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Rashid M, Arseneau N, Kemble T, Lightning MP, Forbes KL. Exploring medical students' experiences with indigenous patient care: a phenomenological study. MEDICAL EDUCATION ONLINE 2024; 29:2350251. [PMID: 38720424 PMCID: PMC11086002 DOI: 10.1080/10872981.2024.2350251] [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: 12/15/2023] [Accepted: 04/27/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Indigenous Peoples in Canada bear a disproportionate burden of disease and experience poorer health outcomes as compared to non-Indigenous populations within Canada; these conditions are said to be mediated and exacerbated by pervasive and uninterrupted anti-Indigenous racism. Third and fourth-year medical students at a Canadian medical school were asked to reflect on their experiences working with Indigenous patients in clinical settings, and how their preclinical Indigenous health curriculum impacted these experiences. METHOD Phenomenology was used, guided by Goffman's theory of social stigma. Eleven undergraduate medical students were recruited using purposeful sampling. Semi-structured phone interviews were conducted to gain an in-depth understanding of the participants' experiences. Interviews were recorded and transcribed verbatim. Data were analyzed using the four main processes for phenomenological analysis. RESULTS Four main themes emerged from students' descriptions of clinical experiences involving Indigenous patients: 1) students describe how their Indigenous patients encounter the health care system and their own lack of cultural sensitivity in this context; 2) racism was evident in students' clinical interactions with Indigenous patients, but students do not always perceive these biases nor the impact of this on patient care; 3) identifying the impact of racism on care is complicated by situational clinical encounters; and 4) practicality of preclinical Indigenous health education is desired by students to prepare them for working with Indigenous patients in the clinical setting. CONCLUSIONS In their clinical experiences, students witness racism against Indigenous peoples yet are unprepared to stand up against it. Findings highlight the importance of enhancing undergraduate medical training to allow students to better understand the unique experiences and perspectives of Indigenous patients. The results support the need for ongoing Indigenous health education, to foster culturally sensitive experiences while learning about Indigenous patients.
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Affiliation(s)
| | - Nicole Arseneau
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | | | - Mosom Patrick Lightning
- Elder in Residence, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Karen L. Forbes
- Department of Pediatrics, University of Alberta, Edmonton, Canada
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Cianciolo AT, O'Brien BC, Klamen DL, Mellinger J. Building on Strengths: An Affirmational and Systems-Level Approach to Revisiting Character in Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:708-715. [PMID: 38466581 DOI: 10.1097/acm.0000000000005670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
ABSTRACT Although U.S. medical education has continued to place increased emphasis on defining competency standards and ensuring accountability to the public, health care inequities have persisted, several basic health outcomes have worsened, public trust in the health care system has eroded, and moral distress, burnout, and attrition among practicing physicians have escalated. These opposing trends beg the question of how the "good doctor" concept may be strengthened. In this perspective, the authors argue that revisiting the construct of physician character from an affirmational perspective could meaningfully improve medical education's impact on overall health by more holistically conceptualizing what-and who-a good doctor is. The authors introduce positive psychology's framework of character strengths, probe the distinction between character strengths and medical professionalism, and summarize the role of character strengths in promoting physician engagement and well-being in health care work. They contend that a systems-level approach to cultivating character strengths will foster physician moral agency and well-being and, by extension, transformational change in health care. Consistent with best practice in modern character education, the authors propose that institutions mindfully cultivate moral community among all stakeholders (students, faculty, staff, postgraduate trainees, and patients) and that moral community interaction centers on each member's personal aspirations with respect to living a good life, guided by the character strengths framework and informed by patient perspectives.
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Smith M, McGuire-Adams T, Eady K. Anti-oppression pedagogy in health professions: a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10336-0. [PMID: 38740650 DOI: 10.1007/s10459-024-10336-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/28/2024] [Indexed: 05/16/2024]
Abstract
Health professional learners are increasingly called to learn about health inequity to reduce inequities and improve patient care and health outcomes. Anti-oppression pedagogy (AOP) addresses the need for health professional learners to understand multiple health inequities and the structures and systems that produce inequities. However, the inclusion of AOP in health professions education varies and there is a lack of clarity in its conceptualization and integration. A scoping review was conducted to address this gap and to understand how AOP is conceptualized and integrated in health professions education. Thirty-six articles met the inclusion criteria. The articles demonstrated that AOP is not commonly utilized terminology within health professions education. When AOP is integrated, it is not consistently conceptualized but is generally viewed as a broad concept that focuses on antiracism; decoloniality; intersectionality; and supporting learners to understand, critically reflect on, and act against structural and systemic forms of oppressions. In addition, there is variation in the integration of AOP in health professions education with the most common methods consisting of discussions, cases, reflection, learning through lived experiences, and the incorporation of humanities within a longitudinal curriculum. The results of this scoping review highlight the need for health professions education to develop one clear concept that educators use when teaching about anti-oppression, which may reduce working in silos and allow educators to better collaborate with each other in advancing this work. In addition, this review suggests that health professional programs should consider incorporating AOP in curricula with a broad and longitudinal approach utilizing the common methods of delivery. To better support programs in including AOP in curricula, further research is required to emphasize the benefits, provide clarity on its conceptualization, and determine the most effective methods of integration.
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Affiliation(s)
- Meredith Smith
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
| | - Tricia McGuire-Adams
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Kaylee Eady
- Faculty of Education, University of Ottawa, Ottawa, ON, Canada
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Bussey SR, Dobrof J. Social work's opportunity and obligation to achieve population health equity. SOCIAL WORK IN HEALTH CARE 2024; 63:154-167. [PMID: 38185123 DOI: 10.1080/00981389.2024.2302620] [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: 01/14/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024]
Abstract
US healthcare remains a system in crisis, wherein spending outpaces other Western economies but health inequities match those of an emerging market economy. As a country founded in tenets of white supremacy, structural racism persists as evidenced by longstanding race-based disparities. Although the population health approach offers a potential framework for preventative and community-based health, without overt race-conscious design, race-based disparities will be replicated. This article outlines the current US context and healthcare policy changes that led to population health taking hold. It then articulates social work's pivotal role in population health by explicitly challenging colorblindness to reach race-based health equity. Opportunities for social work practice, leadership, and research are discussed.
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Affiliation(s)
- Sarah Ross Bussey
- Mount Sinai Health Partners, Mount Sinai Health System, New York, New York, USA
| | - Judith Dobrof
- Mount Sinai Health Partners, Mount Sinai Health System, New York, New York, USA
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Saffran L, Doobay-Persaud A. 'You just emotionally break': understanding COVID-19 narratives through public health humanities. MEDICAL HUMANITIES 2023; 49:537-544. [PMID: 37419677 DOI: 10.1136/medhum-2022-012607] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/09/2023]
Abstract
News reports that feature the experiences of healthcare workers have shaped public conversations about the pandemic from its earliest days. For many, stories of the pandemic have been an introduction to the way public health emergencies intersect with cultural, social, structural, political and spiritual determinants. Such stories often feature clinicians and other providers as characters in pandemic tales of heroism, tragedy and, increasingly, frustration. Examining three common categories of provider-focused news narratives-the clinician as a uniquely vulnerable front-line worker, clinician frustration with vaccine and masking resistance, and the clinician as a hero-the authors argue that the framework of public health humanities offers useful tools to understand and potentially shift public conversation of the pandemic. Close reading of these stories illuminates frames that relate to the role of providers, responsibility for the spread of the virus and how the US health system functions in a global context. Public conversations of the pandemic are shaped by and shape news stories and have important implications for policy. Acknowledging that contemporary health humanities in all its iterations considers how non-clinical factors, such as culture, embodiment and power, impact our understanding of health, illness and healthcare delivery, the authors locate their argument amid critiques that focus on social and structural factors. They argue that it is still possible to shift our understanding of and telling of those stories towards a more population-focused frame.
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Affiliation(s)
- Lise Saffran
- Department of Public Health, University of Missouri Columbia, Columbia, Missouri, USA
| | - Ashti Doobay-Persaud
- Department of Medicine and Medical Education, Northwestern University, Evanston, Illinois, USA
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Huddle TS. Against the Turn to Critical Race Theory and "Anti-racism" in Academic Medicine. HEC Forum 2023; 35:337-356. [PMID: 35171431 DOI: 10.1007/s10730-022-09471-1] [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] [Accepted: 01/20/2022] [Indexed: 11/25/2022]
Abstract
Medical academics are increasingly bringing critical race theory (CRT) or its corollaries to their discourse, to their curricula, and to their analyses of health and medical treatment disparities. The author argues that this is an error. The author considers the history of CRT, its claims, and its current presence in the medical literature. He contends that CRT is inimical to usual academic modes of inquiry and has obscured rather than aided the analysis of social and medical treatment disparities. Remedies for racism suggested by CRT advocates will not work and some of them will make things worse. Academic medicine should avoid the embrace of CRT and should maintain an allegiance to rigorous empirical inquiry and to treating patients not as essentialized ethnic group members but as individual human beings in need of care.
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Affiliation(s)
- Thomas S Huddle
- Department of Medicine, University of Alabama at Birmingham School of Medicine, 1534 3rd Avenue South, Birmingham, AL, 35294, USA.
