational interventions lasted over a week and 21 were compulsory. Cultural competence conceptualisation varied; a focus on knowledge about different cultures or on culturally competent behaviours or a continuum with knowledge at one end and behaviour at the other. CONCLUSION There is variation in how cultural competence is embedded in pharmacy programmes, which could be a reflection of the differences in how educators conceptualised cultural competence. Further research is needed to develop a unified understanding of the meaning of cultural competence and how it can be embedded in pharmacy education.
Collapse
Affiliation(s)
- Rawand Jarrar
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle upon Tyne, NE1 7RU, UK
| | - Rosemary Lim
- Reading School of Pharmacy, University of Reading, Whiteknights, Reading, RG6 6AP, UK
| | - Charlotte Lucy Richardson
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle upon Tyne, NE1 7RU, UK
| | - Atta Abbas Naqvi
- Reading School of Pharmacy, University of Reading, Whiteknights, Reading, RG6 6AP, UK
| | - Adam Pattison Rathbone
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle upon Tyne, NE1 7RU, UK
| | - Wing Man Lau
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle upon Tyne, NE1 7RU, UK.
| |
Collapse
|
9
|
Lopez KN, Allen KY, Baker-Smith CM, Bravo-Jaimes K, Burns J, Cherestal B, Deen JF, Hills BK, Huang JH, Lizano Santamaria RW, Lodeiro CA, Melo V, Moreno JS, Nuñez Gallegos F, Onugha H, Pastor TA, Wallace MC, Ansah DA. Health Equity and Policy Considerations for Pediatric and Adult Congenital Heart Disease Care among Minoritized Populations in the United States. J Cardiovasc Dev Dis 2024; 11:36. [PMID: 38392250 PMCID: PMC10888593 DOI: 10.3390/jcdd11020036] [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: 12/29/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
Achieving health equity in populations with congenital heart disease (CHD) requires recognizing existing disparities throughout the lifespan that negatively and disproportionately impact specific groups of individuals. These disparities occur at individual, institutional, or system levels and often result in increased morbidity and mortality for marginalized or racially minoritized populations (population subgroups (e.g., ethnic, racial, social, religious) with differential power compared to those deemed to hold the majority power in the population). Creating actionable strategies and solutions to address these health disparities in patients with CHD requires critically examining multilevel factors and health policies that continue to drive health inequities, including varying social determinants of health (SDOH), systemic inequities, and structural racism. In this comprehensive review article, we focus on health equity solutions and health policy considerations for minoritized and marginalized populations with CHD throughout their lifespan in the United States. We review unique challenges that these populations may face and strategies for mitigating disparities in lifelong CHD care. We assess ways to deliver culturally competent CHD care and to help lower-health-literacy populations navigate CHD care. Finally, we review system-level health policies that impact reimbursement and research funding, as well as institutional policies that impact leadership diversity and representation in the workforce.
Collapse
Affiliation(s)
- Keila N Lopez
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kiona Y Allen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Carissa M Baker-Smith
- Center for Cardiovascular Research and Innovation, Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE 19803, USA
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Joseph Burns
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Bianca Cherestal
- Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, MO 64108, USA
| | - Jason F Deen
- Department of Pediatrics and Medicine, University of Washington, Seattle, WA 98105, USA
| | - Brittany K Hills
- Division of Pediatric Cardiology, UT Southwestern, Children's Health, Dallas, TX 75390, USA
| | - Jennifer H Huang
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR 97239, USA
| | | | - Carlos A Lodeiro
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Valentina Melo
- Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jasmine S Moreno
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Flora Nuñez Gallegos
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, San Francisco, CA 94158, USA
| | - Harris Onugha
- Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Tony A Pastor
- Division of Pediatric Cardiology, Yale School of Medicine, Yale New Haven Hospital, New Haven, CT 06510, USA
| | - Michelle C Wallace
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Deidra A Ansah
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| |
Collapse
|
10
|
Iwai Y, Holdren S, Browne AR, Lenze NR, Lopez FG, Randolph AM, Weil AB. By Medical Students, for Medical Students: A Narrative Medicine Antiracism Program. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241261238. [PMID: 38882027 PMCID: PMC11179471 DOI: 10.1177/23821205241261238] [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: 01/11/2024] [Accepted: 05/17/2024] [Indexed: 06/18/2024]
Abstract
Objectives Medical schools have sought to incorporate concepts of race and racism in their curricula to facilitate students' abilities to grapple with healthcare disparities in the United States; however, these efforts frequently fail to address implicit bias or equip students with cultural humility, reflective capacity, and interpersonal skills required to navigate racialized systems in healthcare. The purpose of this study was to develop and evaluate an antiracism narrative medicine (NM) program designed by and for preclinical medical students. Method Preclinical medical students at a single center were eligible to participate from June-July 2021. Program evaluation included a postprogram qualitative interview and electronic survey. The semistructured interview included questions about program experience, lessons learned, and perspectives on antiracism curricula in medical education. Interviews were qualitatively analyzed using open and axial coding. Survey data were analyzed with descriptive statistics. Results A total of 30 students registered. All (100%) respondents reported "somewhat true" or "very true" in the postprogram survey when asked about their ability to reflect on their own racial identity, racial identity of others, and influence of their racial identity on their future role as a healthcare worker through the program. Qualitative analysis revealed 3 themes: (1) curricular engagement; (2) racism and antiracism in medicine; and (3) group experience. Subthemes included: meaningful theoretical content; multimodal works and unique perspectives; race, identity, and intersectionality; deeper diversity, equity, and inclusion engagement; reconstructive visions; future oriented work; close reading and writing build confidence in discomfort; community and support system; and authentic space among peer learners. Conclusion This virtual, peer-facilitated antiracism NM program provided an engaging and challenging experience for participants. Postprogram interviews revealed the program deepened students' understanding of racism, promoted self-reflection and community building, and propagated reconstructive visions for continuing antiracism work.
Collapse
Affiliation(s)
- Yoshiko Iwai
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Sarah Holdren
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Alyssa R Browne
- Department of Sociology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Nicholas R Lenze
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Felix Gabriel Lopez
- Department of Psychology, The New School for Social Research, New York, NY, USA
| | - Antonia M Randolph
- Department of American Studies, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Amy B Weil
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| |
Collapse
|
11
|
Stryker SD, Conway K, Kaeppler C, Porada K, Tam RP, Holmberg PJ, Schubert C. Underprepared: influences of U.S. medical students' self-assessed confidence in immigrant and refugee health care. MEDICAL EDUCATION ONLINE 2023; 28:2161117. [PMID: 36594616 PMCID: PMC9815430 DOI: 10.1080/10872981.2022.2161117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/19/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND United States (U.S.) census data from 2017 indicates that the percentage of persons born outside of the U.S. is increasing. However, no studies describe the amount of class time focused on immigrant and refugee health during medical school in the U.S. nor on incoming residents' confidence in providing culturally sensitive care. The objective of this study is to characterize final-year medical students' exposure to immigrant and refugee health and their confidence in caring for these populations. METHODS A voluntary, cross-sectional survey was sent electronically to fourth-year medical students at twelve U.S. medical schools in 2020, with 707 respondents (46% response rate). Questions addressed respondents' curricular exposure to immigrant and refugee health care during medical school and their confidence in providing culturally sensitive care. Chi-square tests were used to assess relationships between categorical variables, and odds ratios were calculated for dichotomized variables. RESULTS Most students (70.6%) described insufficient class time dedicated to culturally sensitive care, and many (64.5%) reported insufficient clinical exposure in caring for immigrants/refugees. The odds that incoming residents felt 'usually' or 'always' confident in their ability to provide culturally sensitive care to immigrants and refugees were higher in those with more class time on culturally sensitive care (OR 5.2 [3.6-7.4]), those with more clinical opportunities to care for immigrants and refugees (OR 7.2 [5.1-10.2]), and those who participated in a domestic low-resource or international elective (OR 1.4 [1.02-1.9]). More than half (55.3%) of respondents reported feeling 'not at all' or only 'sometimes' confident in their ability to provide culturally sensitive care to immigrants/refugees. CONCLUSIONS Most fourth-year U.S. medical students entering residency feel unprepared to deliver culturally sensitive care to immigrants and refugees. This may be mediated by increased exposure to didactic curricula class time and/or experiential clinical activities, as those factors are associated with improved student confidence.
