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Jewell TI, Petty EM. LGBTQ+ health education for medical students in the United States: a narrative literature review. MEDICAL EDUCATION ONLINE 2024; 29:2312716. [PMID: 38359164 PMCID: PMC10877666 DOI: 10.1080/10872981.2024.2312716] [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: 09/18/2023] [Accepted: 01/26/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION People who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, and other sexual/gender minorities (LGBTQ+) may experience discrimination when seeking healthcare. Medical students should be trained in inclusive and affirming care for LGBTQ+ patients. This narrative literature review explores the landscape of interventions and evaluations related to LGBTQ+ health content taught in medical schools in the USA and suggests strategies for further curriculum development. METHODS PubMed, ERIC, and Education Research Complete databases were systematically searched for peer-reviewed articles on LGBTQ+ health in medical student education in the USA published between 1 January 2011-6 February 2023. Articles were screened for eligibility and data was abstracted from all eligible articles. Data abstraction included the type of intervention or evaluation, sample population and size, and key outcomes. RESULTS One hundred thirty-four articles met inclusion criteria and were reviewed. This includes 6 (4.5%) that evaluate existing curriculum, 77 (57.5%) study the impact of curriculum components and interventions, 36 (26.9%) evaluate student knowledge and learning experiences, and 15 (11.2%) describe the development of broad learning objectives and curriculum. Eight studies identified student knowledge gaps related to gender identity and affirming care and these topics were covered in 34 curriculum interventions. CONCLUSION Medical student education is important to address health disparities faced by the LGBTQ+ community, and has been an increasingly studied topic in the USA. A variety of curriculum interventions at single institutions show promise in enhancing student knowledge and training in LGBTQ+ health. Despite this, multiple studies indicate that students report inadequate education on certain topics with limitations in their knowledge and preparedness to care for LGBTQ+ patients, particularly transgender and gender diverse patients. Additional integration of LGBTQ+ curriculum content in areas of perceived deficits could help better prepare future physicians to care for LGBTQ+ patients and populations.
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Affiliation(s)
- Tess I. Jewell
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Elizabeth M. Petty
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Tiako MJN, Aguilar G, Adeyemo O, Reynolds H, Campbell KH, Stanwood N, Galerneau F. Developing an interactive reproductive health equity session for pre-clerkship medical students. MEDICAL EDUCATION ONLINE 2024; 29:2364984. [PMID: 38903002 PMCID: PMC11195450 DOI: 10.1080/10872981.2024.2364984] [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: 09/02/2023] [Accepted: 06/03/2024] [Indexed: 06/22/2024]
Abstract
In the United States, sexual, reproductive, and perinatal health inequities are well documented and known to be caused by a history of systemic oppression along many axes, including but not limited to race, ethnicity, gender, socioeconomic position, sexual orientation, and disability. Medical schools are responsible for educating students on systems of oppression and their impact on health. Reproductive justice advocates, including lay persons, medical students, and teaching faculty, have urged for integrating the reproductive justice framework into medical education and clinical practice. In response to medical student advocacy, we developed introductory didactic sessions on social and reproductive justice for preclinical medical students. These were created in a team-based learning format and include pre-course primer materials on reproductive justice. During the sessions, students engaged with hypothetical clinical vignettes in small groups to identify oppressive structures that may have contributed to the health outcomes described and potential avenues for contextually relevant and level-appropriate advocacy. The sessions took place in November 2019 (in-person) and 2020 (virtually) and were well attended by students. We highlight our experience, student feedback, and next steps, including further integration of reproductive health equity into medical school curricula in concert with department-wide education for faculty, residents, nursing, and allied health professionals. This introduction to social and reproductive justice can be adapted and scaled across different medical school curricula, enhancing the training of a new generation of physicians to become critically aware of how oppressive structures create health inequities and able to mitigate their impact through their roles as clinicians, researchers, and advocates.
