1
|
Parikh R, Jones SB. Providing Impactful Feedback to the Current Generation of Anesthesiology Residents. Int Anesthesiol Clin 2024; 62:1-7. [PMID: 38798143 DOI: 10.1097/aia.0000000000000441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Affiliation(s)
- Reena Parikh
- Department of Anesthesiology, Albany Medical College, Albany, New York
| | | |
Collapse
|
2
|
Gonzalez CM, Greene RE, Cooper LA, Lypson ML. Recommendations for Faculty Development in Addressing Implicit Bias in Clinical Encounters and Clinical Learning Environments. J Gen Intern Med 2024:10.1007/s11606-024-08832-5. [PMID: 38831249 DOI: 10.1007/s11606-024-08832-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024]
Affiliation(s)
- Cristina M Gonzalez
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA.
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Richard E Greene
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
- Office of Diversity Affairs, NYU Grossman School of Medicine, New York, NY, USA
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine and Johns Hopkins Center for Health Equity, Baltimore, MD, USA
| | - Monica L Lypson
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| |
Collapse
|
3
|
Schoenfeld D, Lemack GE, Badalato GM. A Comparative Review of Oral Board Delivery Across Procedural Disciplines. JOURNAL OF SURGICAL EDUCATION 2024; 81:866-871. [PMID: 38658310 DOI: 10.1016/j.jsurg.2024.01.002] [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: 10/06/2023] [Revised: 12/18/2023] [Accepted: 01/06/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Despite its ubiquity in the certification process among surgical specialties, there is little data regarding oral board delivery across various procedural fields. In this study we sought to determine the specifics of oral board exam administration across surgical disciplines with the goal of highlighting common practices, differences, and areas of innovation. This comparative analysis might further serve to identify unifying principles that undergird the oral board examination process across specialties. DESIGN A standardized questionnaire was developed that included domains of exam structure/administration, content development, exam prerequisites, information about examiners, scoring, pass/failure rates, and emerging technologies. Between December 2022 and February 2023 structured interviews were conducted to discuss specifics of various oral board exams. Interview answers were compared between various specialties to extrapolate themes and to highlight innovative or emerging techniques among individual boards. SETTING Interviews were conducted virtually. PARTICIPANTS Executive members of 9 procedural medical boards including anesthesiology, neurosurgery, obstetrics, and gynecology, ophthalmology, orthopaedic surgery, otolaryngology-head and neck surgery, plastic surgery, general surgery, and urology RESULTS: Common themes include assessment of pre-, intra- and postoperative care; all testing involved candidate examination by multiple examiners and psychometricians were used by all organizations. Important differences included virtual versus in person administration (3 out of 9), inclusion and discussion of candidates' case logs as part of the exam (4 out of 9), formal assessment of professionalism (4 out of 9), and inclusion of an objective structured clinical examination (2 out of 9). CONCLUSIONS While there are common themes and practices in the oral board delivery process between various surgical fields, and important differences continue to exist. Ongoing efforts to standardize exam administration and determine best practices are needed to ensure oral board exams continue to effectively establish that candidates meet the qualifications required for board certification.
Collapse
Affiliation(s)
- Daniel Schoenfeld
- Department of Urology, Columbia University Irving Medical Center, New York, New York.