Collapse
Affiliation(s)
- Shanna D. Stryker
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Katharine Conway
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
| | - Caitlin Kaeppler
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin,USA
| | - Kelsey Porada
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin,USA
| | - Reena P. Tam
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Charles Schubert
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | |
Collapse
|
12
|
Asokan N. Community Dermatology: Current Status and the Way Forward. Indian Dermatol Online J 2023; 14:762-768. [PMID: 38099039 PMCID: PMC10718120 DOI: 10.4103/idoj.idoj_497_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/02/2022] [Accepted: 12/13/2022] [Indexed: 12/17/2023] Open
Abstract
Community health interventions in dermatology have the potential to deliver healthcare to large populations. Such interventions can bridge the gap between increasing demands from vast populations and limited availability and asymmetric geographical distribution of specialist doctors. This narrative review aims to delineate various areas in which community dermatology initiatives are useful, the different approaches used, and the factors which could determine their effectiveness. We did a PubMed search using the search terms, "Community Health Services"[Mesh]) AND "Dermatology"[Mesh]. A further literature search was performed by cross-referencing these articles. In addition to its primary purpose of increasing access, community involvement can augment medical education, foster research, and help to develop more patient-centered clinical guidelines, understand disease trends and influences of the environment on various diseases, and formulate population-centered health policy. Task shifting, development of culture-sensitive and gender-sensitive community healthcare teams, disease-specific patient support groups, and use of advances in technology such as telemedicine are some of the important methods used in community dermatology. Task shifting may be performed at different levels - general practitioners, pharmacists, nurses, and community health workers. Community interventions harness volunteerism among health professionals as well as various stakeholders in the community. Partnering with non-governmental organizations, involving members of the community, and being a part of a long-term public health program help to sustain community interventions. The interventions should adapt to the ethical and cultural norms of the community. Continuity of care, fidelity, and evidence support are crucial for the success of community interventions in dermatology.
Collapse
Affiliation(s)
- Neelakandhan Asokan
- Department of Dermatology and Venereology, Government Medical College, Thrissur, Kerala, India
| |
Collapse
|
13
|
Kulesa J, Crawford L, Ferrer K, Thahane L, Sanders J, Ottolini M, Chua I. Cultural Considerations for Patient and Community Education in Global Health: A Qualitative Study in Lesotho. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2023; 44:55-63. [PMID: 37724028 DOI: 10.1177/0272684x221074447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Background: In global health, international nongovernmental organizations (NGOs) frequently hire, train, and partner with host-country clinicians who manage public outreach and patient care. Purpose and Research Design: We conducted a general interpretivist study of Basotho clinicians hired by NGOs and academic affiliates in Lesotho to identify cultural barriers and facilitators to community and patient education. Data Collection and Analysis: We conducted 13 interviews involving 16 participants (one physician, one nutritionist, 14 nurses). Using an inductive and iterative approach, we analyzed interview transcripts through the lens of social cognitive theory and identified 15 themes. Results: Major findings highlighted: 1) patient and community learners may view Basotho clinicians as authority figures; 2) family and community power dynamics affect healthcare access for vulnerable patient groups; and 3) village leaders may refuse community education when excluded from problem-solving and early planning. Conclusions: Although local clinicians and community members may identify with the same cultural group, clinicians can encounter cultural barriers to patient and community education.
Collapse
Affiliation(s)
- John Kulesa
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Children's National Hospital, Washington, DC, USA
| | | | - Kathleen Ferrer
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Children's National Hospital, Washington, DC, USA
| | - Lineo Thahane
- Baylor College of Medicine, Children's Foundation - Lesotho, Maseru, Lesotho
- Baylor College of Medicine, Houston, TX, USA
- Baylor College of Medicine, International Pediatric AIDS Initiative, Houston, TX. USA
| | - Jill Sanders
- Baylor College of Medicine, Children's Foundation - Lesotho, Maseru, Lesotho
| | | | - Ian Chua
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Children's National Hospital, Washington, DC, USA
- Stanford University School of Medicine, Palo Alto, CA, USA
| |
Collapse
|
14
|
Lauckner C, Lambert D, Truszczynski N, Jann JT, Hansen N. A qualitative assessment of barriers to healthcare and HIV prevention services among men who have sex with men in non-metropolitan areas of the south. AIDS Care 2023; 35:1563-1569. [PMID: 35914115 DOI: 10.1080/09540121.2022.2105798] [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: 08/19/2021] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
Abstract
HIV cases are increasing in the rural Southern United States, especially among men who have sex with men (MSM). To facilitate healthcare access and encourage HIV prevention for non-metropolitan MSM, it is essential to examine their barriers to care. This qualitative study conducted semi-structured interviews with 20 MSM living in non-metropolitan areas of the South. Analysis revealed that MSM experience multiple barriers accessing healthcare in non-metropolitan areas such as finding knowledgeable and affirming providers with desired characteristics and beliefs and communicating with providers about sexual health and HIV prevention. To aid in identification, many respondents expressed a desire for providers to publicly signal that they provide care for sexual and gender minority patients and are an inclusive clinical space. Overall, results suggest that MSM face unique healthcare-related challenges, beyond those typically experienced by the broader population in non-metropolitan areas, because of tailored identity-based needs. To better support MSM in non-metropolitan areas, especially in the South where increased experiences of stigma are found, providers should seek further training regarding sexual health communication and HIV prevention, indicate on websites and in offices that they support sexual and gender minority patients, and provide telehealth services to MSM living in more geographically isolated areas.