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Affiliation(s)
| | - Gabriela Aguilar
- Department of Obstetrics and Gynecology, NYU Langone Health, New York, NY, USA
| | - Oluwatosin Adeyemo
- Yale School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Section of Obstetrics and Midwifery, New Haven, CT, USA
| | | | - Katherine H. Campbell
- Yale School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal and Fetal Medicine, New Haven, CT, USA
| | - Nancy Stanwood
- Planned Parenthood of Southern New England, New Haven, CT, USA
| | - France Galerneau
- Yale School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal and Fetal Medicine, New Haven, CT, USA
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Berk AL, Pickett A, Kusters IS, Gregory ME. Healthcare Experiences of Black Patients During and After Pregnancy: a Needs Assessment for Provider Training to Improve Quality of Care. J Racial Ethn Health Disparities 2024; 11:992-1004. [PMID: 37010801 DOI: 10.1007/s40615-023-01579-5] [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: 02/16/2023] [Revised: 02/16/2023] [Accepted: 03/21/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Black patients are at a higher risk of experiencing less safe and lower quality care during pregnancy and childbirth, compared to their White counterparts. Behaviors that healthcare professionals engage in that can facilitate or hinder high-quality care for this population are underexplored. We sought to explore Black patients' experiences with healthcare professionals during and after pregnancy, as a needs assessment to inform the development of training for healthcare professionals. METHODS We conducted semi-structured interviews of Black patients who were in their third trimester of pregnancy or within 18 months of giving birth. Questions focused on experiences with healthcare professionals during pregnancy-related healthcare, including quality of care and discrimination. Thematic analysis was conducted using a combined deductive-inductive approach. Findings were considered in the context of the Institute of Medicine's Six Domains of Quality (equitable, patient-centered, timely, safe, effective, efficient). RESULTS We interviewed 8 participants who received care from various clinics and institutions. Over half (62%) described experiencing discrimination or microaggressions during their pregnancy-related healthcare. Participants most commonly reflected upon experiences within the patient-centered care domain, regarding whether care was in alignment with their preferences, positive and negative interpersonal interactions, and varied experiences with patient education/shared decision-making. CONCLUSIONS Black patients commonly report experiencing discrimination from healthcare professionals during pregnancy-related healthcare. Reducing microaggressions and improving patient-centered care is a key focus for healthcare professionals who serve this group. Training needs include addressing implicit bias, educating on common microaggressions, improving communication, and promoting an inclusive workplace.
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Affiliation(s)
- Abigail L Berk
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Isabelle S Kusters
- Department of Clinical, Health, and Applied Sciences, University of Houston-Clear Lake, Houston, TX, USA
| | - Megan E Gregory
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, FL, USA.
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Pepe CS, Saadi A, Molina RL. Reproductive Justice in the U.S. Immigration Detention System. Obstet Gynecol 2023; 142:804-808. [PMID: 37734088 PMCID: PMC10510835 DOI: 10.1097/aog.0000000000005335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/25/2023] [Accepted: 05/04/2023] [Indexed: 09/23/2023]
Abstract
Reproductive coercion extends from a historical context in which the obstetrics and gynecology profession has interfered with the reproductive and bodily autonomy of immigrants. We provide illustrative examples of historical and contemporary immigration policies that allow mechanisms of reproductive control to persist within the immigration detention system. We end by compelling obstetrician-gynecologists to act as agents of change by leveraging their social, economic, and political power to resist and eliminate structures and norms that enable reproductive oppression of immigrant groups in detention.