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Jarvis GE, Andermann L, Ayonrinde OA, Beder M, Cénat JM, Ben-Cheikh I, Fung K, Gajaria A, Gómez-Carrillo A, Guzder J, Hanafi S, Kassam A, Kronick R, Lashley M, Lewis-Fernández R, McMahon A, Measham T, Nadeau L, Rousseau C, Sadek J, Schouler-Ocak M, Wieman C, Kirmayer LJ. Taking Action on Racism and Structural Violence in Psychiatric Training and Clinical Practice. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:780-808. [PMID: 37198904 PMCID: PMC10517653 DOI: 10.1177/07067437231166985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- G Eric Jarvis
- Division of Social and Transcultural Psychiatry, McGill University, Montréal, QC, Canada; Cultural Consultation Service and Culture and Psychosis Working Group, Jewish General Hospital, Montréal, QC, Canada
| | - Lisa Andermann
- Equity and Inclusion Council; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Oyedeji A Ayonrinde
- Department of Psychiatry, Queen's University, Kingston, ON, Canada; Community Psychiatry, Providence Care, Kingston, ON, Canada
| | - Michaela Beder
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada; Interdisciplinary Centre for Black Health, University of Ottawa, Ottawa, ON, Canada
| | - Imen Ben-Cheikh
- Department of Psychiatry, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Kenneth Fung
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Asian Initiative in Mental Health, University Health Network, Toronto, ON, Canada; Society for the Study of Psychiatry and Culture, Beverly Hills, CA, USA
| | - Amy Gajaria
- Margaret and Wallace McCain Centre for Child, Youth, and Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ana Gómez-Carrillo
- Montréal Children's Hospital (MCH), McGill University Health Centre (MUHC), Montréal, QC, Canada; Inuulitsivik Health Centre, Puvirnituq, QC, Canada; Ungava Tulattavik Health Centre, Kuujjuaq, QC, Canada
| | | | - Sarah Hanafi
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Azaad Kassam
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Ottawa Newcomer Health Centre, Ottawa, ON, Canada; Wholistic Health and Wellness, Mohawk Council of Akwesasne, Akwesasne, QC, Canada
| | - Rachel Kronick
- Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montréal, QC, Canada; Lady Davis Institute and Sherpa Research Institute, Montréal, QC, Canada
| | - Myrna Lashley
- Department of Psychiatry, McGill University, Montréal, QC, Canada; Research Ethics Board, CIUSSS du Centre-Ouest-de-l'île-de-Montréal, Sir B. Mortimer Jewish General Hospital, Montréal, QC, Canada; Lady Davis Institute for Medical Research, Sir B. Mortimer Jewish General Hospital, Montréal, QC, Canada
| | - Roberto Lewis-Fernández
- Columbia University, New York, NY, USA; New York State Center of Excellence for Cultural Competence and Research Area Leader, Anxiety, Mood, Eating and Related Disorders, New York State Psychiatric Institute, New York, NY, USA
| | | | - Toby Measham
- Department of Psychiatry, McGill University, Montréal, QC, Canada; Divisions of Child Psychiatry and Social and Transcultural Psychiatry, McGill University, Montréal, QC, Canada
| | - Lucie Nadeau
- Department of Psychiatry, McGill University, Montréal, QC, Canada; Montréal University Health Centre, Montréal, QC, Canada; Inuulitsivik Health Centre, Puvirnituq, QC, Canada
| | - Cécile Rousseau
- Division of Social and Cultural Psychiatry, McGill University, Montréal, QC, Canada
| | - Joseph Sadek
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Meryam Schouler-Ocak
- Social Psychiatry, Charité - Universitätsmedizin, Berlin, Germany; Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - Cornelia Wieman
- Indigenous Physicians Association of Canada (IPAC), Vancouver, BC, Canada; First Nations Health Authority (FNHA), Vancouver, BC, Canada
| | - Laurence J Kirmayer
- Division of Social and Transcultural Psychiatry, McGill University, Montréal, QC, Canada; Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montréal, QC, Canada
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Sumpter D, Thurman W, Wright M, Johnson K, Duplechain D, Abbyad C. ART Praxis: Evidence-Based Strategies for Antiracist Teaching in Nursing. Nurs Educ Perspect 2023; 44:273-278. [PMID: 37594418 DOI: 10.1097/01.nep.0000000000001171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
AIM This integrative review seeks to provide effective teaching and learning strategies for teaching about racism and advancing health equity. BACKGROUND Most faculty preparation remains devoid of an exploration of racism and the skills to critique how historical events and socialization create and reinforce the biases that influence how we teach and provide care. It is difficult to teach what we do not know. METHOD Using Whittmore and Knafl's approach, we conducted an integrative review of multidisciplinary literature from 2009 to 2021 to uncover best practices for teaching about racism. Seven databases yielded 55 relevant articles from 18 disciplines. RESULTS Four themes emerged illuminating effective strategies for teaching and learning about systemic racism: encounter education, reflection, discussion, and activism. CONCLUSION Findings of this review align with Mezirow's transformative learning theory and highlight the importance of not just "doing" antiracist activities in a course but "becoming" an antiracist educator.
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Affiliation(s)
- Danica Sumpter
- About the Authors The authors are faculty at the University of Texas at Austin School of Nursing, Austin, Texas. Danica Sumpter, PhD, RN, CNE, is a clinical associate professor. Whitney Thurman, PhD, RN, is an assistant professor. Michelle Wright, PhD, RN, FAAN, is an assistant professor. Karen Johnson, PhD, RN, FSAHM, FAAN, is an associate professor. Danielle Duplechain, MSN, RN, is a graduate research assistant. Chris Abbyad, PhD, RN, WHNP, is a clinical associate professor. This research was support by a Josiah Macy Jr. Award to Dr. Sumpter. For more information, contact Dr. Sumpter at
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Kelly ML, Parente V, Redmond R, Willis R, Railey K. Development of a curriculum in cultural determinants of health and health disparities. J Natl Med Assoc 2023; 115:428-435. [PMID: 37407380 PMCID: PMC10977997 DOI: 10.1016/j.jnma.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 06/14/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Current sociopolitical events coupled with requirement modifications by the Liaison Committee on Medical Education have reinvigorated a need for training in cultural awareness and health disparities in undergraduate medical education. Many institutions, however, have not established longitudinal courses designed to address this content. Additionally, little is known about the change in learners' awareness of cultural determinants of health and health disparities after enrollment in such curricula. In 2016, the authors developed a yearlong required course entitled Cultural Determinants of Health and Health Disparities for first year medical students at a large university medical school in the United States. The course launched in the 2017 academic year. METHODS Two cohorts participated in twelve 2.5 to 3-hour multi-modal sessions focused on various aspects of healthcare delivery for marginalized populations and factors that contribute to health disparities. The Multicultural Assessment Questionnaire was used pre and post course to assess students' self-evaluated changes in knowledge, skills, and awareness related to cultural competency in healthcare. RESULTS Students' self-reported knowledge, skills, and awareness scores regarding cultural competence in health care increased from pre to post-course assessment. On the knowledge scale, students' mean score increased from 2.63 to 2.97 (P < .001), with 16% reporting a decreased score, 30% reporting no change, and 54% reporting growth. On the skills scale, students' mean score increased from 2.64 to 3.38 (P < .001), with 11% reporting a decreased score, 17% reporting no change, and 72% reporting growth. On the awareness scale, students' overall score increased from 3.76 to 3.97 (P < .05), with 16% reporting a decreased score, 50% reporting no change, and 34% reporting growth. There were no changes in KSA scores across cohorts pre and post course. CONCLUSION Perceived knowledge, skills, and awareness related to the importance of cultural competence in healthcare delivery increased at the end of the academic year. This type of longitudinal course model could be broadly adopted at other institutions to enhance patient, peer, and future provider awareness regarding cultural impacts on care and health disparities among vulnerable populations.
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Affiliation(s)
- Megan L Kelly
- Medical Scientist Training Program, Department of Biochemistry, Duke University School of Medicine, Durham, NC, USA
| | - Victoria Parente
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca Redmond
- Office of Diversity and Inclusion, Duke University School of Medicine, Durham, NC, USA
| | - Rheaya Willis
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kenyon Railey
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA.
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Royce CS, Morgan HK, Baecher-Lind L, Cox S, Everett EN, Fleming A, Graziano SC, Sims SM, Morosky C, Sutton J, Sonn T. The time is now: addressing implicit bias in obstetrics and gynecology education. Am J Obstet Gynecol 2022; 228:369-381. [PMID: 36549568 DOI: 10.1016/j.ajog.2022.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/29/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Obstetrician-gynecologists can improve the learning environment and patient care by addressing implicit bias. Accumulating evidence demonstrates that racial and gender-based discrimination is woven into medical education, formal curricula, patient-provider-trainee interactions in the clinical workspace, and all aspects of learner assessment. Implicit bias negatively affects learners in every space. Strategies to address implicit bias at the individual, interpersonal, institutional, and structural level to improve the well-being of learners and patients are needed. The authors review an approach to addressing implicit bias in obstetrics and gynecology education, which includes: (1) curricular design using an educational framework of antiracism and social justice theories, (2) bias awareness and management pedagogy throughout the curriculum, (3) elimination of stereotypical patient descriptions from syllabi and examination questions, and (4) critical review of epidemiology and evidence-based medicine for underlying assumptions based on discriminatory practices or structural racism that unintentionally reinforce stereotypes and bias. The movement toward competency-based medical education and holistic evaluations may result in decreased bias in learner assessment. Educators may wish to monitor grades and narratives for bias as a form of continuous educational equity improvement. Given that practicing physicians may have little training in this area, faculty development efforts in bias awareness and mitigation strategies may have significant impact on learner well-being.
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Affiliation(s)
- Celeste S Royce
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
| | - Helen Kang Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Laura Baecher-Lind
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA
| | - Susan Cox
- Department of Medical Education, The University of Texas at Tyler School of Medicine, Tyler, TX
| | - Elise N Everett
- Department of Obstetrics, Gynecology and Reproductive Sciences, Robert Larner College of Medicine, The University of Vermont, Burlington, VT
| | - Angela Fleming
- Department of Obstetrics and Gynecology, Michigan State University College of Osteopathic Medicine, East Lansing, MI
| | - Scott C Graziano
- Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Shireen Madani Sims
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL
| | - Christopher Morosky
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT
| | - Jill Sutton
- Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Tammy Sonn
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO
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Barrere-Cain R, Garriga M, Kaki DA, Lawrence C, Reardon A, Martin A. Why and How Civic Health Should Be Incorporated Into Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1760-1764. [PMID: 36149387 DOI: 10.1097/acm.0000000000004765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Civic health refers to the ability of a community to organize and collectively address problems that affect the well-being of its members through democratic participation. Civic health should be an integral part of the medical school curriculum because improving a community's civic health shifts the distribution of power toward patients, better enabling them to address social determinants of health that are affecting their well-being. This article details how to effectively integrate civic health curriculum into already-existing medical education frameworks, outlines how these interventions will improve both patient care and the student experience, and addresses barriers that might restrict the implementation. Civic health can be integrated into the didactic curriculum in the form of lunchtime guest lectures, panels with community organizations, and small-group discussions; it can be integrated into experiential curriculum by distributing QR codes to aid in voter registration, organizing voter registration drives, and participating in nonpartisan canvassing. This civic health content can be integrated into existing social justice curricula without massive investment or structural change. Medical students are capable and effective messengers of civic health and can affect change at all levels of training. Notably, because civic health is directly actionable, it can be a source of motivation rather than burnout for medical students. As students develop into medical professionals, the training in civic health improves their understanding of social determinants of health and enables them to play an important role in promoting civic engagement and empowering patients with the democratic tools necessary to enact social change.