Collapse
Affiliation(s)
- Carolyn Lauckner
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
| | - Danielle Lambert
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | | | | | - Nathan Hansen
- Department of Health Promotion & Behavior, University of Georgia, Athens, GA, USA
| |
Collapse
|
15
|
Kamal K, Keuroghlian AS, Potter J. Promoting Sexual and Gender Minority Health Clinical Skills Training for All Medical Students. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:987-993. [PMID: 37043757 DOI: 10.1097/acm.0000000000005240] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Despite societal, legal, and cultural improvements in their well-being, sexual and gender minority (SGM) people in the United States still face substantial physical and mental health disparities that are exacerbated by physician stigma and lack of training. Although there have been efforts at medical schools nationwide to address these disparities and interweave SGM health education into existing preclerkship courses, opportunities to practice related clinical skills during the clerkship years remain largely elective. Furthermore, national survey data from 2020 indicate that SGM Americans continue to delay or avoid medical care because of physician discrimination. By providing predominantly opt-in opportunities for hands-on SGM health clinical training, educators risk perpetuating existing structural inequities and widening health disparities. In this article, the authors advocate for required SGM health clinical training for all undergraduate medical students, regardless of intended specialty. They highlight 3 types of elective SGM health clinical training models currently in use at medical schools across the country, including student-run clinics, advanced electives, and longitudinal scholarly concentrations. Using these examples, the authors then outline ways that educators can interweave required SGM health clinical training into undergraduate medical education, including with the recruitment and retention of SGM faculty, staff, and students; required SGM standardized patient experiences; the integration of SGM clinical opportunities throughout the core clerkships; and partnerships with SGM health centers. Using these methods, medical schools can mobilize passionate students, faculty, and leaders to both counter the bigotry and hate faced by SGM populations and develop innovative strategies to improve SGM patient health outcomes and expand opportunities for SGM health scholarship.
Collapse
Affiliation(s)
- Kanika Kamal
- K. Kamal is a medical student, Harvard Medical School, Boston, Massachusetts
| | - Alex S Keuroghlian
- A.S. Keuroghlian is director, Division of Education and Training, The Fenway Institute, director, Division of Public and Community Psychiatry, Massachusetts General Hospital, and codirector, Harvard Medical School Sexual and Gender Minority Health Equity Initiative, Boston, Massachusetts
| | - Jennifer Potter
- J. Potter is cochair, The Fenway Institute, program lead, Harvard Medical School-Fenway Health LGBTQIA+ Health Fellowship Program, codirector, Harvard Medical School Sexual and Gender Minority Health Equity Initiative, and internist, Division of General Medicine, Beth Israel Lahey Health, Boston, Massachusetts
| |
Collapse
|
16
|
Loncharich MF, Robbins RC, Durning SJ, Soh M, Merkebu J. Cognitive biases in internal medicine: a scoping review. Diagnosis (Berl) 2023; 10:205-214. [PMID: 37079281 DOI: 10.1515/dx-2022-0120] [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: 11/07/2022] [Accepted: 03/30/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Medical errors account for up to 440,000 deaths annually, and cognitive errors outpace knowledge deficits as causes of error. Cognitive biases are predispositions to respond in predictable ways, and they don't always result in error. We conducted a scoping review exploring which biases are most prevalent in Internal Medicine (IM), if and how they influence patient outcomes, and what, if any, debiasing strategies are effective. CONTENT We searched PubMed, OVID, ERIC, SCOPUS, PsychINFO, and CINAHL. Search terms included variations of "bias", "clinical reasoning", and IM subspecialties. Inclusion criteria were: discussing bias, clinical reasoning, and physician participants. SUMMARY Fifteen of 334 identified papers were included. Two papers looked beyond general IM: one each in Infectious Diseases and Critical Care. Nine papers distinguished bias from error, whereas four referenced error in their definition of bias. The most commonly studied outcomes were diagnosis, treatment, and physician impact in 47 % (7), 33 % (5), and 27 % (4) of studies, respectively. Three studies directly assessed patient outcomes. The most commonly cited biases were availability bias (60 %, 9), confirmation bias (40 %, 6), anchoring (40 %, 6), and premature closure (33 %, 5). Proposed contributing features were years of practice, stressors, and practice setting. One study found that years of practice negatively correlated with susceptibility to bias. Ten studies discussed debiasing; all reported weak or equivocal efficacy. OUTLOOK We found 41 biases in IM and 22 features that may predispose physicians to bias. We found little evidence directly linking biases to error, which could account for the weak evidence of bias countermeasure efficacy. Future study clearly delineating bias from error and directly assessing clinical outcomes would be insightful.
Collapse
Affiliation(s)
- Michael F Loncharich
- Rheumatology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Uniformed Services University, Bethesda, MD, USA
| | - Rachel C Robbins
- Rheumatology Service, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | - Michael Soh
- Uniformed Services University, Bethesda, MD, USA
| | | |
Collapse
|
17
|
Lakra R, Bhayani S, Sulaiman K. Cultural competency education in the medical curriculum to overcome health care disparities. Proc AMIA Symp 2023; 36:616-619. [PMID: 37614855 PMCID: PMC10443984 DOI: 10.1080/08998280.2023.2221126] [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: 04/24/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 08/25/2023] Open
Abstract
Background Our increasingly diverse population demands the adoption of transcultural approaches to health care delivery. Training courses in medical education have been developed across the country for cultural competency, but have not been standardized or incorporated consistently. This study sought to formulate an educational intervention in medical training using the concepts of cultural competency and humility to improve understanding of cultural disparities in health care. Methods This study used three domains of Tools for Assessing Cultural Competence Training (TACCT) by the Association of American Medical Colleges. Participants included 106 fourth-year medical students and 19 internal medicine residents at Louisiana State University in Shreveport in 2022. The training session included a lecture introducing cultural and structural competency for 30 minutes followed by three workshops based on the TACCT domains of key aspects of cultural competence, understanding the impact of stereotyping on medical decision-making, and cross-cultural clinical skills. The participants were given a pre- and postsession questionnaire. Results After the session, 68% of students rated their understanding of cultural competency as excellent. For methods of teaching-lecture versus workshop versus both-66% rated the combination as excellent. Conclusion The rudimentary understanding of cultural competency and cultural humility improved after the session.
Collapse
Affiliation(s)
- Rachaita Lakra
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Shahzeem Bhayani
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Karina Sulaiman
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| |
Collapse
|
18
|
Providing home hospice care for LGBTQ+ patients and caregivers: Perceptions and opinions of hospice interdisciplinary care team providers. Palliat Support Care 2023; 21:3-11. [PMID: 35586976 DOI: 10.1017/s1478951522000657] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Hospice patients and caregivers who are members of sexual and gender minority groups (i.e., LGBTQ+) have reported experiencing unmet needs at end of life (EOL). Negative experiences often stem from challenging interactions with healthcare providers due to ineffective or poor communication and providers' heteronormative assumptions and biases. Few studies, however, examine hospice care team (HCT) providers' knowledge, experience, and opinions related to EOL care for LGBTQ+ patients and caregivers despite this being identified as a gap in competency and education. We sought to examine HCT providers' perceptions regarding (1) awareness of LGBTQ+ patients and caregivers; (2) knowledge of specific or unique needs; and (3) opinions on best care and communication practices. METHODS Six focus groups conducted with HCT providers (n = 48) currently delivering hospice care in three US states were audio-recorded and transcribed. Data were content coded (κ = 0.77), aggregated by topical categories, and descriptively summarized. RESULTS Participants were mostly white and non-Hispanic (n = 43, 89.6%), cisgender female (n = 42, 87.5%), heterosexual (n = 35, 72.9%), and religious (n = 33, 68.8%); they averaged 49 years of age (range 26-72, SD = 11.66). Awareness of LGBTQ+ patients and caregivers depended on patient or caregiver self-disclosure and contextual cues; orientation and gender identity data were not routinely collected. Many viewed being LGBTQ+ as private, irrelevant to care, and not a basis for people having specific or unique EOL needs because they saw EOL processes as universal, and believed that they treat everyone equally. Providers were more comfortable with patients of lesbian or gay orientation and reported less comfort and limited experience caring for transgender and gender-diverse patients or caregivers. SIGNIFICANCE OF RESULTS Many HCT members were unaware of specific issues impacting the EOL experiences of LGBTQ+ patients and caregivers, or how these experiences may inform important care and communication needs at EOL.