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Affiliation(s)
- Claudia S Pepe
- Northeastern University School of Law, the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, and the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Graham M, Haintz GL, Bugden M, de Moel-Mandel C, Donnelly A, McKenzie H. Re-defining reproductive coercion using a socio-ecological lens: a scoping review. BMC Public Health 2023; 23:1371. [PMID: 37461078 DOI: 10.1186/s12889-023-16281-8] [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: 02/09/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Reproductive coercion is a significant public health issue in Australia which has mainly been conceptualised as a form of violence at the interpersonal level. This limited scope ignores the role of the gendered drivers of violence and fails to encompass a socio-ecological lens which is necessary to consider the multiple interacting layers that create the context in which reproductive coercion occurs. The aim of the scoping review was to explore how the reproductive coercion is defined by international research. Specifically, how is reproductive coercion defined at the social-cultural-systems-structural levels, and are the definitions of reproductive coercion inclusive of the conditions and contexts in which reproductive coercion occurs? METHODS A scoping review was undertaken to explore existing definitions of reproductive coercion. Searches were conducted on Embase, Cochrane Library, Informit Health Collection, and the EBSCOHost platform. Google was also searched for relevant grey literature. Articles were included if they were: theoretical research, reviews, empirical primary research, grey literature or books; published between January 2018 and May 2022; written in English; and focused on females aged 18-50 years. Data from eligible articles were deductively extracted and inductively thematically analysed to identify themes describing how reproductive coercion is defined. RESULTS A total of 24 articles were included in the scoping review. Most research defined reproductive coercion at the interpersonal level with only eight articles partially considering and four articles fully considering the socio-cultural-systems-structural level. Thematic analysis identified four main themes in reproductive coercion definitions: Individual external exertion of control over a woman's reproductive autonomy; Systems and structures; Social and cultural determinants; and Freedom from external forces to achieve reproductive autonomy. CONCLUSIONS We argue for and propose a more inclusive definition of reproductive coercion that considers the gendered nature of reproductive coercion, and is linked to power, oppression and inequality, which is and can be perpetrated and/or facilitated at the interpersonal, community, organisational, institutional, systems, and societal levels as well as by the state.
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Affiliation(s)
- Melissa Graham
- Department of Public Health, School of Psychology and Public Health, La Trobe University, 3086, Bundoora, VIC, Australia.
| | - Greer Lamaro Haintz
- School of Health and Social Development, Deakin University, Locked Bag 20, Geelong, 000, 3220, Australia
| | - Megan Bugden
- Department of Public Health, School of Psychology and Public Health, La Trobe University, 3086, Bundoora, VIC, Australia
| | - Caroline de Moel-Mandel
- Department of Public Health, School of Psychology and Public Health, La Trobe University, 3086, Bundoora, VIC, Australia
| | - Arielle Donnelly
- Department of Public Health, School of Psychology and Public Health, La Trobe University, 3086, Bundoora, VIC, Australia
| | - Hayley McKenzie
- School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, 3125, VIC, Australia
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Rowley S, Broomfield C, Min J, Quinn S, Campbell K, Wood S. Racial Inequities in Adolescent Contraceptive Care Delivery: A Reproductive Justice Issue. J Pediatr Adolesc Gynecol 2023; 36:298-303. [PMID: 36423806 PMCID: PMC10149577 DOI: 10.1016/j.jpag.2022.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE The objective of this study was to examine racial/ethnic disparities in contraceptive delivery for adolescent patients within an adolescent medicine subspecialty clinical system before and during the COVID-19 pandemic. Secondarily, we aimed to assess the relationship between race and contraceptive delivery by telehealth. DESIGN Retrospective cohort study using electronic health record data SETTING: Three adolescent medicine subspecialty clinics in a large academic hospital system, including an urban location and 2 suburban locations PARTICIPANTS: Patients assigned female sex at birth prescribed hormonal contraception between January 1st, 2018, and May 31st, 2021. MAIN OUTCOME MEASURES Method and type of contraceptive prescribed (short-acting, medium-acting, long-acting reversible contraception [LARC]) RESULTS: There were 2453 patients in the study; 47.5% were White, 36.0% were Black, and 8.1% identified as Hispanic. After controlling for insurance and age, Black patients, compared with non-Black patients, had twofold higher odds of receiving LARC compared with a short-acting method across the study period (aOR = 2.0; 95% CI, 1.52-2.62). We identified effect modification with significant interaction between Black race and the pandemic period, with evidence of a higher marginal probability of Black patients receiving LARCs during the pandemic. Additionally, during the pandemic, patients receiving new contraceptive prescriptions via telehealth were less likely to be Black (aOR = 0.63; 95% CI, 0.41-0.94) or publicly insured (aOR = 0.56; 95% CI, 0.38-0.81). CONCLUSION Our data show significantly higher prescribing of LARCs to Black adolescents by clinicians, which could suggest differences in physician contraceptive counseling with a bias toward preferentially counseling Black patients toward LARCs. Our data also show that Black and publicly insured patients had decreased utilization of contraceptive care by telehealth during the pandemic.