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Affiliation(s)
- Rio Barrere-Cain
- R. Barrere-Cain is an MD-PhD student, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0002-0522-253X
| | - Meera Garriga
- M. Garriga is a medical student, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0002-8603-621X
| | - Dahlia A Kaki
- D.A. Kaki is a medical student, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0001-9998-0026
| | - Carlton Lawrence
- C. Lawrence is a resident, Department of Pediatrics, Mount Sinai Hospital, New York, New York; ORCID: https://orcid.org/0000-0001-7507-5582
| | - Alexander Reardon
- A. Reardon is a resident, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-0246-0196
| | - Alister Martin
- A. Martin is an emergency physician and assistant professor, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-7826-5939
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Hawkins BE, Coupet E, Saint-Hilaire S, Dodington J. Trauma-Informed Acute Care of Patients With Violence-Related Injury. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP18376-NP18393. [PMID: 34463589 DOI: 10.1177/08862605211041375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Violently-injured individuals presenting to the emergency department (ED) have an elevated risk of repeat injury after being discharged from acute care settings and a high rate of unaddressed mental health and social needs. While there is a growing body of programmatic interventions to address these needs, including hospital-based violence intervention programs, there is a lack of data regarding physician perspectives of current practice for this patient population. Understanding current practice is critical for integrating new programs into workflow and developing evidence-based medical education to improve care. The aim of this study is to elucidate current trauma-informed care practices of emergency medicine and general surgery trainee physicians to inform future curriculum development surrounding care of violently injured patients. In this study, emergency medicine and surgical trainees with at least one year of residency experience participated in simulation-primed interviews in pairs or small groups. Interviews garnered perspectives on the physician role in treating violently injured youth, using simulation as a priming event focused on previously known patient concerns. Qualitative themes that emerged were participants (1) perceived their role as managing medical/surgical concerns and seek others to build trust and manage psychosocial and legal concerns, (2) had a high level of knowledge of ED stressors and de-escalation strategies, (3) perceived that patient distrust can negatively impact their ability to provide care, and (4) perceived that law enforcement can negatively impact care and are sometimes uncertain about how to interact with law enforcement. These findings support that medical education for providers should focus on medicolegal issues, particularly managing law enforcement presence in the ED, structural and interpersonal causes of distrust of medical providers and the medical system, and addressing postdischarge mental health and social needs.
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Zhou B, Louie AK. Beyond Humility: Empowering Minoritized Learners Through Culturally Reflective Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1299-1304. [PMID: 35583951 DOI: 10.1097/acm.0000000000004744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In the wake of the Black Lives Matter and other antiracism justice movements, medical education is evolving to incorporate health equity principles for all medical students and residents, while also increasing institutional diversity recruitment of minoritized physicians. As the demographics of U.S. medical trainees shift to reflect a rapidly evolving patient population, the prevalence of culturally concordant patient-physician visits, where patients share elements of language, religion, customs, and identities with their physician, is also expected to increase. However, existing antiracist curricula are standardized to all learners and there is a dearth of cultural sensitivity training designed specifically for minoritized learners to interrogate the culturally concordant space they share with patients and mentors. In this article, the authors propose a new model for minoritized learners' cultural training, culturally reflective medicine (CRM) that identifies unanticipated tensions that may arise as minoritized learners bridge both White and Eurocentric professional and personal identities, examines how intersectionality can both strengthen encounters and lead to shared blind spots, and empowers minoritized physicians with tools for self- and group reflection to advocate for their communities. CRM is contextualized within the current landscape of cultural sensitivity training in medical education. The authors provide 2 clinical vignettes to demonstrate how CRM can unveil more nuanced understandings of health disparities than existing cultural training. As institutions work toward diversity, equity, justice, and antioppression, CRM provides a novel framework for redesigning medical education that better acknowledges and incorporates the unique knowledge of minoritized learners.
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Affiliation(s)
- Bright Zhou
- B. Zhou is a first-year family medicine resident, Stanford University-O'Connor Family Medicine Residency Program, San Jose, California; ORCID: https://orcid.org/0000-0002-0253-9179
| | - Alan K Louie
- A.K. Louie is a professor, associate chair, and director of education, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California; ORCID: https://orcid.org/0000-0002-6762-1835
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14
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Sanky C, Bai H, He C, Appel JM. Medical students' knowledge of race-related history reveals areas for improvement in achieving health equity. BMC MEDICAL EDUCATION 2022; 22:612. [PMID: 35948907 PMCID: PMC9365447 DOI: 10.1186/s12909-022-03650-x] [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: 03/06/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Medical schools have increasingly integrated social justice, anti-racism, and health equity training into their curricula. Yet, no research examines whether medical students understand the complex history of racial injustice. We sought to investigate the relationship between medical students' historical knowledge and their perceptions regarding health equity. METHODS Medical students at one large urban medical school self-rated their familiarity and importance of various racially-significant historical events and persons, as well as their agreement with statements regarding health equity, education, and preparedness to act. Descriptive and multivariate analyses were conducted in R. RESULTS Of 166 (RR=31.3%) participants, 96% agreed that understanding historical context is necessary in medicine; yet 65% of students could not describe the historical significance of racial events or persons. Only 57% felt that they understood this context, and the same percentage felt other medical students did not. A minority of students felt empowered (40%) or prepared (31%) to take action when they witness racial injustice in healthcare. Multiracial identity was significantly associated with increased knowledge of African American history (p<0.01), and a humanities background was significantly associated with increased knowledge of Latin American history (p=0.017). There was a positive, significant relationship between advocacy statements, such as "I have taken action" (p<0.001) and "I know the roots of racism" (p<0.001) with mean familiarity of historical events. CONCLUSIONS This study demonstrates that while students agree that racism has no place in healthcare, there remains a paucity of knowledge regarding many events and figures in the history of American race relations and civil rights, with implications for future physicians' patient care and health equity efforts.
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Affiliation(s)
- Charles Sanky
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Halbert Bai
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Celestine He
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jacob M Appel
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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15
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Ayyala MS, Hill J, Traba C, Soto-Greene M, Shiau S, DallaPiazza M. Teaching Health Equity in the Time of COVID-19: a Virtual Look Through the Lens of Structural Racism. J Gen Intern Med 2022; 37:2323-2326. [PMID: 35710672 PMCID: PMC9202964 DOI: 10.1007/s11606-022-07516-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/25/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In the context of marked health disparities affecting historically marginalized communities, medical schools have an obligation to rapidly scale up COVID-19 education through the lens of structural racism. AIM To develop and implement a virtual curriculum on structural racism in a required COVID-19 course for medical students using "just-in-time" training. SETTING Academic medical institution during the height of COVID-19 in the spring of 2020. PARTICIPANTS Three hundred ninety-three 3rd and 4th-year medical students prior to re-entry into clinical care. PROGRAM DESCRIPTION Three educational sessions focused on (1) racial health disparities, (2) othering and pandemics, and (3) frameworks to address health inequity. The virtual teaching methods included narrated recorded presentations, reflections, and student-facilitated small group dialogue. PROGRAM EVALUATION In matched pre- and post-surveys, participants reported significant changes in their confidence in achieving the learning objectives and high satisfaction with small group peer facilitation. DISCUSSION The use of "just-in-time" training exploring the intersection between COVID-19 and structural racism facilitated the delivery of time-relevant and immediately clinically applicable content as students were preparing to re-enter a transformed clinical space. Similar approaches can be employed to adapt to changing healthcare landscapes as academic medical centers strive to build more equitable health systems.
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Affiliation(s)
- Manasa S Ayyala
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
| | - James Hill
- Office of Student Affairs, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Christin Traba
- Office of Education, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Maria Soto-Greene
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Office for Diversity and Community Engagement, Rutgers New Jersey Medical School, Newark, NJ, USA
| | | | - Michelle DallaPiazza
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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16
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Balhara KS, Ehmann MR, Irvin N. Antiracism in Health Professions Education Through the Lens of the Health Humanities. Anesthesiol Clin 2022; 40:287-299. [PMID: 35659401 DOI: 10.1016/j.anclin.2021.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Racism represents a public health crisis, adversely impacting patient outcomes and health care workplace inclusivity. Dismantling racism requires transforming both racist systems and individual and collective consciousness. Focusing on antiracism in health professions education through the transdisciplinary lens of the health humanities can spur self-reflection, critical thinking, and collaboration among health professions educators and trainees to create more equitable structures of care. This article describes how the health humanities provide a powerful framework for antiracist health professions education. The authors conclude with a snapshot of an existing humanities-based antiracist curriculum, with suggestions to facilitate implementation in other settings.
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Affiliation(s)
- Kamna S Balhara
- Emergency Medicine Residency Program, Johns Hopkins University School of Medicine, Johns Hopkins Department of Emergency Medicine, 1830 E Monument Street, Suite 6-100, Baltimore, MD 21287, USA.
| | - Michael R Ehmann
- Emergency Medicine Residency Program, Johns Hopkins University School of Medicine, Johns Hopkins Department of Emergency Medicine, 1830 E Monument Street, Suite 6-100, Baltimore, MD 21287, USA. https://twitter.com/MichaelEhmannMD
| | - Nathan Irvin
- Johns Hopkins University School of Medicine, Johns Hopkins Department of Emergency Medicine, 1830 E Monument Street, Suite 6-100, Baltimore, MD 21287, USA. https://twitter.com/swervinnirvin
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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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18
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Brown A, Auguste E, Omobhude F, Bakana N, Sukhera J. Symbolic Solidarity or Virtue Signaling? A Critical Discourse Analysis of the Public Statements Released by Academic Medical Organizations in the Wake of the Killing of George Floyd. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:867-875. [PMID: 35044980 DOI: 10.1097/acm.0000000000004597] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Many academic medical organizations issued statements in response to demand for collective action against racial injustices and police brutality following the murder of George Floyd in May 2020. These statements may offer insight into how medical schools and national organizations were reflecting on and responding to these incidents. The authors sought to empirically examine the initial statements published by academic medical organizations in response to societal concerns about systemic, anti-Black racism. METHOD The authors searched for initial public statements released by a sample of academic medical organizations in Canada and the United States between May 25 and August 31, 2020. They assembled an archive with a purposive sample of 45 statements, including those issued by 35 medical schools and 10 national organizations. They analyzed the statements using Fairclough's 3-dimensional framework for critical discourse analysis (descriptive, interpretive, explanatory), which is a qualitative approach to systematically analyzing language and how it reflects and shapes social practice. RESULTS Many statements used formal and analytical language and reflected hierarchical thinking and power differentials between statement producers and consumers. The authors identified several tensions in the statements between explicit messaging and implied ideologies (e.g., self-education vs action to address racism), and they found a lack of critical reflection and commitment to institutional accountability to address anti-Black racism in academic medicine. The authors also found that many statements minimized discussions of racism and de-emphasized anti-Black racism as well as portrayed anti-Black racism as outside the institution and institutional accountability. CONCLUSIONS This research offers insight into how 45 academic medical organizations initially responded following the murder of George Floyd. Many of these statements included self-exculpatory and nonracist discursive strategies. While these statements may have been well intentioned, organizations must move beyond words to transformative action to abolish institutional racism in academic medicine.