Collapse
|
19
|
Bann M, Larimore S, Wheeler J, Olsen LD. Implementing a Social Determinants of Health Curriculum in Undergraduate Medical Education: A Qualitative Analysis of Faculty Experience. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1665-1672. [PMID: 35797577 DOI: 10.1097/acm.0000000000004804] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Following shifts that broadened the medical profession's conceptualization of the underlying drivers of health, medical schools are required to integrate curricula on health disparities and the social context of medicine into undergraduate medical education. Although previous research has focused on student experiences and outcomes in these curricula, less attention has been paid to the experiences of the physician-faculty involved. This study aimed to capture faculty insights to improve understanding of the challenges and opportunities of implementing this curricular reform. METHOD In-depth, semistructured interviews were conducted with 10 faculty members at one U.S. medical school in spring 2019 to capture their experiences designing and teaching a new curriculum related to the social determinants of health and health disparities. Study design, including interview guide development, was informed by the critical pedagogy perspective and social constructionist approaches to curriculum implementation. With the use of a constructivist grounded theory approach, interview transcripts were analyzed using open, thematic, and axial coding techniques. Primary themes were categorized as professional, organizational, interactional, or intrapersonal and organized into the final model. RESULTS Participants processed their experiences at 4 concentric levels: professional, organizational, interactional, and intrapersonal. Faculty generally embraced the movement to incorporate more discussion of social context as a driver of health outcomes. However, they struggled with the shortcomings of their training and navigating structural constraints within their school when developing and delivering content. When confronted with these limitations, faculty experienced unexpected tension in the classroom setting that catalyzed self-reflection and reconstruction of their teaching approach. CONCLUSIONS Findings highlight the challenges that faculty encounter when integrating social determinants of health and related curricula into undergraduate medical education. They also speak to the need for a broader conceptualization of relevant expertise and have implications for how medical schools select, train, and support medical educators in this work.
Collapse
Affiliation(s)
- Maralyssa Bann
- M. Bann is assistant professor, Department of Medicine, University of Washington, Seattle, Washington; ORCID: https://orcid.org/0000-0002-5893-950X
| | - Savannah Larimore
- S. Larimore is a postdoctoral research associate, Department of Sociology, and a postdoctoral affiliate, Center for the Study of Race, Ethnicity & Equity, Washington University in St. Louis, St. Louis, Missouri
| | - Jessica Wheeler
- J. Wheeler is a program operations analyst, University of Washington School of Medicine, Seattle, Washington
| | - Lauren D Olsen
- L.D. Olsen is assistant professor, Department of Sociology, College of Liberal Arts, Temple University, Philadelphia, Pennsylvania
| |
Collapse
|
20
|
Khoury NM, Suser JL, Germain LJ, Myers K, Brown AEC, Lu FG. A Study of a Cultural Competence and Humility Intervention for Third-Year Medical Students. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:451-454. [PMID: 34410628 PMCID: PMC8375280 DOI: 10.1007/s40596-021-01518-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study evaluates the effectiveness of a cultural competence and humility intervention for third-year medical students by assessing changes in clinical evaluation assessments in patient encounters. METHODS This study examines the effect of a 1-h educational intervention on cultural competence and cultural humility for third-year medical students. Clinical assessments during observed patient encounters are compared in the clerkship before and after the intervention. The intervention adapts a previously studied cultural competence didactic and emphasizes cultural humility practices. Change in scores from the intervention cohort (clinical year 2019-2020) is compared to a pre-intervention cohort (2018-2019). RESULTS Students who completed the intervention demonstrate greater clinical competency in "relating to patients in a respectful, caring, empathetic manner" as assessed by supervising physicians compared with pre-intervention cohort students (2.7% difference in earning top two scores in subsequent clerkship, P value 0.05, Cramer's V 0.04). Greater clinical competencies were also found in the intervention students compared with pre-intervention students in the domains "demonstrates accountability, contribution and commitment to patient care" and "develops insightful, focused, pertinent questions based on clinical scenarios" (3.8% difference in earning top two scores in subsequent clerkship, P value 0.01 and 5.1% difference, P-value 0.003 with Cramer's V of 0.05 and 0.06, respectively). CONCLUSIONS Educational interventions to improve cultural competence and cultural humility are important during clinical years to shape future physicians. Our study suggests that brief interventions may improve medical students' clinical competencies. A future study with a more robust intervention is expected to yield more substantial results.
Collapse
Affiliation(s)
| | | | | | - Kathryn Myers
- SUNY Upstate Medical University, Syracuse, NY, USA
- Joint Base Elmendorf-Richardson Hospital, Anchorage, AK, USA
| | | | - Francis G Lu
- University of California, Davis, Sacramento, CA, USA
| |
Collapse
|
21
|
Draper JK, Feltner C, Vander Schaaf EB, Mieses Malchuk A. Preparing Medical Students to Address Health Disparities Through Longitudinally Integrated Social Justice Curricula: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1226-1235. [PMID: 35476779 DOI: 10.1097/acm.0000000000004718] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The education of health care professionals is a contributing factor to persistent health disparities. Although medical students are expected to understand racism, classism, and other social and structural drivers of health (SDH), standardization and best practices for teaching these concepts are lacking. Some medical schools are adopting social justice curricula (SJC) that prioritize health equity in teaching students to recognize SDH and preparing them to address the consequent health disparities. This systematic review sought to evaluate how these schools have integrated SJC into their core teaching; the criteria they have used to measure success and to what extent these criteria are met; and best practices in planning, implementing, and evaluating SJC. METHOD The authors searched 7 databases for English-language studies published between January 2000 and April 2020, reporting on longitudinally integrated SJC at U.S. medical schools intended for all students. Quantitative and qualitative outcomes were synthesized and summarized. RESULTS Searches identified 3,137 articles, of which 11 met inclusion criteria. Results demonstrated schools use a variety of teaching methods over a wide range of didactic hours to teach SJC concepts. Surveys and objective tests indicated students in SJC are generally satisfied and demonstrated improved knowledge and skills related to understanding and mitigating SDH, although findings related to changes in attitudes were equivocal. Evaluations at graduation and in residency demonstrated students who experience SJC are more prepared than their peers to work with patients who are underserved. Best practices in SJC included addressing the hidden curriculum, considering medical mistrust, and using tools like the Racial Justice Report Card and Tool for Assessing Cultural Competence Training. CONCLUSIONS These findings indicated SJC can prepare students to better address the root causes of health disparities. Future research should consider the long-term influences of these curricula on students, patients, and the community.