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Affiliation(s)
- Sarah Rowley
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | | | - Jungwon Min
- Department of Biomedical and Health Informatics, Children...s Hospital of Philadelphia
| | - Sheila Quinn
- Craig-Dalsimer Division of Adolescent Medicine, Children...s Hospital of Philadelphia; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
| | - Kenisha Campbell
- Policy Lab, Children...s Hospital of Philadelphia; Craig-Dalsimer Division of Adolescent Medicine, Children...s Hospital of Philadelphia; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
| | - Sarah Wood
- Policy Lab, Children...s Hospital of Philadelphia; Craig-Dalsimer Division of Adolescent Medicine, Children...s Hospital of Philadelphia; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
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Smith C, Fatima H, McClain E, Bryant K, Verbiest S, Hassmiller Lich K. Supporting reproductive health among birthing persons with chronic conditions in the United States: A qualitative multilevel study using systems thinking to inform action. Health Serv Res 2023; 58:521-533. [PMID: 36632673 PMCID: PMC10012242 DOI: 10.1111/1475-6773.14131] [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: 01/13/2023] Open
Abstract
OBJECTIVE (STUDY QUESTION) To use systems thinking with diverse system actors to (a) characterize current problems at the intersection of chronic conditions (CCs) and reproductive health (RH) care and their determinants, (b) determine necessary system actors for change, and (c) document cross-system actions that can improve identified problems in the United States. DATA SOURCES/STUDY SETTING Data were collected from six groups of system actors via online focus groups. STUDY DESIGN This is a qualitative multilevel study using the iceberg systems thinking framework. DATA COLLECTION/EXTRACTION METHODS Data were collected by note-taking and recording six focus groups; analysis incorporated perspective triangulation using the systems thinking iceberg and system mapping to visualize interconnected system challenges, actors, and action ideas. PRINCIPAL FINDINGS Participants described eight necessary system actors: health care institutions, medical leaders, medical providers, patient advocates and foundations, patients and families, payors, policy makers, and research funders. Forty pain points were identified, spread across each of the four levels of the systems thinking iceberg: undesirable outcomes (6), concerning trends (9), system structure flaws (15), and problematic mental models (10). In response to these pain points, a set of 46 action ideas was generated by participants and mapped into nine action themes: (1) adjust QI metrics, incentives, and reimbursement, (2) bolster RH medical education and training, (3) break down medical silos, (4) enrich patient education, (5) expand the health care team, (6) improve holistic health care, (7) modify research and programmatic funding to prioritize RH and CC, (8) spur innovation for patient visits, and (9) support professional champions and leaders. CONCLUSIONS By embracing system complexity, creating visual maps, and pushing participants to identify actionable strategies for improvement, this study generates a set of specific actions that can be used to address pain points across the multiple system levels that make improving reproductive care for people with CCs so challenging.