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Affiliation(s)
- Allison Brown
- A. Brown is assistant professor, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; ORCID: https://orcid.org/0000-0002-4552-8146
| | - Emmanuelle Auguste
- E. Auguste is an undergraduate student, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Favour Omobhude
- F. Omobhude is an undergraduate student, Faculty of Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naomie Bakana
- N. Bakana is an undergraduate student, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
| | - Javeed Sukhera
- J. Sukhera is chair/chief, Psychiatry Institute of Living and Hartford Hospital, Hartford, Connecticut; ORCID: https://orcid.org/0000-0001-8146-4947
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19
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Perez NP, Ahmad H, Alemayehu H, Newman EA, Reyes-Ferral C. The impact of social determinants of health on the overall wellbeing of children: A review for the pediatric surgeon. J Pediatr Surg 2022; 57:587-597. [PMID: 34893308 DOI: 10.1016/j.jpedsurg.2021.10.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 01/10/2023]
Abstract
Disparities in health care access, quality, and outcomes for pediatric patients, and their relationship to race and socioeconomic status (SES) have been extensively documented. The underlying causes behind such disparities have been less carefully studied, as clinicians and researchers often fail to look past immutable features such as race, into modifiable factors like social determinants of health (SDOH). A child's environment affects their patterns of social engagement, sense of security, and overall well-being. Resources such as affordable housing, access to education, public safety, and availability of healthy foods and safe play spaces impact and enhance quality of life, and have significant influence on both health and health care outcomes. These upstream indicators are often unrecognized or misidentified as health concerns. Few pediatric surgery publications discuss SDOH and their effects on children. This paper aims to introduce the five domains of SDOH (economic stability, education, social and community context, health and healthcare, and neighborhood and built environment) along with strategies to identify and address needs in these domains from a provider, hospital, and health system's perspective. It is anticipated that this information will serve as a foundation for pediatric surgeons to understand and develop processes that ameliorate disparities related to SDOH and improve surgical outcomes and the well-being of all children.
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Affiliation(s)
- Numa P Perez
- Department of Surgery, Division of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St GRB-425, Boston, MA 02114, United States.
| | - Hira Ahmad
- Department of Surgery, Nationwide Children's Hospital, Columbus, The Ohio State University College of Medicine, OH, United States
| | - Hanna Alemayehu
- Department of Surgery, Children's and Women's Hospital, University of South Alabama Health System, Mobile, AL, United States
| | - Erika A Newman
- Department of Surgery, CS Mott Children's Hospital, The University of Michigan, Ann Arbor, MI, United States
| | - Cynthia Reyes-Ferral
- Department of Surgery, St. Joseph's Children's Hospital, Tampa, FL, United States
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20
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Jindal M, Mistry KB, McRae A, Unaka N, Johnson T, Thornton RLJ. "It Makes Me a Better Person and Doctor": A Qualitative Study of Residents' Perceptions of a Curriculum Addressing Racism. Acad Pediatr 2022; 22:332-341. [PMID: 34923147 DOI: 10.1016/j.acap.2021.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Explore how pediatric residents perceive the impact of a curriculum addressing racism on their knowledge, motivation, skills and behaviors, and investigate the contextual factors that promote or impede the curriculum's effectiveness. METHODS Open-ended, semistructured interviews were conducted at 2 academic medical centers between August 2019 and 2020 among pediatric residents who participated in the curriculum. Interviews were recorded, transcribed, and analyzed by using inductive content analysis. RESULTS Pediatric residents (n = 16) were predominantly white (66.7%), female (86.7%) interns (60%) from the Midwest (40%). Six major themes emerged describing the perceived impact of the curriculum on: knowledge - (1) Understanding of race and racism as structural forces in a historical context; motivation - (2) Owning the issue of racism, (3) Having the curriculum makes a statement; skills - (4) Critical self-reflection, (5) Perceived development of skills to mitigate biases; and action-planning - (6) Turning insight into strategies to combat racism and improve patient care. Two additional themes emerged describing contextual factors that promoted or impeded the curriculum such as the content of the curriculum itself, the racial demographics of the participants, the implementation infrastructure and environmental factors such as the culture of the training program. CONCLUSIONS Medical education addressing racism can facilitate the perceived acquisition of foundational knowledge regarding race and racism; motivation and skill-building to combat racism; and action planning aimed at improving patient care. Contextual factors should be considered when developing and implementing such curricula to not only promote racial equity but avoid unintended harms.
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Affiliation(s)
- Monique Jindal
- Division of General Pediatrics, Department of Pediatrics (M Jindal, KB Mistry, RLJ Thornton), Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Kamila B Mistry
- Division of General Pediatrics, Department of Pediatrics (M Jindal, KB Mistry, RLJ Thornton), Johns Hopkins University School of Medicine, Baltimore, Md; Office of Extramural Research, Education, and Priority Populations (KB Mistry), Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Md
| | - Ashlyn McRae
- Division of General Pediatrics, Department of Pediatrics (M Jindal, KB Mistry, RLJ Thornton), Johns Hopkins University School of Medicine, Baltimore, Md
| | - Ndidi Unaka
- Division of Hospital Medicine (N Unaka), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (N Unaka), University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tiffani Johnson
- Department of Emergency Medicine (T Johnson), University of California, Davis, Calif
| | - Rachel L J Thornton
- Division of General Pediatrics, Department of Pediatrics (M Jindal, KB Mistry, RLJ Thornton), Johns Hopkins University School of Medicine, Baltimore, Md; Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society (RLJ Thornton), Baltimore, Md
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21
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Muldoon KM. IMPROVing communication about diversity, equity, and inclusion in health professions education. Anat Rec (Hoboken) 2022; 305:1000-1018. [PMID: 35103421 DOI: 10.1002/ar.24864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/26/2021] [Accepted: 12/21/2021] [Indexed: 12/22/2022]
Abstract
There has never been a stronger call for authenticity in health professions education than this moment in time. The health inequities laid bare by the COVID-19 syndemic (a concept that describes the clustering of SARS-CoV-2 infection and disease by political, social, and economic factors) compels health professions educators to learn how to best engage in, sustain, and deepen conversations on diversity, equity, and inclusion (DEI) within our learning environments. Health professions curricula should address such concerns through explicit faculty training programs in dialogue models of communication. In this commentary, I propose that medical improv can help refocus health professions training to the humanistic values of empathy for others and respect for multiple viewpoints. Medical improv refers to teaching methods that adapt improvisation principles and exercises to enhance professional competencies in the health professions, such as communication. I describe a training series implemented at one institution to prepare faculty facilitators to engage in conversations about DEI in a discussion-based core course on the social determinants of health for first year medical students called "Humanity in Medicine." Key elements of dialogue training, including examinations of identity and positionality, caretaking and team-making, and conversations with a skeptic, are viewed through the lens of improv exercises as a pedagogy in communication. I report on facilitator and medical students' positive response to facilitator training and the Humanity in Medicine course. Potential next steps towards a formal evaluation of the method, and outcomes assessments of the use of improv in health professions training are discussed.
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Affiliation(s)
- Kathleen M Muldoon
- Department of Anatomy, College of Graduate Studies and Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
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22
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Garvey A, Lynch G, Mansour M, Coyle A, Gard S, Truglio J. From Race to Racism: Teaching a Tool to Critically Appraise the Use of Race in Medical Research. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11210. [PMID: 35128047 PMCID: PMC8784584 DOI: 10.15766/mep_2374-8265.11210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 10/05/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Despite the ubiquitous use of race within scientific literature, medical trainees are not taught how to critically appraise the use of racial categories. We developed a tool to appraise the use of race in medical literature and a workshop to teach this approach. METHODS Third-year medical students and second- and third-year residents participated in workshops between 2015 and 2018. We evaluated our UME workshop with a postworkshop survey. We evaluated our GME workshop with a pretest, immediate posttest, and 6-month posttest on self-assessed knowledge, skills, and use of the Critical Appraisal of Race in Medical Literature (CARMeL) tool in subsequent journal clubs. RESULTS We delivered this workshop to 560 students and 82 residents. Of the initial 140-student cohort evaluating the workshop, 99 (71% response rate) highly rated clarity of presentation, quality of teaching, and quality of slides. Of PGY 2 and PGY 3 residents, 67 (82% response rate) rated the workshop greater than 4.5 out of 5 on quality, clarity, and appropriateness of content. Residents had significant improvements in self-assessed knowledge and skills immediately after the session and 6 months later. Of residents, 74% reported using the CARMeL tool in subsequent presentations. DISCUSSION We designed the CARMeL tool and a workshop to teach it. Trainees rated this workshop as useful, with the majority of residents later applying the tool. Limitations included a lack of objective assessment of knowledge acquisition. We recommend that institutions invest time in faculty development and pair new faculty with those experienced in anti-oppressive facilitation.
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Affiliation(s)
- Amy Garvey
- Third-Year Resident, Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Giselle Lynch
- Third-Year Resident, Department of Ophthalmology, Icahn School of Medicine at Mount Sinai
| | - Mayce Mansour
- Assistant Professor, Department of Medicine and Department of Medical Education, Icahn School of Medicine at Mount Sinai
| | - Andrew Coyle
- Associate Professor, Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health
| | - Sabrina Gard
- Assistant Professor, Department of Medicine, Icahn School of Medicine at Mount Sinai
| | - Joseph Truglio
- Assistant Professor, Department of Medicine, Department of Pediatrics, and Department of Medical Education, Icahn School of Medicine at Mount Sinai
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Finn GM, Danquah A, Matthan J. Colonization, cadavers, and color: Considering decolonization of anatomy curricula. Anat Rec (Hoboken) 2022; 305:938-951. [PMID: 34989137 PMCID: PMC9304213 DOI: 10.1002/ar.24855] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022]
Abstract
Anatomy is a discipline that, despite its universal nature, offers limited diversity in terms of representation in cadavers, imagery, technology, and models used within teaching. The universal move toward inclusive curricula has put anatomy education under the microscope, particularly with respect to efforts to decolonize curricula. This paper considers the challenges and opportunities to diversify the anatomy curriculum. Decolonizing anatomy education curricula will entail addressing the ingrained cultures within the disciplines, such that produces a number of challenges including: underrepresentation of certain bodies, difficulty talking about difference, and the hidden curriculum in anatomy education. In order to aid educators in achieving inclusive anatomy curricula, a toolkit and considerations are presented, alongside both do's, don'ts and case examples. We highlight the black-or-white dichotomy, and the absence of brown in between. The paper is a conversation starter for what it means to begin the process of decolonizing the curriculum within anatomy education.