Collapse
Affiliation(s)
- Julia K Draper
- J.K. Draper is a family medicine resident, Mountain Area Health Education Center, Asheville, North Carolina; ORCID: https://orcid.org/0000-0003-3355-8054
| | - Cynthia Feltner
- C. Feltner is assistant professor, Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0002-4773-2570
| | - Emily B Vander Schaaf
- E.B. Vander Schaaf is assistant professor, Division of General Pediatrics and Adolescent Medicine, UNC School of Medicine, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0002-1408-7413
| | - Alexa Mieses Malchuk
- A. Mieses Malchuk is assistant professor, Department of Family Medicine, UNC School of Medicine, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0002-9979-7253
| |
Collapse
|
22
|
Sonneville SA. Spiritual support of transgender individuals: a literature review. J Health Care Chaplain 2022; 29:196-210. [PMID: 35776733 DOI: 10.1080/08854726.2022.2080965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Spiritual support has been a staple of healthcare before hospitals in western civilizations were established by communities of faith. Research has demonstrated that wellbeing is associated with balanced care for the body, mind, and spirit. Healthcare disparities are being identified as disproportionally impacting transgender and gender nonconforming (TGNC) individuals. The root cause of this disparity is being studied as are medical and wellbeing interventions, including the benefit of spiritual support. This author's objective was two-fold. First, to identify opportunities for extending spiritual support to TGNC individuals in healthcare by chaplains. Secondly, to identify evidence of current spiritual support advocacy initiatives and interventions for TGNC patients in healthcare by chaplains.
Collapse
Affiliation(s)
- Seth A Sonneville
- Program Director, , Wellbeing & Inclusion, Center for Wellbeing, Children's Mercy, Kansas City, MO, USA
| |
Collapse
|
23
|
Reyes MA, Vance-Chalcraft HD. Understanding undergraduate students’ eHealth usage and views of the patient-provider relationship. PLoS One 2022; 17:e0266802. [PMID: 35421140 PMCID: PMC9009692 DOI: 10.1371/journal.pone.0266802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 03/18/2022] [Indexed: 11/19/2022] Open
Abstract
eHealth has grown exponentially alongside technology and has become widely accessed by some populations, but little is documented about how undergraduate students use eHealth or perceive their eHealth literacy. As access to online information and non-traditional options for interacting with providers has increased, patient views of the provider-patient relationship may also be changing. This study evaluates how frequently undergraduates use eHealth, how they perceive their ability to use eHealth appropriately, and how they view their patient-provider relationships. A mixed methods approach was used to address the research questions, with quantitative data from a survey and qualitative data from follow-up interviews of twelve of the survey respondents. The survey was distributed to over 650 undergraduate students in introductory biology laboratory courses for students of all fields of interest at one university. Based on 527 survey responses and 12 interviews, students reported commonly using eHealth but being skeptical of telehealth appointments. Although students generally felt capable of finding and interpreting eHealth sources, they were not strongly confident in their ability to do so. Use of eHealth was not seen as altering the patient-provider relationship, but students expressed a desire for their physician to act more as a counselor or advisor than a guardian. Students from minority populations were more likely to use eHealth in comparison to their peers. In addition, student comfort with their provider differed by race and ethnicity, as well as whether they shared the same gender identity as their provider. This research highlights how undergraduate students, who are often making medical decisions for themselves for the first time as adults, access health information and view the patient-provider relationship differently than the traditional guardian or paternalistic model. In addition, having diverse, culturally competent medical providers are critical for students to develop the relationship with their provider that they desire.
Collapse
Affiliation(s)
- Michelle Anne Reyes
- Department of Biology, East Carolina University, Greenville, North Carolina, United States of America
| | - Heather D. Vance-Chalcraft
- Department of Biology, East Carolina University, Greenville, North Carolina, United States of America
- * E-mail:
| |
Collapse
|
24
|
Jacob SA, Palanisamy UD, Napier J, Verstegen D, Dhanoa A, Chong EYC. Health Care Needs of Deaf Signers: The Case for Culturally Competent Health Care Providers. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:335-340. [PMID: 34039854 DOI: 10.1097/acm.0000000000004181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
There is a need for culturally competent health care providers (HCPs) to provide care to deaf signers, who are members of a linguistic and cultural minority group. Many deaf signers have lower health literacy levels due to deprivation of incidental learning opportunities and inaccessibility of health-related materials, increasing their risk for poorer health outcomes. Communication barriers arise because HCPs are ill-prepared to serve this population, with deaf signers reporting poor-quality interactions. This has translated to errors in diagnosis, patient nonadherence, and ineffective health information, resulting in mistrust of the health care system and reluctance to seek treatment. Sign language interpreters have often not received in-depth medical training, compounding the dynamic process of medical interpreting. HCPs should thus become more culturally competent, empowering them to provide cultural- and language-concordant services to deaf signers. HCPs who received training in cultural competency showed increased knowledge and confidence in interacting with deaf signers. Similarly, deaf signers reported more positive experiences when interacting with medically certified interpreters, HCPs with sign language skills, and practitioners who made an effort to improve communication. However, cultural competency programs within health care education remain inconsistent. Caring for deaf signers requires complex, integrated competencies that need explicit attention and practice repeatedly in realistic, authentic learning tasks ordered from simple to complex. Attention to the needs of deaf signers can start early in the curriculum, using examples of deaf signers in lectures and case discussions, followed by explicit discussions of Deaf cultural norms and the potential risks of low written and spoken language literacy. Students can subsequently engage in role plays with each other or representatives of the local signing deaf community. This would likely ensure that future HCPs are equipped with the knowledge and skills necessary to provide appropriate care and ensure equitable health care access for deaf signers.
Collapse
Affiliation(s)
- Sabrina A Jacob
- S.A. Jacob is research associate, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, Scotland, United Kingdom, and adjunct lecturer, School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia; ORCID: https://orcid.org/0000-0001-8012-7789
| | - Uma Devi Palanisamy
- U.D. Palanisamy is associate professor, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia; ORCID: https://orcid.org/0000-0002-8615-8241
| | - Jemina Napier
- J. Napier is professor, chair of intercultural communication, and director of research, School of Social Sciences, Heriot-Watt University, Edinburgh, Scotland, United Kingdom; ORCID: https://orcid.org/0000-0001-6283-5810
| | - Daniëlle Verstegen
- D. Verstegen is programme director, Master of Health Professions Education Program, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0001-6811-175X
| | - Amreeta Dhanoa
- A. Dhanoa is associate professor, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia; ORCID: https://orcid.org/0000-0002-4541-4819
| | - Elizabeth Yie-Chuen Chong
- E.Y.-C. Chong is research assistant, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia; ORCID: https://orcid.org/0000-0001-9281-8667
| |
Collapse
|
25
|
Atkinson RB, Khubchandani JA, Chun MBJ, Reidy E, Ortega G, Bain PA, Demko C, Barreiro-Rosado J, Kent TS, Smink DS. Cultural Competency Curricula in US Graduate Medical Education: A Scoping Review. J Grad Med Educ 2022; 14:37-52. [PMID: 35222820 PMCID: PMC8848887 DOI: 10.4300/jgme-d-21-00414.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/19/2021] [Accepted: 09/21/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Cultural competency training provides participants with knowledge and skills to improve cross-cultural communication and is required for all graduate medical education (GME) training programs. OBJECTIVE The authors sought to determine what cultural competency curricula exist specifically in GME. METHODS In April 2020, the authors performed a scoping review of the literature using a multidatabase (PubMed, Ovid, MedEdPORTAL) search strategy that included keywords relevant to GME and cultural competency. The authors extracted descriptive data about the structure, implementation, and analysis of cultural competency curricula and analyzed these data for trends. RESULTS Sixty-seven articles met criteria for inclusion, of which 61 (91%) were focused exclusively on residents. The most commonly included specialties were psychiatry (n=19, 28.4%), internal medicine (n=16, 23.9%), and pediatrics (n=15, 22.4%). The shortest intervention was a 30-minute online module, while the longest contained didactics, electives, and mentoring programs that spanned the entirety of residency training (4 years). The sample sizes of included studies ranged from 6 to 833 participants. Eight (11.9%) studies utilized OSCEs as assessment tools, while 17 (25.4%) conducted semi-structured interviews or focus groups. Four common themes were unique interventions, retention of learning, trainee evaluation of curricula, and resources required for implementation. CONCLUSIONS Wide variation exists in the design, implementation, and evaluation of cultural competency curricula for residents and fellows.