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Affiliation(s)
- Cambray Smith
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hiba Fatima
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erin McClain
- Collaborative for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katherine Bryant
- Collaborative for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sarah Verbiest
- Collaborative for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Jordan Institute for Families, School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Schaaf M, Jaffe M, Tunçalp Ö, Freedman L. A critical interpretive synthesis of power and mistreatment of women in maternity care. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000616. [PMID: 36962936 PMCID: PMC10021192 DOI: 10.1371/journal.pgph.0000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Labouring women may be subjected to physical and verbal abuse that reflects dynamics of power, described as Mistreatment of Women (MoW). This Critical Interpretive Synthesis on power and MoW consolidates current research and advances theory and practice through inter-disciplinary literature exploration. The review was undertaken in 3 phases. Phase 1 consisted of topic scoping; phase 2 entailed exploration of key power-related drivers emerging from the topic scoping; and phase 3 entailed data synthesis and analysis, with a particular focus on interventions. We identified 63 papers for inclusion in Phase 1. These papers utilized a variety of methods and approaches and represented a wide range of geographic regions. The power-related drivers of mistreatment in these articles span multiple levels of the social ecological model, including intrapersonal (e.g. lack of knowledge about one's rights), interpersonal (e.g. patient-provider hierarchy), community (e.g. widespread discrimination against indigenous women), organizational (e.g. pressure to achieve performance goals), and law/policy (e.g. lack of accountability for rights violations). Most papers addressed more than one level of the social-ecological model, though a significant minority were focused just on interpersonal factors. During Phase 1, we identified priority themes relating to under-explored power-related drivers of MoW for exploration in Phase 2, including lack of conscientization and normalization of MoW; perceptions of fitness for motherhood; geopolitical and ethnopolitical projects related to fertility; and pressure to achieve quantifiable performance goals. We ultimately included 104 papers in Phase 2. The wide-ranging findings from Phase 3 (synthesis and analysis) coalesce in several key meta-themes, each with their own evidence-base for action. Consistent with the notion that research on power can point us to "drivers of the drivers," the paper includes some intervention-relevant insights for further exploration, including as relating to broader social norms, health systems design, and the utility of multi-level strategies.
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Affiliation(s)
- Marta Schaaf
- Independent Consultant, Brooklyn, New York, United States of America
| | - Maayan Jaffe
- Independent Consultant, Brooklyn, New York, United States of America
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Lynn Freedman
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America
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Ojo A, Singer MR, Morales B, Merz AA, Molina RL, Pelletier A, Carmen A, Moreno MA, Lopez-Carmen VA, Ye SY, Starosta A, Rowley J, Yin SH, Amanuel H, Radford CC, Schwartz LN, Wijangco I, Jowell AR, Schaefer KM, Potter J, Mateo CM, Bartz D. Reproductive Justice: A Case-Based, Interactive Curriculum. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11275. [PMID: 36310568 PMCID: PMC9592687 DOI: 10.15766/mep_2374-8265.11275] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/11/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Reproductive injustices such as forced sterilization, preventable maternal morbidity and mortality, restricted access to family planning services, and policy-driven environmental violence undermine reproductive autonomy and health outcomes, with disproportionate impact on historically marginalized communities. However, curricula focused on reproductive justice (RJ) are lacking in medical education. METHODS We designed a novel, interactive, case-based RJ curriculum for postclerkship medical students. This curriculum was created using published guidelines on best practices for incorporating RJ in medical education. The session included a prerecorded video on the history of RJ, an article, and four interactive cases. Students engaged in a 2-hour small-group session, discussing key learning points of each case. We evaluated the curriculum's impact with a pre- and postsurvey and focus group. RESULTS Sixty-eight students participated in this RJ curriculum in October 2020 and March 2021. Forty-one percent of them completed the presurvey, and 46% completed the postsurvey. Twenty-two percent completed both surveys. Ninety percent of respondents agreed that RJ was relevant to their future practice, and 87% agreed that participating in this session would impact their clinical practice. Most respondents (81%) agreed that more RJ content is needed. Focus group participants appreciated the case-based, interactive format and the intersectionality within the cases. DISCUSSION This interactive curriculum is an innovative and effective way to teach medical students about RJ and its relevance to clinical practice. Walking alongside patients as they accessed reproductive health care in a case-based curriculum improved students' comfort and self-reported knowledge on several RJ topics.