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Affiliation(s)
- Gabrielle M Finn
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Adam Danquah
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Joanna Matthan
- School of Dental Sciences, Newcastle University, Newcastle, UK
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Neff KE, Puttagunta KS, Grob KL, Ahmed AZ, Daniel MM. Institutionalizing Health Justice Frameworks in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S194-S195. [PMID: 34705694 DOI: 10.1097/acm.0000000000004316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Katherine E Neff
- Author affiliations: K.E. Neff, K.S. Puttagunta, K.L. Grob, A.Z. Ahmed, M.M. Daniel, University of Michigan Medical School
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Singh MK, Gullett HL, Thomas PA. Using Kern's 6-Step Approach to Integrate Health Systems Science Curricula Into Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1282-1290. [PMID: 33951679 DOI: 10.1097/acm.0000000000004141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The term "health systems science" (HSS) has recently emerged as a unifying label for competencies in health care delivery and in population and community health. Despite strong evidence that HSS competencies are needed in the current and future health care workforce, heretofore the integration of HSS into medical education has been slow or fragmented-due, in part, to a lack of evidence that these curricula improve education or population outcomes. The recent COVID-19 pandemic and the national reckoning with racial inequities in the United States further highlight the time-sensitive imperative to integrate HSS content across the medical education continuum. While acknowledging challenges, the authors highlight the unique opportunities inherent in an HSS curriculum and present an elaborated curricular framework for incorporating health care delivery and population health into undergraduate medical education. This framework includes competencies previously left out of medical education, increases the scope of faculty development, and allows for evidence of effectiveness beyond traditional learner-centric metrics. The authors apply a widely adopted 6-step approach to curriculum development to address the unique challenges of incorporating HSS. Two examples-of a module on quality improvement (health care delivery) and of an introductory course on health equity (population and community health)-illustrate how the 6-step approach can be used to build HSS curricula. The Supplemental Digital Appendix (at http://links.lww.com/ACADMED/B106) outlines this approach and provides specific examples and resources. Adapting these resources within local environments to build HSS curricula will allow medical educators to ensure future graduates have the expertise and commitment necessary to effect health systems change and to advocate for their communities, while also building the much-needed evidence for such curricula.
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Affiliation(s)
- Mamta K Singh
- M.K. Singh is professor of medicine, Jerome Kowal, MD Designated Professor for Geriatric Health Education, Veterans Affairs Northeast Ohio Healthcare System, and former assistant dean, Health Systems Science, Case Western Reserve University School of Medicine, Cleveland, Ohio; ORCID: https://orcid.org/0000-0001-8235-4272
| | - Heidi L Gullett
- H.L. Gullett is associate professor and Charles Kent Smith, MD and Patricia Hughes Moore, MD Professor in Medical Student Education in Family Medicine, Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, Ohio; ORCID: https://orcid.org/0000-0002-3984-517X
| | - Patricia A Thomas
- P.A. Thomas was, when this was written, professor of medicine, Amasa B. Ford Professor of Geriatrics, and vice dean, Medical Education, Case Western Reserve University School of Medicine, Cleveland, Ohio; she is currently professor of medicine emerita, Johns Hopkins University School of Medicine, Baltimore, Maryland; ORCID: https://orcid.org/0000-0003-4528-9891
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Grossman LG, Mechanic OJ, Orr Z, Cioe‐Peña EC, Landry A, Unger S, Greenstein J, Alpert EA. An analysis of social determinants of health and structural competency training in global emergency medicine fellowship programs in the United States. AEM EDUCATION AND TRAINING 2021; 5:S28-S32. [PMID: 34616970 PMCID: PMC8480506 DOI: 10.1002/aet2.10660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/19/2021] [Accepted: 04/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Clinicians must be aware of the structural forces that affect their patients to appropriately address their unique health care needs. This study aimed to assess the participation of global emergency medicine (GEM) fellowship programs in formal social determinants of health (SDH) and structural competency (SC) training to evaluate the existence and procedures of such programs. METHODS A cross-sectional study conducted with a short, online survey with questions regarding the presence of curriculum focused on SDH, SC, educational metrics, and the desire for further formal training in this domain was sent to all 25 GEM fellowship directors through the Global Emergency Medicine Fellowship Consortium (GEMFC) email listserv. RESULTS Eighty percent (20/25) of GEM fellowship directors responded to the survey. All (20/20) of participating fellowship programs included SDH and SC training in their didactic curriculum, and eight of 20 (40%) programs offered similar training for faculty. Additionally, 19 of 20 (95%) of respondents indicated interest in an open-source tool for emergency medicine (EM) fellowship training in SDH and SC. CONCLUSIONS While multiple GEM programs offer formal training on SDH and SC, gaps exist regarding similar training for faculty. Additionally, there is a lack of metrics to determine fellows' comfort with the content of this training. As a majority of GEMFC programs requested, an open-source tool would allow a uniform curriculum and measurement of EM fellowship training in SDH and SC.
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Affiliation(s)
- Lindsay G. Grossman
- Perelman School of MedicineThe University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Oren J. Mechanic
- Harvard Medical Faculty PhysiciansBostonMassachusettsUSA
- Department of Emergency MedicineMount Sinai Medical CenterMiami BeachFloridaUSA
| | - Zvika Orr
- Department of NursingJerusalem College of TechnologyJerusalemIsrael
| | | | - Alden Landry
- Department of Emergency MedicineBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Shifra Unger
- Department of NursingJerusalem College of TechnologyJerusalemIsrael
| | - Josh Greenstein
- Department of Emergency MedicineNorthwell Staten Island University HospitalStaten IslandNew YorkUSA
| | - Evan Avraham Alpert
- Department of Emergency MedicineShaare Zedek Medical CenterFaculty of Medicine, Hebrew University of JerusalemJerusalemIsrael
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Zaidi Z, Razack S, Kumagai AK. Professionalism revisited during the pandemics of our time: COVID-19 and racism. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:238-244. [PMID: 33738767 PMCID: PMC7971352 DOI: 10.1007/s40037-021-00657-w] [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: 08/23/2020] [Revised: 02/20/2021] [Accepted: 02/25/2021] [Indexed: 05/07/2023]
Abstract
In this article the authors review the current-day definition of professionalism through the lens of the two ongoing pandemics: COVID-19 and racism. The pandemics have led to contemporary practice-related questions, such as: does professionalism entail that health care providers (HCP) be compelled to treat patients without PPE or if patients refuse to wear masks? And what role do HCP play in society when confronted with glaring health disparities and police brutality? The authors propose using care ethics as a theory to view professionalism, as it takes into account broadly encompassing relationships between HCP and society, history and context. Professionalism viewed through a care ethics lens would require professionalism definitions to be expanded to allow for interventions, i.e., not just refrain from doing harm but actively interfere or take action if wrong is being witnessed. Principles related to the primacy of patient welfare need to be re-addressed to prevent systematic self-sacrifice which results in harm to HCP and burnout. Mature care should be a characteristic of professionalism ensuring that HCP care for the sick but be practically wise, highlighting the importance of balancing too little and too much care for self and others. Professionalism needs to be viewed as a bi-directional relational exchange, with society demonstrating solidarity with those providing care. Additionally, given the scale of health disparities, simply stating that HCP need to work towards social justice oversimplifies the problem. Professionalism needs to encompass incorporating critical action and critical pedagogy into health care training and the health care profession to demonstrate solidarity with those impacted by racism.
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Affiliation(s)
- Zareen Zaidi
- Department of Medicine, University of Florida College of Medicine, 32610, Gainesville, FL, USA.
| | - Saleem Razack
- Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Canada
| | - Arno K Kumagai
- Department of Medicine, University of Toronto, Toronto, Canada
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Tsai J, Lindo E, Bridges K. Seeing the Window, Finding the Spider: Applying Critical Race Theory to Medical Education to Make Up Where Biomedical Models and Social Determinants of Health Curricula Fall Short. Front Public Health 2021; 9:653643. [PMID: 34327185 PMCID: PMC8313803 DOI: 10.3389/fpubh.2021.653643] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/23/2021] [Indexed: 11/18/2022] Open
Abstract
A professional and moral medical education should equip trainees with the knowledge and skills necessary to effectively advance health equity. In this Perspective, we argue that critical theoretical frameworks should be taught to physicians so they can interrogate structural sources of racial inequities and achieve this goal. We begin by elucidating the shortcomings in the pedagogic approaches contemporary Biomedical and Social Determinants of Health (SDOH) curricula use in their discussion of health disparities. In particular, current medical pedagogy lacks self-reflexivity; encodes social identities like race and gender as essential risk factors; neglects to examine root causes of health inequity; and fails to teach learners how to challenge injustice. In contrast, we argue that Critical Race Theory (CRT) is a theoretical framework uniquely adept at addressing these concerns. It offers needed interdisciplinary perspectives that teach learners how to abolish biological racism; leverage historical contexts of oppression to inform interventions; center the scholarship of the marginalized; and understand the institutional mechanisms and ubiquity of racism. In sum, CRT does what biomedical and SDOH curricula cannot: rigorously teach physician trainees how to combat health inequity. In this essay, we demonstrate how the theoretical paradigms operationalized in discussions of health injustice affect the ability of learners to confront health inequity. We expound on CRT tenets, discuss their application to medical pedagogy, and provide an in-depth case study to ground our major argument that theory matters. We introduce MedCRT: a CRT-based framework for medical education, and advocate for its implementation into physician training.