| | - Gary E Lemack
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas
| | - Gina M Badalato
- Department of Urology, Columbia University Irving Medical Center, New York, New York
| |
Collapse
|
4
|
Dyess NF, Carr CB, Mavis SC, Caruso CG, Izatt S, French H, Dadiz R, Bonachea EM, Gray MM. Implicit Bias and Health Disparities Education in the Neonatal Intensive Care Unit. Am J Perinatol 2024. [PMID: 38190976 DOI: 10.1055/a-2240-1979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVE This study aimed to characterize implicit bias (IB) and health disparities (HD) education in neonatal-perinatal medicine (NPM), including current educational opportunities, resources, and barriers. STUDY DESIGN A national web-based survey was sent to NPM fellows, neonatologists, and frontline providers after iterative review by education experts from the National Neonatology Curriculum Committee. Quantitative data were analyzed with chi-square and Fisher's exact tests. Qualitative data were evaluated using thematic analysis. RESULTS Of the 452 NPM survey respondents, most desired additional IB (76%) and HD (83%) education. A greater proportion of neonatologists than fellows received IB (83 vs. 57%) and HD (87 vs. 74%) education. Only 41% of neonatologists reported that their institution requires IB training. A greater proportion of fellows than neonatologists expressed dissatisfaction with the current approaches for IB (51 vs. 25%, p < 0.001) and HD (43 vs. 25%, p = 0.015) education. The leading drivers of dissatisfaction included insufficient time spent on the topics, lack of specificity to NPM, inadequate curricular scope or depth, and lack of local educator expertise. A minority of faculty who were tasked to educate others have received specific educator training on IB (21%) and HD (16%). Thematic analysis of survey free-text responses identified three main themes on the facilitators and barriers to successful IB and HD education: individual, environmental, and curricular design variables. CONCLUSION NPM trainees and neonatologists desire tailored, active, and expert-guided IB and HD education. Identified barriers are important to address in developing an effective IB/HD curriculum for the NPM community. KEY POINTS · There is a gap between the current delivery of IB/HD education and the needs of the NPM community.. · NPM trainees and neonatologists desire tailored, active, and expert-guided IB and HD education.. · A successful curriculum should be widely accessible, NPM-specific, and include facilitator training..
Collapse
Affiliation(s)
| | - Cara Beth Carr
- Division of Neonatology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie C Mavis
- Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Catherine G Caruso
- Division of Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Susan Izatt
- Division of Neonatology, Department of Pediatrics, Duke University, Durham, North Carolina
| | - Heather French
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rita Dadiz
- Division of Neonatology, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Elizabeth M Bonachea
- Division of Neonatology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Megan M Gray
- Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| |
Collapse
|
5
|
Zambrano J, Celano CM, Onyeaka H, Rodriguez AM, Shea T, Ahn-Horst R, Grossman M, Mullersman K, Ordoñez AS, Smith FA, Beach S. Ethnoracial disparities in care on a consultation-liaison service at an academic hospital. Gen Hosp Psychiatry 2024; 86:50-55. [PMID: 38070241 PMCID: PMC10843593 DOI: 10.1016/j.genhosppsych.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/13/2023] [Accepted: 11/25/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND There is currently an increasing recognition of and focus on structural and institutional racism and its impacts on health disparities. In psychiatry and mental health, research has focused on racial and ethnic disparities in the availability and utilization of mental health services, care in emergency departments, and inpatient psychiatric services. Little is known about disparities in care on general hospital psychiatry consultation-liaison (CL) services. METHODS In this exploratory study, we conducted a retrospective chart review using electronic health record (EHR) data of all adults (≥ 18 years of age) admitted to inpatient medical or surgical floors at an urban academic medical center for whom a psychiatric consultation was requested during the study period. We examined differences by race and ethnicity in: rates of consultation requests; use of legal holds, constant observation, restraints; follow-up by the CL service; and ultimate disposition. RESULTS The service received 310 unique consults during the study period. Compared to hospital-wide numbers, Black-identifying patients were over-represented in our sample (11.9% vs 6.6%), while Latinx patients were underrepresented (6.1% vs 9.8%). Of the clinical and outcome variables collected, there were higher odds of being placed on a legal hold both prior to (OR 2.6) and after the consult question (OR 2.98) and in the odds of having a one-to-one observer prior to (OR 2.47) and after (OR 2.9) the initial consult visit for Black-identifying patients, when adjusting for confounders. There were no other measurable differences in care or outcomes by racial or ethnic categories. CONCLUSION Black-identifying patients may be more likely to receive psychiatric consultation and be placed on legal holds because of a combination of chronic adverse social determinants of health and race-based bias. Conversely, Latinx patients may be less likely to receive psychiatric consultation because of language barriers among other factors. The lack of disparities identified in other domains may be encouraging, but larger studies are needed. Further research is also needed to identify causality and interventions that could help close the gap in care and outcomes for racial and ethnic minorities.