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Affiliation(s)
- Ayotomiwa Ojo
- First-Year Resident, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine
- Co-primary author
| | - Miriam R. Singer
- Fourth-Year Medical Student, Harvard Medical School
- Co-primary author
| | - Blanca Morales
- Third-Year Resident, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Allison A. Merz
- Third-Year Resident, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | - Rose L. Molina
- Assistant Professor, Department of Obstetrics and Gynecology, Division of Global and Community Health, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Andrea Pelletier
- Biostatistician, Department of Obstetrics & Gynecology, Harvard Medical School/Brigham and Women's Hospital
| | - Andrea Carmen
- Executive Director, Yaqui Nation, International Indian Treaty Council
- Tribal Affiliation: Yaqui Nation
| | - Marcos A. Moreno
- Second-Year Resident, Department of Psychiatry, Yale School of Medicine
- Tribal Affiliation: Yaqui Nation
| | | | | | - Anabel Starosta
- Second-Year Resident, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University
| | | | | | | | - Caitlin C. Radford
- First-Year Resident, Department of Obstetrics & Gynecology, Weill Cornell Medicine
| | | | - Isabelle Wijangco
- Second-Year Resident, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco
| | | | - Kimberly M. Schaefer
- First-Year Resident, Department of Obstetrics and Gynecology, Oregon Health & Science University
| | | | - Camila M. Mateo
- Instructor, Division of Pediatrics, Boston Children's Hospital
| | - Deborah Bartz
- Associate Professor, Department of Obstetrics & Gynecology, Harvard Medical School/Brigham and Women's Hospital
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Salhi BA, Zeidan A, Stehman CR, Kleinschmidt S, Liu EL, Bascombe K, Preston‐Suni K, White MH, Druck J, Lopez BL, Samuels‐Kalow ME. Structural competency in emergency medical education: A scoping review and operational framework. AEM EDUCATION AND TRAINING 2022; 6:S13-S22. [PMID: 35783075 PMCID: PMC9222890 DOI: 10.1002/aet2.10754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 06/15/2023]
Abstract
Objectives Existing curricula and recommendations on the incorporation of structural competency and vulnerability into medical education have not provided clear guidance on how best to do so within emergency medicine (EM). The goal of this scoping review and consensus building process was to provide a comprehensive overview of structural competency, link structural competency to educational and patient care outcomes, and identify existing gaps in the literature to inform curricular implementation and future research in EM. Methods A scoping review focused on structural competency and vulnerability following Arksey and O'Malley's six-step framework was performed in concurrence with a multistep consensus process culminating in the 2021 SAEM Consensus Conference. Feedback was incorporated in developing a framework for a national structural competency curriculum in EM. Results A literature search identified 291 articles that underwent initial screening. Of these, 51 were determined to be relevant to EM education. The papers consistently conceptualized structural competency as an interdisciplinary framework that requires learners and educators to consider historical power and privilege to develop a professional commitment to justice. However, the papers varied in their operationalization, and no consensus existed on how to observe or measure the effects of structural competency on learners or patients. None of the studies examined the structural constraints of the learners studied. Conclusions Findings emphasize the need for training structurally competent physicians via national structural competency curricula focusing on standardized core competency proficiencies. Moreover, the findings highlight the need to assess the impact of such curricula on patient outcomes and learners' knowledge, attitudes, and clinical care delivery. The framework aims to standardize EM education while highlighting the need for further research in how structural competency interventions would translate to an ED setting and affect patient outcomes and experiences.