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Affiliation(s)
- Jennifer Tsai
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Edwin Lindo
- Office of Healthcare Equity, University of Washington School of Medicine, Seattle, WA, United States
| | - Khiara Bridges
- University of California, Berkeley School of Law, Berkeley, CA, United States
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Blanchet Garneau A, Bélisle M, Lavoie P, Laurent Sédillot C. Integrating equity and social justice for indigenous peoples in undergraduate health professions education in Canada: a framework from a critical review of literature. Int J Equity Health 2021; 20:123. [PMID: 34020674 PMCID: PMC8139059 DOI: 10.1186/s12939-021-01475-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/10/2021] [Indexed: 11/16/2022] Open
Abstract
Understanding how to create structural change by actively counteracting racialized ways of interacting with Indigenous peoples at an individual and organizational level within health care systems and health professions education is essential for creating a more inclusive, equitable, and healthier society. In health professions education, the primary means of teaching about health inequities has been to frame them as stemming from culturally or ethnically based issues. While attention to culturally specific practices can be valuable to health and healing in some contexts, education that solely focuses on Indigenous cultures risks perpetuating cultural stereotypes and othering, rather than focusing on how Eurocentric systems continue to exert oppressive effects on Indigenous peoples. We present an organizational transformation framework grounded in equitable partnerships from a comprehensive critical review of the literature on the integration of equity and social justice in undergraduate health professions education with a focus on Indigenous health. We did a thematic analysis of the results and discussions presented in the 26 selected articles to identify promising practices and challenges associated with the integration of equity and social justice in undergraduate health professions education. The framework resulting from this analysis is composed of three interrelated components: 1) adopt critical pedagogical approaches that promote Indigenous epistemologies; 2) partner with Indigenous students, educators and communities; 3) engage educators in critical pedagogical approaches and health equity issues. This framework could guide the development of contextually tailored interventions that contribute to decolonizing health professions education.
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Affiliation(s)
- Amélie Blanchet Garneau
- Faculty of Nursing, Université de Montréal, 2375, chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1A8, Canada.
| | - Marilou Bélisle
- Faculty of education, Université de Sherbrooke, 2500, boul. de l'Université, Sherbrooke, Quebec, J1K 2R1, Canada
| | - Patrick Lavoie
- Faculty of Nursing, Université de Montréal, 2375, chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1A8, Canada
| | - Catherine Laurent Sédillot
- Department of anthropology, Cégep Édouard-Montpetit, 945, chemin de Chambly, Longueuil, Quebec, J4H 3M6, Canada
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Gajaria A, Guzder J, Rasasingham R. What's race got to do with it? A proposed framework to address racism's impacts on child and adolescent mental health in Canada. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2021; 30:131-137. [PMID: 33953765 PMCID: PMC8056965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 02/04/2021] [Indexed: 06/12/2023]
Abstract
This commentary responds to current events that have highlighted the ways that systemic racism affects a wide variety of health outcomes. We specifically discuss how systemic racism adversely affects the mental health of children and adolescents in a Canadian context and use a structural framework to demonstrate how race is embedded in various Canadian systems and thus affects child and adolescent mental health in both conscious and unconscious ways throughout the lifespan. Experiences of systemic racism affect the mental health of Canadian young people in multiple complex and intersecting ways including access to care, experience of mental health services, and outcomes of care. We currently lack a national best practice framework for mental health professionals that unifies approaches to research, education, and clinical care for young racialized Canadians; in addition, concerted efforts to collect race-based data are lacking. We suggest that a blueprint for improved services for racialized young people in Canada would include: Development of a funded and sustainable research agenda responsive to community expertise, development and implementation of a Canadian Child and Adolescent task force focused on educational strategies on racism and service provision at both the postgraduate and continuing professional development (CPD) levels, and consideration of clinical parameters that improve access to, and experience of, care for Canadian racialized youth.
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Affiliation(s)
- Amy Gajaria
- Staff Psychiatrist, Centre for Addiction and Mental Health (CAMH), Assistant Professor, Department of Psychiatry, University of Toronto, Clinician Scientist, Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Toronto, Ontario
| | - Jaswant Guzder
- Professor, McGill University Department of Psychiatry, Division of Social and Cultural Psychiatry, Division of Child Psychiatry, Institute of Community and Family Psychiatry, Montreal, Quebec
| | - Raj Rasasingham
- Director of Continuing Professional and Practice Development, Department of Psychiatry, University of Toronto, Director of Post-Graduate Education, Psychiatry, Humber River Hospital, University of Toronto, Clinical Head, Outpatient Child and Youth, Humber River Hospital, University of Toronto, Section Head, Global Psychiatry, Canadian Academy of Child and Adolescent Psychiatry., Toronto, Ontario
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Ufomata E, Merriam S, Puri A, Lupton K, LeFrancois D, Jones D, Nemeth A, Snydman LK, Stark R, Spagnoletti C. A Policy Statement of the Society of General Internal Medicine on Tackling Racism in Medical Education: Reflections on the Past and a Call to Action for the Future. J Gen Intern Med 2021; 36:1077-1081. [PMID: 33483823 PMCID: PMC8042052 DOI: 10.1007/s11606-020-06445-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/10/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Eloho Ufomata
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Sarah Merriam
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Division of General Internal Medicine, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Aditi Puri
- Division of Hospital Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Katherine Lupton
- Division of General Internal Medicine at Zuckerberg San Francisco General, University of California San Francisco, San Francisco, CA, USA
| | - Darlene LeFrancois
- Division of General Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Danielle Jones
- Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Attila Nemeth
- Division of Acute Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA
| | - Laura K Snydman
- Division of General Internal Medicine, Tufts Medical Center, Boston, MA, USA
| | - Rachel Stark
- Department of Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Carla Spagnoletti
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Ross PT, Lypson ML, Byington CL, Sánchez JP, Wong BM, Kumagai AK. Learning From the Past and Working in the Present to Create an Antiracist Future for Academic Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1781-1786. [PMID: 33031120 DOI: 10.1097/acm.0000000000003756] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Paula T Ross
- Administrative director, Research. Innovation. Scholarship. Education. (RISE)-Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Monica L Lypson
- Vice chair and director, Division of General Internal Medicine, and professor, Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Carrie L Byington
- Executive vice president, University of California Health, Oakland, California
| | - John P Sánchez
- Professor, Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Brian M Wong
- Associate professor of medicine, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, and director, Centre for Quality Improvement and Patient Safety, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arno K Kumagai
- Vice chair for education, Department of Medicine, and F.M. Hill Chair in Humanism Education, Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
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Garg M, Eniasivam A, Satterfield J, Norton B, Austin E, Dohan D. Rapid transition of a preclinical health systems science and social justice course to remote learning in the time of coronavirus. MEDICAL EDUCATION ONLINE 2020; 25:1812225. [PMID: 32822280 PMCID: PMC7482827 DOI: 10.1080/10872981.2020.1812225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/14/2020] [Accepted: 08/14/2020] [Indexed: 06/01/2023]
Abstract
As the coronavirus pandemic started, we rapidly transitioned a preclinical social justice and health systems sciences course at our medical school to asynchronous, remote learning. We describe processes, curricular innovations, and lessons learned. Small groups were converted into independent learning modules and lectures were given live via videoconferencing technology. We started with a simplified approach and then built technological capabilities over time. Current events were incorporated into curriculum and assessment. Our course ran from 16 March-3 April 2020 for the 155-person first-year class. Student attendance for optional, synchronous remote sessions was higher than in-person attendance in previous years. Completion rates for assignments were high but with minimal student collaboration. Faculty office hours were underutilized. Focus group and formal evaluations were largely positive, with numerical ratings for quality of the course and faculty teaching higher than the 2 years prior. Student engagement with social justice topics in aremote format was successful through modifications to small groups and lecture structure. Students, faculty, and administrative staff appreciated the consistency of session format throughout the course. Students exam performance was similar to prior years. Attention should be paid to what can be learned via self-study as opposed to small group learning. Better methods of soliciting real-time student feedback, and encouraging engagement with each other and with faculty in aremote environment are needed.
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Affiliation(s)
- Megha Garg
- Department of Medicine, University of California San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Archna Eniasivam
- Departments of Medicine and Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Jason Satterfield
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Betsy Norton
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Elizabeth Austin
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
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Coleman T. Anti-Racism in Nursing Education: Recommendations for Racial Justice Praxis. J Nurs Educ 2020; 59:642-645. [DOI: 10.3928/01484834-20201020-08] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/01/2020] [Indexed: 11/20/2022]
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Acholonu RG, Cook TE, Roswell RO, Greene RE. Interrupting Microaggressions in Health Care Settings: A Guide for Teaching Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10969. [PMID: 32754633 PMCID: PMC7394346 DOI: 10.15766/mep_2374-8265.10969] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Microaggressions are connected to broader conceptualizations of the impact of implicit bias and systems of inequity. The body of evidence supporting the need for more-open discussions in medical education about race, racism, and their impact on health disparities continues to grow. Some have advocated for the importance of bringing anti-racist pedagogy into medical education curricula, which involves explicitly attempting to move beyond people's comfort zones and acknowledging that discomfort can be a catalyst for growth. To discuss the intent and impact of microaggressions in health care settings and how we might go about responding to them, we developed a workshop for third-year undergraduate medical students within a longitudinal undergraduate medical education diversity and inclusion curriculum. METHODS This workshop occurred during a regularly scheduled clerkship intersession during the 2016-2017 academic year for third-year undergraduate medical students (N = 154). Prior to the workshop, the students were asked to anonymously submit critical incident reports on any microaggressions experienced or witnessed to develop case studies for problem-based learning. Teaching modalities included lecture, problem-based learning with case studies, pair and share, and facilitated small- and large-group debriefs. RESULTS The session was evaluated using a 4-point Likert scale to assess students' comfort in learning about the information presented. Ninety-eight percent felt confident in identifying microaggressions, and 85% felt confident in interrupting microaggressions when they occur. DISCUSSION This personalized workshop exposes students to microaggressions personally experienced by colleagues with an attempt to interrupt them using empathy, awareness, and communication techniques.