Collapse
Affiliation(s)
- Rachel B. Atkinson
- Rachel B. Atkinson, MD, is a Resident, Department of Surgery, and Research Fellow, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School
| | - Jasmine A. Khubchandani
- Jasmine A. Khubchandani, MD, is a Resident, Department of Surgery, and Research Fellow, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School
| | - Maria B. J. Chun
- Maria B. J. Chun, PhD, is a Specialist and Associate Chair in Administration and Finance, Department of Surgery, John A. Burns School of Medicine, University of Hawaii
| | - Emma Reidy
- Emma Reidy, MPH, is Senior Project Manager, Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School
| | - Gezzer Ortega
- Gezzer Ortega, MD, MPH, is Lead Faculty for Research and Innovation for Equitable Surgical Care, Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical
| | - Paul A. Bain
- Paul A. Bain, PhD, is Reference and Instruction Librarian, Countway Library of Medicine, Harvard Medical School
| | - Caroline Demko
- Caroline Demko, is a First-Year Masters Student, Goldman School of Public Policy, University of California, Berkeley
| | - Jeenn Barreiro-Rosado
- Jeenn Barreiro-Rosado, is a Research Assistant, Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School
| | - Tara S. Kent
- Tara S. Kent, MD, MS, is Associate Professor of Surgery, Vice Chair for Education, and Program Director, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Douglas S. Smink
- Douglas S. Smink, MD, MPH, is Chief of Surgery, Brigham and Women's Faulkner Hospital, Associate Chair of Education and Associate Professor of Surgery, and Core Faculty, Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School
| |
Collapse
|
26
|
Solchanyk D, Ekeh O, Saffran L, Burnett-Zeigler IE, Doobay-Persaud A. Integrating Cultural Humility into the Medical Education Curriculum: Strategies for Educators. TEACHING AND LEARNING IN MEDICINE 2021; 33:554-560. [PMID: 33573412 DOI: 10.1080/10401334.2021.1877711] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/01/2020] [Accepted: 01/17/2021] [Indexed: 06/12/2023]
Abstract
ISSUE The framework of cultural humility, which emphasizes curiosity and self-reflection over mastery, was identified over 20 years ago as a way to address implicit bias in health care, an important factor in health disparities. Despite growing interest from researchers and educators, as well as the urgent call to adopt these values, the foundational elements of cultural humility remain challenging to teach in medical education and have not yet been widely adopted. EVIDENCE Health disparities persist throughout the United States among a growing population of diverse patients. The cultural humility framework undermines power imbalances by encouraging the clinician to view their patient as an expert of their own experience. This approach strengthens relationships within the community, illuminates racial and historical injustices, and contributes to equitable care. However, recent reviews have shown that humility-based principles have yet to be widely integrated into cultural curricula. Based on available evidence, this article introduces the foundational concepts of cultural humility with the aim of helping medical educators better understand and implement the principles of cultural humility into undergraduate medical education. IMPLICATIONS Cultural humility is a powerful and feasible adjunct to help student physicians cultivate effective tools to provide the best patient care possible to an increasingly diverse patient population. However, there is little known about how best to implement the principles of cultural humility into existing undergraduate medical education curricula. The analyses and strategies presented provide educators with the background, instructional and curricular methods to enable learners to cultivate cultural humility. Future systematic research will need to focus on investigating design, implementation and impact.
Collapse
Affiliation(s)
- Daniel Solchanyk
- Center for Global Health Education, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Odera Ekeh
- Center for Global Health Education, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lise Saffran
- Department of Public Health, University of Missouri, Columbia, Missouri, USA
| | - Inger E Burnett-Zeigler
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ashti Doobay-Persaud
- Center for Global Health Education, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Division of Hospital Medicine, Departments of Medicine and Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| |
Collapse
|
27
|
Wu A, Maddula V, Singh J, Sagoo MG, Chien CL, Wingate R, Kielstein H, Traxler H, Brassett C, Waschke J, Vielmuth F, Sakurai T, Zeroual M, Olsen J, El-Batti S, Viranta-Kovanen S, Kitahara S, Keay K, Kunzel C, Bernd P, Noël GPJC. Alternatives to Student Outbound Mobility-Improving Students' Cultural Competency Skills Online to Improve Global Health Without Travel. MEDICAL SCIENCE EDUCATOR 2021; 31:1441-1451. [PMID: 34123512 PMCID: PMC8184130 DOI: 10.1007/s40670-021-01332-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 06/12/2023]
Abstract
Introduction Student outbound mobility is a major element in internationalization of medical education and global health education. However, this approach is often criticized, as it is inherently inequitable. Internationalization at home is a newer concept that aims to provide students with international skills and experiences without exchange travel. We report detailed outcomes of an international online program during the COVID-19 pandemic, which aimed to include acquisition of cultural awareness and competency-similar to what the students would have obtained if they had travelled abroad. Method Sixty-eight students from 12 international universities participated in international small peer group collaborative work, and online networking. Perceived improvement of cultural competency using Likert scale and open-ended questions was used as a measure of success. Furthermore, students' definition of cultural competency in the different countries was obtained. Results Students improved their cultural competency skills. Data analysis supported statistically significant improvement of the above skills after the program, in comparison to the start of the program. Discussion Internationalization of medical education can be achieved at home-via structured online peer exchanges-and can provide students with intercultural skills and networking opportunities that are typically achieved via international in-person travel. The above represents a socially just and equitable way to reach all students and can result in improvement of their cultural competency, preparing them for their work in global health, and thereby resulting in improvement of global health. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-021-01332-9.