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Affiliation(s)
- Bisan A. Salhi
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
- Department of AnthropologyEmory UniversityAtlantaGeorgiaUSA
| | - Amy Zeidan
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Christine R. Stehman
- Department of Emergency MedicineUniversity of Illinois College of MedicinePeoriaIllinoisUSA
| | - Sarah Kleinschmidt
- Department of Emergency MedicineUniversity of Massachusetts Medical School—BaystateSpringfieldMassachusettsUSA
| | - E. Liang Liu
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Kristen Bascombe
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Kian Preston‐Suni
- Department of Emergency MedicineVA Greater Los Angeles Healthcare SystemUniversity of California at Los AngelesLos AngelesCaliforniaUSA
| | - Melissa H. White
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Jeff Druck
- Department of Emergency MedicineUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Bernard L. Lopez
- Department of Emergency MedicineSidney Kimmel Medical CollegePhiladelphiaPennsylvaniaUSA
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Horner-Johnson W, Klein KA, Campbell J, Guise JM. Experiences of Women With Disabilities in Accessing and Receiving Contraceptive Care. J Obstet Gynecol Neonatal Nurs 2021; 50:732-741. [PMID: 34389287 PMCID: PMC8759451 DOI: 10.1016/j.jogn.2021.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To conduct an initial exploration of the experiences of women with different types of disability when they attempt to obtain contraceptive care. DESIGN Multiple-category focus group design. SETTING Multiple community sites. PARTICIPANTS Seventeen women with disabilities of reproductive age. METHODS We purposively sampled women with different types of disability and conducted four focus groups organized by disability type: physical disability, intellectual and developmental disability, blind or low vision, and deaf or hard of hearing. We used a semistructured focus group guide to elicit participants' positive and negative experiences with contraceptive care. We analyzed focus group transcripts using content analysis. RESULTS Participants identified challenges to obtaining high-quality contraceptive care in three main thematic areas: Accessibility and Accommodations, Clinician Attitudes, and Health Insurance. Participants with physical disabilities encountered inaccessible clinic rooms and examination tables, and those with sensory disabilities or intellectual and developmental disability described inaccessible clinic forms and information. Participants from multiple disability groups described negative attitudes of health care providers and health insurance limitations. CONCLUSION As described by our participants, the processes and infrastructure of contraceptive care were based on an assumption of an able-bodied norm. Reliance on such a norm, for example, offering a paper pamphlet to a blind woman, is not helpful and can be harmful to women with disabilities. Increased attention to the reproductive health care needs of women with disabilities is important for improving health care equity and quality.
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Changing Obstetrics and Gynecology Residency Education to Combat Reproductive Injustice: A Call to Action. Obstet Gynecol 2021; 137:717-722. [PMID: 33706356 DOI: 10.1097/aog.0000000000004297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/17/2020] [Indexed: 10/21/2022]
Abstract
Although reproductive injustices and reproductive health disparities are well-documented in the United States, recent studies have begun to explore the health care professional's role in their perpetuation. We hypothesized that obstetrics and gynecology residents would observe reproductive injustices during their training. Thus, using a national survey, we asked obstetrics and gynecology residents to share clinical cases in which discrimination, bias, inequity, or injustice was involved in a patient's reproductive health care and queried their preparedness to respond. Through qualitative analysis, we found that respondents shared cases involving racism, discrimination, and structural barriers to care and that they felt poorly equipped to handle injustice. We call for clinician educators to combat reproductive injustice through three key changes to obstetrics and gynecology residency training: 1) incorporate reproductive justice training into formal residency education; 2) create safe spaces for residents to collectively debrief about their experiences with injustice and collaborate on care improvement; and 3) teach community engagement and advocacy skills that identify, center, and elevate local reproductive health priorities.