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Affiliation(s)
- Rhonda Graves Acholonu
- Assistant Professor of Pediatrics, Division of Hospital Medicine, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine
- Corresponding author:
| | - Tiffany E. Cook
- Interim Director, Office of Diversity Affairs, New York University Robert I. Grossman School of Medicine
| | - Robert O. Roswell
- Associate Professor of Cardiology and Science Education, Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
| | - Richard E. Greene
- Associate Professor of Medicine, Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University Langone Medical Center/New York University Robert I. Grossman School of Medicine
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Cahn PS. How interprofessional collaborative practice can help dismantle systemic racism. J Interprof Care 2020; 34:431-434. [DOI: 10.1080/13561820.2020.1790224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Peter S. Cahn
- Center for Interprofessional Studies and Innovation, MGH Institute of Health Professions, Boston, MA 02129, USA
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DallaPiazza M, Ayyala MS, Soto-Greene ML. Empowering future physicians to advocate for health equity: A blueprint for a longitudinal thread in undergraduate medical education. MEDICAL TEACHER 2020; 42:806-812. [PMID: 32180494 DOI: 10.1080/0142159x.2020.1737322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In light of a growing body of evidence demonstrating pervasive health disparities, medical schools are increasingly incorporating educational programs on social medicine in undergraduate and graduate medical curricula. In 2015, we significantly restructured the cultural competency instruction for medical students at our institution, focusing on achieving greater health equity through caring for vulnerable populations and acknowledging and addressing bias and stereotyping. In order to facilitate educational sustainability while students were immersed in clinical care, a key element of our approach included extending teaching into the clerkship year. The resulting longitudinal thread, Health Equity and Social Justice, empowers future physicians with the knowledge and skills to work towards greater health equity. This article discusses the lessons learned in the implementation of this novel educational program. Our approach can serve as a model for other institutions considering similar instructional reform.
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Affiliation(s)
- Michelle DallaPiazza
- Department of Medicine, Division of Infectious Diseases, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Manasa S Ayyala
- Department of Medicine, Division of General Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
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Frye V, Camacho-Rivera M, Salas-Ramirez K, Albritton T, Deen D, Sohler N, Barrick S, Nunes J. Professionalism: The Wrong Tool to Solve the Right Problem? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:860-863. [PMID: 32134778 DOI: 10.1097/acm.0000000000003266] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Medical schools and other higher education institutions across the United States are grappling with how to respond to racism on and off campus. Institutions and their faculty, administrators, and staff have examined their policies and practices, missions, curricula, and the representation of racial and ethnic minority groups among faculty, staff, and students. In addition, student-led groups, such as White Coats for Black Lives, have emerged to critically evaluate medical school curricula and advocate for change. Another approach to addressing racism has been a focus on the role of professionalism, which has been variably defined as values, traits, behaviors, morality, humanism, a role, an identity, and even a social contract.In this article, the authors consider the potential role that professionalism might play in responding to racism in medical education and at medical schools. They identify 3 concerns central to this idea. The first concern is differing definitions of what the problem being addressed really is. Is it isolated racist acts or institutional racism that is a reflection of white supremacy? The second concern is the notion that professionalism may be used as a tool of social control to maintain the interests of the social groups that dominate medicine. The third concern is that an overly simplistic application of professionalism, regardless of how the problem of racism is defined, may result in trainees practicing professionalism that is performative rather than internally motivated. The authors conclude that professionalism may complement a more systematic and holistic approach to addressing racism and white supremacy in medical education, but it is an insufficient stand-alone tool to address this core problem.
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Affiliation(s)
- Victoria Frye
- V. Frye is associate medical professor, Department of Community Health and Social Medicine, CUNY School of Medicine/Sophie Davis Program in Biomedical Education, New York, New York; ORCID: http://orcid.org/0000-0003-3239-7201. M. Camacho-Rivera is assistant professor, Department of Community Health Sciences, SUNY Downstate School of Public Health, Brooklyn, New York. K. Salas-Ramirez is assistant medical professor, Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine/Sophie Davis Program in Biomedical Education, New York, New York. T. Albritton is assistant medical professor, Department of Community Health and Social Medicine, CUNY School of Medicine/Sophie Davis Program in Biomedical Education, New York, New York; ORCID: http://orcid.org/0000-0002-7592-4318. D. Deen is distinguished lecturer, CUNY School of Medicine/Sophie Davis Program in Biomedical Education, New York, New York. N. Sohler is associate medical professor, Department of Community Health and Social Medicine, CUNY School of Medicine/Sophie Davis Program in Biomedical Education, New York, New York. S. Barrick is lecturer and director, Humanities in Medicine Program, CUNY School of Medicine/Sophie Davis Program in Biomedical Education, New York, New York. J. Nunes is medical professor, Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine/Sophie Davis Program in Biomedical Education, New York, New York
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Vianden J, Gruber C. "It's hard to speak up": Lessons learned from engaging U.S. white college men in conversations on racism. GMS JOURNAL FOR MEDICAL EDUCATION 2020; 37:Doc16. [PMID: 32328518 PMCID: PMC7171355 DOI: 10.3205/zma001309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/17/2019] [Accepted: 01/07/2020] [Indexed: 06/11/2023]
Abstract
Objective: This position paper draws on findings from the Straight White College Men Project, a qualitative study with heterosexual white college male participants across college campuses in the United States. The purpose of the larger project was to explore and understand how participants perceived institutional and community diversity issues; how they conceptualized their own privileges; and how they articulated their own responsibility to engage in social change. Thus, this paper delivers "lessons learned" from engaging white men in conversations on racism and to provide recommendations for medical educators in the U.S. and in Europe. Methods: Following purposeful sampling methods using expert nominators, data were collected in phenomenological focus groups at 10 U.S. 4-year universities. Focus groups included 3 to 8 participants and were 60 to 90 minutes in length. Analysis included open and axial coding and two themes emerged from a single question focusing on students' potential dissent of racist family or peer comments. Results: Participants struggled articulating how and in what contexts they would challenge family members or friends on inappropriate language or behavior. Reasons for their reticence included struggling to confront parents, not wanting to ruin male friendships, or jeopardizing being ousted by the male peer group. Conclusion: Educators must find ways to help male university students explore their privileges and proclivity to engage in oppressive behaviors. Men also need to understand how their inactions perpetuate systemic oppression and create environments in which minoritized individuals cannot thrive. Recommendations for medical school educators are provided.
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Affiliation(s)
- Jörg Vianden
- UW-La Crosse, Department of Student Affairs Administration in Higher Education, La Crosse, USA
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Alang S, McAlpine DD, Hardeman R. Police Brutality and Mistrust in Medical Institutions. J Racial Ethn Health Disparities 2020; 7:760-768. [PMID: 31989532 DOI: 10.1007/s40615-020-00706-w] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/24/2019] [Accepted: 01/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND People bring the social contexts of their lives into the medical encounter. As a social determinant of health, police brutality influences physical and mental health. However, negative experiences with institutions such as law enforcement might decrease trust in other institutions, including medical institutions. Mistrust might limit engagement with the healthcare system and affect population health. This study investigates the relationship between police brutality and medical mistrust and assesses whether it varies by race. BASIC PROCEDURES Data were obtained from a 2018 cross-sectional survey of adults living in urban areas in the USA (N = 4389). Medical mistrust was regressed on police brutality (experiences and appraisal of negative encounters with the police), controlling for socio-demographics, health status, and healthcare access. Means of mistrust were predicted by racial group after including interactions between police brutality and race. MAIN FINDINGS Respondents who had negative encounters with the police, even if they perceived these encounters to be necessary, had higher levels of medical mistrust compared to those with no negative police encounters. Police brutality increased mistrust for all racial groups. PRINCIPAL CONCLUSIONS Conditions outside the medical system such as experiencing police brutality impact relationships with the medical system. Given that clinicians are in a unique position of having access to firsthand information about the struggles and injustices that shape their patients' health, advocating for systemic change on behalf of their patients might build trust.
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Affiliation(s)
- Sirry Alang
- Department of Sociology and Anthropology, and Program in Health, Medicine, and Society, Lehigh University, Bethlehem, PA, USA.
| | - Donna D McAlpine
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Rachel Hardeman
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE, Minneapolis, MN, 55455, USA
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Perdomo J, Tolliver D, Hsu H, He Y, Nash KA, Donatelli S, Mateo C, Akagbosu C, Alizadeh F, Power-Hays A, Rainer T, Zheng DJ, Kistin CJ, Vinci RJ, Michelson CD. Health Equity Rounds: An Interdisciplinary Case Conference to Address Implicit Bias and Structural Racism for Faculty and Trainees. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2019; 15:10858. [PMID: 32166114 PMCID: PMC7050660 DOI: 10.15766/mep_2374-8265.10858] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION The medical community recognizes the importance of confronting structural racism and implicit bias to address health inequities. Several curricula aimed at teaching trainees about these issues are described in the literature. However, few curricula exist that engage faculty members as learners rather than teachers of these topics or target interdisciplinary audiences. METHODS We developed a longitudinal case conference curriculum called Health Equity Rounds (HER) to discuss and address the impact of structural racism and implicit bias on patient care. The curriculum engaged participants across training levels and disciplines on these topics utilizing case-based discussion, evidence-based exercises, and two relevant conceptual frameworks. It was delivered quarterly as part of a departmental case conference series. We evaluated HER's feasibility and acceptability by tracking conference attendance and administering postconference surveys. We analyzed quantitative survey data using descriptive statistics and qualitatively reviewed free-text comments. RESULTS We delivered seven 1-hour HER conferences at our institution from June 2016 to June 2018. A mean of 66 participants attended each HER. Most survey respondents (88% or more) indicated that HER promoted personal reflection on implicit bias, and 75% or more indicated that HER would impact their clinical practice. DISCUSSION HER provided a unique forum for practitioners across training levels to address structural racism and implicit bias. Our aim in dissemination is to provide meaningful tools for others to adapt at their own institutions, recognizing that HER should serve as a component of larger, multifaceted efforts to decrease structural racism and implicit bias in health care.