Collapse
Affiliation(s)
- Juliana Zambrano
- Massachusetts General Hospital, Department of Psychiatry, USA; Harvard Medical School, USA.
| | - Christopher M Celano
- Massachusetts General Hospital, Department of Psychiatry, USA; Harvard Medical School, USA
| | - Henry Onyeaka
- Massachusetts General Hospital, Department of Psychiatry, USA; Harvard Medical School, USA
| | | | - Timothy Shea
- Massachusetts General Hospital, Department of Psychiatry, USA; Harvard Medical School, USA
| | - Rosa Ahn-Horst
- Massachusetts General Hospital, Department of Psychiatry, USA; Harvard Medical School, USA
| | - Mila Grossman
- Massachusetts General Hospital, Department of Psychiatry, USA; Harvard Medical School, USA
| | - Katherine Mullersman
- Massachusetts General Hospital, Department of Psychiatry, USA; Harvard Medical School, USA
| | - Andrea Soto Ordoñez
- Massachusetts General Hospital, Department of Psychiatry, USA; Harvard Medical School, USA
| | - Felicia A Smith
- Massachusetts General Hospital, Department of Psychiatry, USA; Harvard Medical School, USA
| | - Scott Beach
- Massachusetts General Hospital, Department of Psychiatry, USA; Harvard Medical School, USA
| |
Collapse
|
6
|
Soranno DE, Simon TD, Bora S, Lohr JL, Bagga B, Carroll K, Daniels SR, Davis SD, Fernandez Y Garcia E, Orange JS, Overholser B, Sedano S, Tarini BA, White MJ, Spector ND. Justice, Equity, Diversity, and Inclusion in the Pediatric Faculty Research Workforce: Call to Action. Pediatrics 2023; 152:e2022060841. [PMID: 37529881 DOI: 10.1542/peds.2022-060841] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 08/03/2023] Open
Affiliation(s)
| | - Tamara D Simon
- Department of Pediatrics, University of Southern California, Los Angeles, California
| | - Samudragupta Bora
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Mothers, Babies and Women's Health Program, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Jamie L Lohr
- Department of Pediatrics, University of Minnesota Medical School, Minnesota
| | - Bindiya Bagga
- Department of Pediatrics, LeBonheur Children's Hospital and University of Tennessee, College of Medicine, Memphis, Tennessee
| | - Kecia Carroll
- Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Stephanie D Davis
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Erik Fernandez Y Garcia
- Division of General Pediatrics, UC Davis Health Department of Pediatrics, Sacramento, California
| | - Jordan S Orange
- Department of Pediatrics, Columbia University School of Medicine, New York, New York
| | | | - Sabrina Sedano
- Department of Pediatrics, University of Southern California, Los Angeles, California
| | - Beth A Tarini
- Department of General and Community Pediatrics, Children's National Hospital, Washington, District of Columbia
| | - Michelle J White
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Nancy D Spector
- Department of Pediatrics
- Drexel University, College of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
7
|
Roberts KJ, Omaits E. Evaluation of a Virtual Health Equity Training for Mid-Career Primary Healthcare Providers. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231219614. [PMID: 38116494 PMCID: PMC10729640 DOI: 10.1177/23821205231219614] [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: 12/08/2022] [Accepted: 11/22/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Providing cultural competence training is recommended as a way to improve patient-centered care and reduce health disparities. Increasing awareness of implicit biases and understanding internal motivations for overcoming these biases can influence provider decisions and communications with patients. This study aims to provide a health equity and implicit bias training to healthcare providers and assess knowledge and attitude gains. METHODS Mid-career primary healthcare providers (n = 21) with at least 5 years of primary care experience participated in the training as a prerequisite for providing patient care in a telehealth primary care practice that overwhelmingly serves patients of color. RESULTS There was a significant increase in knowledge (p < .001) as well as attitudes (p < .001) in healthcare providers from pretest to posttest. Almost none (4.5%) of the providers were distracted during the training, which may be due to the interactive nature of the training that included group-based reflection discussions. CONCLUSION A virtual training for primary healthcare providers on health equity and implicit bias improved knowledge and equitable attitudes and had high satisfaction. Additional research is needed to determine if this type of training can influence providers' ability to actively address known disparities in care.
Collapse
|