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Burger K, Evans-Agnew R, Johnson S. Reproductive justice and black lives: A concept analysis for public health nursing. Public Health Nurs 2021; 39:238-250. [PMID: 33970521 DOI: 10.1111/phn.12919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Inequities in maternal mortality in the United States are a form of structural violence against Black women. The concept of reproductive justice has been employed in the social sciences for almost 30 years, yet nursing has been slow to adopt this concept in promoting maternal-child health. OBJECTIVE To analyze the concept of reproductive justice as used in peer-reviewed publications with the aim of reframing black maternal health in public health nursing scholarship, research, practice, and advocacy. DESIGN We conducted a systematic review of the social science literature. We analyzed selected articles though a principle-based concept analysis focusing on epistemological, pragmatic, linguistic, and logical principles. SAMPLE Eight articles were selected from a pool of 377. RESULTS Race was identified as a source of power for understanding reproductive justice through individual knowledge, collective knowledge, and praxis. Pragmatically, reproductive justice is a social justice-oriented platform that bridges the pro-choice/pro-life divide; aids coalition building; and promotes inclusion. Linguistically, the concept is distinct from both reproductive health and reproductive rights. Reproductive justice is logically situated within intersectionality theory and the cumulative embodiment of oppressions Black women experience based on race, class, and gender. CONCLUSION Reproductive justice reframes public health nursing actions for Black women by focusing on uncovering systems of oppression, recognizing past historical injustices, and advancing cultural safety in health promotion. Multilevel interventions are needed to simultaneously address these injustices particularly in the areas of preconception health, maternal health, infant and child health, and Black family well-being across the reproductive lifespan.
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Affiliation(s)
- Kathryn Burger
- University of Washington Medical Center in Seattle, Seattle, WA, USA
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Huysman BC, Paul R, Nigaglioni Rivera A, Tal E, Maddipati R, Madden T. Patient and counselor satisfaction with structured contraceptive counseling by health center staff in federally qualified health centers. Contraception 2020; 103:97-102. [PMID: 33160909 DOI: 10.1016/j.contraception.2020.10.020] [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: 06/30/2020] [Revised: 10/16/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To characterize patient and counselor satisfaction with structured, tier-based contraceptive counseling provided by a nonclinician. STUDY DESIGN We conducted a planned secondary analysis of patient and counselor surveys from a study that enrolled women in 2 contraceptive care programs. All participants received structured contraceptive counseling from trained staff members. Women and counselors completed a confidential post-visit survey regarding satisfaction with counseling and medical mistrust. We used univariate and multivariable regressions to examine differences in high satisfaction with counseling (top score), perceived counselor influence, and perceived counselor judgment by participant characteristics. RESULTS Nine hundred forty-two participants completed surveys; most reported they felt respected (100.0%), trusted the counseling information (99.5%), and that counseling helped them choose a contraceptive method (83.8%). Black race, high school education, public insurance, an income below the federal poverty level, and enrollment site were associated with high medical mistrust. Participants with high medical mistrust were less likely to be highly satisfied with counseling (adjusted relative risk (RR) 0.72; 95% confidence interval [CI] 0.63-0.82), more likely to perceive influence (RR 1.77; 95% CI 1.37-2.28), and more likely to perceive judgment (adjusted odds ratio 8.91; 95% CI 3.61-22.01). Mostly, counselors felt they were able to answer participant questions (98.8%), establish good rapport (95.9%), and that participants understood the information presented (98.0%). CONCLUSIONS Overall, participants were satisfied with tier-based contraceptive counseling delivered by nonclinician staff members. Those with high levels of medical mistrust were less likely to be satisfied. The majority of women found the information beneficial in contraceptive decision making. IMPLICATIONS Overall, women reported high satisfaction with tier-based contraceptive counseling delivered by a nonclinician in 3 federally qualified health centers. However, women with high medical mistrust were less likely to report high levels of satisfaction and more likely to report perceived influence or judgment from the counselor.
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Affiliation(s)
- Bridget C Huysman
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Rachel Paul
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Adriana Nigaglioni Rivera
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Elana Tal
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Ragini Maddipati
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Tessa Madden
- Divisions of Clinical Research & Family Planning, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
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