Collapse
Affiliation(s)
- Anette Wu
- Vagelos College of Physicians and Surgeons, Columbia University, 650 W 168th St, New York, NY 10032 USA
| | - Vinay Maddula
- College of Dental Medicine, Columbia University, New York, NY USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kevin Keay
- The University of Sydney, Sydney, Australia
| | - Carol Kunzel
- College of Dental Medicine, Columbia University, New York, NY USA
| | - Paulette Bernd
- Vagelos College of Physicians and Surgeons, Columbia University, 650 W 168th St, New York, NY 10032 USA
| | | |
Collapse
|
28
|
Vasquez Guzman CE, Sussman AL, Kano M, Getrich CM, Williams RL. A Comparative Case Study Analysis of Cultural Competence Training at 15 U.S. Medical Schools. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:894-899. [PMID: 33637658 DOI: 10.1097/acm.0000000000004015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Twenty years have passed since the Liaison Committee on Medical Education (LCME) mandated cultural competence training at U.S. medical schools. There remain multiple challenges to implementation of this training, including curricular constraints, varying interpretations of cultural competence, and evidence supporting the efficacy of such training. This study explored how medical schools have worked to implement cultural competence training. METHOD Fifteen regionally diverse public and private U.S. medical schools participated in the study. In 2012-2014, the authors conducted 125 interviews with 52 administrators, 51 faculty or staff members, and 22 third- and fourth-year medical students, along with 29 focus groups with an additional 196 medical students. Interviews were recorded, transcribed, and imported into NVivo 10 software for qualitative data analysis. Queries captured topics related to students' preparedness to work with diverse patients, engagement with sociocultural issues, and general perception of preclinical and clinical curricula. RESULTS Three thematic areas emerged regarding cultural competence training: formal curriculum, conditions of teaching, and institutional commitment. At the formal curricular level, schools offered a range of courses collectively emphasizing communication skills, patient-centered care, and community-based projects. Conditions of teaching emphasized integration of cultural competence into the preclinical years and reflection on the delivery of content. At the institutional level, commitment to institutional diversity, development of programs, and degree of prioritization of cultural competence varied. CONCLUSIONS There is variation in how medical schools approach cultural competence. Among the 15 participating schools, longitudinal and experiential learning emerged as important, highlighting the needs beyond mere integration of cultural competence content into the formal curriculum. To determine efficacy of cultural competence programming, it is critical to conduct systematic assessment to identify and address gaps. While LCME standards have transformed aspects of medical education, further research is needed to clarify evidence-based, effective approaches to this training.
Collapse
Affiliation(s)
- Cirila Estela Vasquez Guzman
- C.E. Vasquez Guzman is a family medicine postdoctoral fellow, Oregon Health & Science University, Portland, Oregon
| | - Andrew L Sussman
- A.L. Sussman is associate professor, Comprehensive Cancer Center and Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Miria Kano
- M. Kano is assistant professor, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Christina M Getrich
- C.M. Getrich is associate professor, Department of Anthropology, University of Maryland, College Park, Maryland
| | - Robert L Williams
- R.L. Williams is Distinguished Professor, Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico
| |
Collapse
|
29
|
Weiss J, Balasuriya L, Cramer LD, Nunez-Smith M, Genao I, Gonzalez-Colaso R, Wong AH, Samuels EA, Latimore D, Boatright D, Sharifi M. Medical Students' Demographic Characteristics and Their Perceptions of Faculty Role Modeling of Respect for Diversity. JAMA Netw Open 2021; 4:e2112795. [PMID: 34086032 PMCID: PMC8178710 DOI: 10.1001/jamanetworkopen.2021.12795] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Faculty role modeling is critical to medical students' professional development to provide culturally adept, patient-centered care. However, little is known about students' perceptions of faculty role modeling of respect for diversity. OBJECTIVE To examine whether variation exists in medical students' perceptions of faculty role modeling of respect for diversity by student demographic characteristics. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed data from the Association of American Medical Colleges' 2016 and 2017 Medical School Graduation Questionnaire, which was administered to graduating students at 140 accredited allopathic US medical schools. Data were analyzed from January 1 to November 1, 2020. MAIN OUTCOMES AND MEASURES Students' perceptions of faculty role modeling of respect for diversity by the independent variables sex, race/ethnicity, sexual orientation, and age. Multivariable logistic regression was used to examine the extent to which student-reported perceptions of faculty respect for diversity varied by demographic characteristics, and logistic regression models were sequentially adjusted first for demographic characteristics and then for marital status and financial variables. RESULTS Of 30 651 students who completed the survey, the final study sample consisted of 28 778 respondents, representing 75.4% of the 38 160 total US medical school graduates in 2016 and 2017. Of the respondents, 14 804 (51.4%) were male participants and 1506 (5.2%) identified as lesbian, gay, or bisexual (LGB); a total of 11 926 respondents (41.4%) were 26 years or younger. A total of 17 159 respondents (59.6%) identified as White, 5958 (20.7%) as Asian, 1469 (5.1%) as Black/African American, 2431 (8.4%) as Hispanic/Latinx, and 87 (0.3%) as American Indian/Alaska Native/Native Hawaiian/Pacific Islander individuals. Overall, 5101 students (17.7%) reported perceiving that faculty showed a lack of respect for diversity. Of those who identified as Black/African American students, 540 (36.8%) reported perceiving a lack of faculty respect for diversity compared with 2468 White students (14.4%), with an OR of perceived lack of respect of 3.24 (95% CI, 2.86-3.66) after adjusting for other demographic characteristics and covariates. American Indian/Alaska Native/Native Hawaiian/Pacific Islander (OR, 1.73; 95% CI, 1.03-2.92), Asian (OR, 1.62; 95% CI, 1.49-1.75), or Hispanic/Latinx (OR, 1.43; 95% CI, 1.26-1.75) students also had greater odds of perceiving a lack of faculty respect for diversity compared with White students. Female students had greater odds compared with male students (OR, 1.17; 95% CI, 1.10-1.25), and students who identified as LGB (OR, 1.96; 95% CI, 1.74-2.22) or unknown sexual orientation (OR, 1.79; 95% CI, 1.29-2.47) had greater odds compared with heterosexual students. Students aged 33 years or older had greater odds of reporting a perceived lack of respect compared with students aged 26 years or younger (OR, 1.81; 95% CI, 1.58-2.08). CONCLUSIONS AND RELEVANCE In this cross-sectional study, female students, students belonging to racial/ethnic minority groups, and LGB students disproportionately reported perceiving a lack of respect for diversity among faculty, which has important implications for patient care, the learning environment, and the well-being of medical trainees.
Collapse
Affiliation(s)
- Jasmine Weiss
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Lilanthi Balasuriya
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Laura D. Cramer
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Marcella Nunez-Smith
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Inginia Genao
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Ambrose H. Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth A. Samuels
- Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Darin Latimore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mona Sharifi
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
30
|
Rothlind E, Fors U, Salminen H, Wändell P, Ekblad S. Virtual patients reflecting the clinical reality of primary care - a useful tool to improve cultural competence. BMC MEDICAL EDUCATION 2021; 21:270. [PMID: 33975581 PMCID: PMC8112065 DOI: 10.1186/s12909-021-02701-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Virtual patients are educational tools that may be described as case-based interactive computer simulations of clinical scenarios. In terms of learning outcomes, improved clinical reasoning skills and knowledge acquisition have been shown. For further exploring the role of virtual patients in medical education, a greater focus on context-specific cases, combined with suitable educational activities, has been suggested. A knowledge gap has been identified in cultural competence in primary care. As primary care physicians are often the main medical providers for patients with refugee backgrounds, they would probably benefit from improved training focusing on how to apply cultural competence in everyday work. Using virtual patient cases, as a complement to clinical training, may be one way forward. The aim of this study was therefore to explore a learner perspective on the educational use of a virtual patient system designed to contribute to training in cultural competence in a primary care context. METHODS Three virtual patient cases portraying patients with refugee backgrounds were developed. The cases addressed various issues and symptoms common in primary care consultations, while also incorporating intercultural aspects. The system also provided the informants with individualized feedback. Primary care physicians and medical students were invited to test the cases and participate in an interview about their experience. Data was analyzed using qualitative content analysis. RESULTS The analysis generated the theme Virtual patients might help improve cultural competence in physicians and medical students by complementing knowledge gained through the informal curriculum. Informants at different educational levels found it suitable as a tool for introducing the topic and for reflecting on one's own consultations. It could also compensate for the predominant informal manner of learning cultural competence, described by the informants. CONCLUSIONS Virtual patients could be useful for gaining cultural competence in a primary care context. Advantages that could benefit learners at both pre- and post-graduate levels are decreased dependence on the informal curriculum and being presented with an illustrative way of how cultural competence may be applied in the consultation.
Collapse
Affiliation(s)
- Erica Rothlind
- Cultural Medicine, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
| | - Uno Fors
- Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
| | - Helena Salminen
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Per Wändell
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
| | - Solvig Ekblad
- Cultural Medicine, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| |
Collapse
|
31
|
Pang S, Vongsachang H, Le TK, Zhang GQ, Li T, Lee JTC, Lawson SM. Knowledge and attitudes of U.S. medical students regarding the care of Asian American patients: a cross-sectional survey study. BMC MEDICAL EDUCATION 2021; 21:148. [PMID: 33676520 PMCID: PMC7937206 DOI: 10.1186/s12909-021-02568-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/15/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND Asian Americans (AsAm) are a rapidly growing population in the U.S. With this growing population, U.S. healthcare providers must be equipped to provide culturally competent care for AsAm patients. This project surveyed U.S. medical students on their knowledge of and attitudes towards AsAm to assess predictors of readiness to care for AsAm patients. METHOD This cross-sectional study surveyed medical students who had completed at least one clinical rotation. The survey was distributed online to nine medical schools throughout the U.S. The survey measured self-rated knowledge of, comfort with, cultural competency (CC) towards, and explicit biases towards AsAm patients. The first three domains were analyzed in a multivariate regression model including sociodemographic characteristics and past clinical, curricular, and social experiences with AsAm. Explicit bias questions were reported descriptively. RESULTS There were 688 respondents. Asian race, AsAm-prevalent hometown, AsAm-related extracurricular activities, Asian language knowledge, and having taken a population health course predicted increased AsAm knowledge. Social interactions with AsAm increased comfort with AsAm patients. Increasing year in medical school, more frequent exposure to AsAm patients on rotations, and prior travel to an Asian country were predictors of increased CC toward AsAm. Importantly, having completed a CC course was a significant predictor in all domains. In terms of explicit bias, students felt that AsAm patients were more compliant than Caucasian patients. Students also believed that Caucasian patients were generally more likely to receive self-perceived "preferred" versus "acceptable" care, but that in their own clinical experiences neither group received preferred care. CONCLUSION Experience with and exposure to AsAm prior to and during medical school and CC courses may increase medical student knowledge, comfort, and CC with AsAm patients. Standardized and longitudinal CC training, increased simulations with AsAm patients, diverse student recruitment, and support for students to engage in AsAm-related activities and interact with AsAm may improve CC of future physicians towards AsAm patients and possibly other minority populations.
Collapse
Affiliation(s)
- Sharon Pang
- Johns Hopkins University School of Medicine, 733 N. Broadway, Miller Research Building 137, Baltimore, MD, 21205, USA
| | - Hursuong Vongsachang
- Johns Hopkins University School of Medicine, 733 N. Broadway, Miller Research Building 137, Baltimore, MD, 21205, USA
| | - Thomas K Le
- Johns Hopkins University School of Medicine, 733 N. Broadway, Miller Research Building 137, Baltimore, MD, 21205, USA
| | - George Q Zhang
- Johns Hopkins University School of Medicine, 733 N. Broadway, Miller Research Building 137, Baltimore, MD, 21205, USA
| | - Taibo Li
- Johns Hopkins University School of Medicine, 733 N. Broadway, Miller Research Building 137, Baltimore, MD, 21205, USA
| | - Jason T C Lee
- Johns Hopkins University School of Medicine, 733 N. Broadway, Miller Research Building 137, Baltimore, MD, 21205, USA
| | - Shari M Lawson
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 733 N. Broadway, Miller Research Building 137, Baltimore, MD, 21205, USA.
| |
Collapse
|
32
|
Abrams MP, Chalise S, Peralta H, Simms-Cendan J. Social, Demographic, Spanish Language, and Experiential Factors Influencing Nursing Students' Cultural Competence. J Nurs Educ 2021; 60:29-33. [PMID: 33400805 DOI: 10.3928/01484834-20201217-07] [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: 05/15/2020] [Accepted: 07/15/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Development of culturally competent nursing students is a core objective in nursing education. METHOD One hundred sixty nursing students completed an online survey assessing sociodemographic information, Spanish language, service-learning participation, and cultural competency. RESULTS Degree of participation in the multidisciplinary farmworkers clinic (r = .374, p = .013), federally qualified health center (FQHC) (r = .387, p = .032), and short-term international medical mission trip (r = .433, p = .021) was associated with higher cultural competency. Furthermore, several demographic factors including being a native Spanish-speaker (p = .022), female (p = .004), Latino (p = .045) or a student of low socioeconomic status (p = .026) were associated with higher cultural competency. CONCLUSION Participation in service-learning opportunities involving care for minority and disadvantaged communities, whether required or voluntary, was correlated with higher cultural competency scores, as long as the students' experiences involved direct patient care responsibilities. These findings highlight the need for identifying more diverse opportunities for service-learning and more diverse direct patient care opportunities to foster students' cultural competence. [J Nurs Educ. 2021;60(1):29-33.].
Collapse
|
33
|
Medical Student Involvement in a Human Rights Program: Impact on Student Development and Career Vision. Ann Glob Health 2020; 86:130. [PMID: 33102150 PMCID: PMC7546113 DOI: 10.5334/aogh.2940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: There is consensus among many medical school deans that exposure to human rights is a necessary component of physician training [78], however little is known about the impact of engagement in human rights programs on students’ personal and professional development [1516171819202122232425262728]. Objective: This study aimed to examine medical students’ experiences in the Mount Sinai Human Rights Program (MSHRP), their motivations for involvement, and the possible influence of engagement on their professional identities, personal growth, and career choices. Methods: Through semi-structured interviews, this qualitative study gathered the experiences of 15 fourth year and recently graduated medical students who participated in the comprehensive training, research, and direct service opportunities provided by the program. Responses were coded using a content analysis approach. Findings: The results of this research highlight the motivations behind students’ involvement in a medical human rights program, as well as the challenges they experienced engaging with this work. The study captured students’ perceptions of the role of the program on their personal growth, clinical skills, and career vision. Nearly all the students interviewed indicated they developed important, clinically applicable skills that enhanced their traditional medical education. Students indicated that their participation directly influenced their professional identities and future career directions by reinforcing previous interests in human rights and social justice work, impacting medical specialty and residency program selections and fostering commitment to working with immigrant populations. Conclusions: The results of this study indicate that longitudinal involvement with the MSHRP contributed to the acquisition of important clinical skills that were not otherwise attained in students’ early medical education. Findings suggest that there is significant opportunity for clinical and leadership development outside the traditional preclinical and clinical setting, and that exposure to human rights education shapes students’ professional identities and career paths. Finally, the findings highlight the essential role of human rights and social justice in medical education.
Collapse
|