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Affiliation(s)
- Joanna Perdomo
- General Academic Pediatrics Fellow, Boston Children's Hospital
- Corresponding author:
| | - Destiny Tolliver
- Resident, Department of Pediatrics, Boston Children's Hospital
- Resident, Department of Pediatrics, Boston Medical Center
| | - Heather Hsu
- Assistant Professor, Department of Pediatrics, Boston Medical Center
- Assistant Professor, Department of Pediatrics, Boston University School of Medicine
| | - Yuan He
- Resident, Department of Pediatrics, Boston Children's Hospital
- Resident, Department of Pediatrics, Boston Medical Center
| | - Katherine A. Nash
- Instructor, Department of Pediatrics, Boston Medical Center
- Instructor, Department of Pediatrics, Boston University School of Medicine
| | | | - Camila Mateo
- Health Services Research Fellow, Boston Children's Hospital
| | - Cynthia Akagbosu
- Resident, Department of Pediatrics, Boston Children's Hospital
- Resident, Department of Pediatrics, Boston Medical Center
| | - Faraz Alizadeh
- Resident, Department of Pediatrics, Boston Children's Hospital
- Resident, Department of Pediatrics, Boston Medical Center
| | - Alexandra Power-Hays
- Resident, Department of Pediatrics, Boston Children's Hospital
- Resident, Department of Pediatrics, Boston Medical Center
| | - Tyler Rainer
- Resident, Department of Pediatrics, Boston Children's Hospital
- Resident, Department of Pediatrics, Boston Medical Center
| | - Daniel J. Zheng
- Resident, Department of Pediatrics, Boston Children's Hospital
- Resident, Department of Pediatrics, Boston Medical Center
| | - Caroline J. Kistin
- Assistant Professor, Department of Pediatrics, Boston Medical Center
- Assistant Professor, Department of Pediatrics, Boston University School of Medicine
| | - Robert J. Vinci
- Professor, Department of Pediatrics, Boston Medical Center
- Professor, Department of Pediatrics, Boston University School of Medicine
| | - Catherine D. Michelson
- Assistant Professor, Department of Pediatrics, Boston Medical Center
- Assistant Professor, Department of Pediatrics, Boston University School of Medicine
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Wheeler DJ, Zapata J, Davis D, Chou C. Twelve tips for responding to microaggressions and overt discrimination: When the patient offends the learner. MEDICAL TEACHER 2019; 41:1112-1117. [PMID: 30277121 DOI: 10.1080/0142159x.2018.1506097] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Microaggressions and expressions of overt discrimination negatively affect the experience of medical trainees at all levels. Mistreatment of trainees, including abusive and discriminatory behavior by patients and families, occurs commonly and is receiving increased attention in both the medical literature and popular press. Heightened awareness of the problem has sparked a call to engage in substantive conversations about bias in health professions education. The emphasis on direct observation in medical education makes the bedside a common setting for educators to witness these behaviors firsthand. Many educators are committed to developing a positive climate for learners but lack the training and skills to facilitate discussions about discrimination. As a result, these difficult but important conversations may not occur. The authors present a three-phase approach to responding to microaggressions and discrimination toward trainees from patients, and offer a communication toolkit that frontline medical educators can use in their daily practice.
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Affiliation(s)
- Daniel J Wheeler
- Department of Medicine, University of Minnesota Medical School , Minneapolis , MN , USA
| | - Josué Zapata
- Department of Medicine, University of California , San Francisco , CA , USA
- San Francisco VA Medical Center , San Francisco , CA , USA
| | - Denise Davis
- Department of Medicine, University of California , San Francisco , CA , USA
- San Francisco VA Medical Center , San Francisco , CA , USA
| | - Calvin Chou
- Department of Medicine, University of California , San Francisco , CA , USA
- San Francisco VA Medical Center , San Francisco , CA , USA
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Hendren EM, Kumagai AK. A Matter of Trust. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1270-1272. [PMID: 31460913 DOI: 10.1097/acm.0000000000002846] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Trust is a fundamental tenet of the patient-physician relationship and is central to providing person-centered care. Because trust is profoundly relational and social, building trust requires navigation around issues of power, perceptions of competence, and the pervasive influence of unconscious bias-processes that are inherently complex and challenging for learners, even under the best of circumstances. The authors examine several of these challenges related to building trust in the patient-physician relationship. They also explore trust in the student-teacher relationship. In an era of competency-based medical education, a learner has the additional duty to be perceived as "entrustable" to 2 parties: the patient and the preceptor. Dialogue, a relational form of communication, can provide a framework for the development of trust. By engaging people as individuals in understanding each other's perspectives, values, and goals, dialogue ultimately strengthens the patient-physician relationship. In promoting a sense of agency in the learner, dialogue also strengthens the student-teacher relationship by fostering trust in oneself through development of a voice of one's own.
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Affiliation(s)
- Elizabeth M Hendren
- E.M. Hendren is chief medical resident, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0003-0905-4585. A.K. Kumagai is professor and vice chair for education, Department of Medicine, University of Toronto, researcher, Wilson Centre, University Health Network, and F.M Hill Chair in Humanism Education, Department of Medicine, Women's College Hospital and University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0001-7088-0208
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Martin ER. Social justice and the medical librarian. J Med Libr Assoc 2019; 107:291-303. [PMID: 31258435 PMCID: PMC6579597 DOI: 10.5195/jmla.2019.712] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/01/2019] [Indexed: 11/20/2022] Open
Abstract
This lecture discusses social justice and the role that medical librarians can play in a democratic society. Social justice needs to be central to the mission of medical librarianship and a core value of the profession. Medical librarians must develop a new professional orientation: one that focuses on cultural awareness or cultural consciousness that goes beyond ourselves and our collections to that which focuses on the users of our libraries. We must develop a commitment to addressing the issues of societal, relevant health information. Using examples from medical education, this lecture makes the case for social justice librarianship. This lecture also presents a pathway for social justice medical librarianship, identifies fundamental roles and activities in these areas, and offers strategies for individual librarians, the Medical Library Association, and library schools for developing social justice education and outcomes. The lecture advocates for an understanding of and connection to social justice responsibilities for the medical library profession and ends with a call to go beyond understanding to action. The lecture emphasizes the lack of diversity in our profession and the importance of diversity and inclusion for achieving social justice. The lecture presents specific examples from some medical libraries to extend the social justice mindset and to direct outreach, collections, archives, and special collection services to expose previously hidden voices. If medical librarians are to remain relevant in the future, we must act to address the lack of diversity in our profession and use our information resources, spaces, and expertise to solve the relevant societal issues of today.
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Affiliation(s)
- Elaine Russo Martin
- Director of Library Services, Countway Library, Harvard Medical School, Boston, MA,
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45
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Krishnan A, Rabinowitz M, Ziminsky A, Scott SM, Chretien KC. Addressing Race, Culture, and Structural Inequality in Medical Education: A Guide for Revising Teaching Cases. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:550-555. [PMID: 30640269 DOI: 10.1097/acm.0000000000002589] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PROBLEM Sociodemographic identities, including race, culture, ethnicity, gender, and sexual orientation (race and culture), are recognized as important determinants of health, with significant impacts on patients' health outcomes, but teaching medical students about this is challenging. The authors sought to identify areas for improvement in delivery of critical content about race, culture, structural inequalities, and health disparities within a set of virtual patient cases used by U.S. medical schools and develop revision guidelines. APPROACH A workgroup (medical students and faculty) conducted a literature review in 2017 to identify challenges and best practices for teaching and learning about race and culture in medicine. Using an analytic framework informed by this review, they analyzed 63 Aquifer virtual patient teaching cases for effectiveness of the presentation of race and culture, resulting in six main themes describing common mistakes or pitfalls. They then developed an evidence-based guide for systematic case revision. OUTCOMES The authors present a novel, practical guide for medical educators to use to revise existing teaching cases and improve the delivery of critical concepts surrounding race and culture. This guide includes fundamental definitions and six sections to guide structured case revision based on the main themes. It includes examples of language, suggested edits, and the rationale and evidence for recommendations. NEXT STEPS Feedback from faculty and students regarding implementation of the guide and delivery of revised content in Aquifer cases will be critical in determining the guide's effectiveness. This structured guide may be adapted to a variety of teaching modalities in medicine.
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Affiliation(s)
- Aparna Krishnan
- A. Krishnan is a fourth-year medical student, Johns Hopkins University School of Medicine, Baltimore, Maryland. M. Rabinowitz is a first-year pediatric resident, Kaiser Permanente Northern California, Oakland, California. A. Ziminsky is production associate, Aquifer, Lebanon, New Hampshire. S.M. Scott is senior associate dean for educational affairs and accreditation and professor of medical education, Texas Christian University and University of North Texas Health Science Center School of Medicine, Fort Worth, Texas. K.C. Chretien is associate dean for student affairs and professor of medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
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Bromage B, Barrenger SL, Clayton A, Rowe M, Williamson B, Benedict P, Kriegel LS. Facilitating community connections among people with mental illnesses: Perspectives from grassroots community leaders. JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 47:663-678. [PMID: 30500066 DOI: 10.1002/jcop.22146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 10/18/2018] [Accepted: 11/18/2018] [Indexed: 06/09/2023]
Abstract
We conducted focus groups comprising 20 grassroots community leaders to identify social and structural elements that affect community engagement among people with serious mental illnesses. Community leaders not affiliated with mental health systems have been mostly left out of the discussions about inclusion and engagement, even though they possess unique information about the places where they live and can be essential partners in making community connections. The findings from the focus groups point to elements that both facilitate and inhibit connections, as well as roles community mental health practitioners may take on, to engage with community leaders and people with mental illness to minimize barriers and foster connections in community settings. Additionally, the focus groups elucidated the interplay between the right to be a member of one's community and a community's responsibility to create a welcoming environment. The current study garnered information regarding the broader needs and implications of community connections, as well as some specific suggestions to enhance community engagement among people with serious mental illness. Hesitation and stigma around engaging individuals with mental illnesses were identified as barriers to inclusion. Further study about how community leaders and groups may be involved in facilitating meaningful community connections is recommended.
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47
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Sharma M. Applying feminist theory to medical education. Lancet 2019; 393:570-578. [PMID: 30739692 DOI: 10.1016/s0140-6736(18)32595-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 09/19/2018] [Accepted: 10/11/2018] [Indexed: 11/30/2022]
Abstract
To adequately address gendered issues of sexual harassment, wage gaps, and leadership inequities, medical institutions must interrogate medical education. Feminist theories can help to understand how power operates within our classrooms and at the bedside. This scoping review maps the four main ways in which feminist theory has been applied to medical education and medical education research-namely, critical appraisal of what is taught in medical curricula; exploration of the experiences of women in medical training; informing pedagogical approaches to how medicine is taught; and finally, medical education research, determining both areas of inquiry and methodologies. Feminist theory has the potential to move clinicians and educators from theory to action, building bridges of solidarity between the medical profession and the community it is called to serve.
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Affiliation(s)
- Malika Sharma
- Casey House, Toronto, ON, Canada; Department of Medicine, Women's College Hospital, University of Toronto, ON, Canada; Maple Leaf Medical Clinic, Toronto, ON, Canada.
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Willging C, Gunderson L, Shattuck D, Sturm R, Lawyer A, Crandall C. Structural competency in emergency medicine services for transgender and gender non-conforming patients. Soc Sci Med 2018; 222:67-75. [PMID: 30605801 DOI: 10.1016/j.socscimed.2018.12.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/20/2018] [Accepted: 12/22/2018] [Indexed: 11/19/2022]
Abstract
In this formative qualitative research, we draw upon the concepts of structural vulnerability and structural competency to examine how transgender and gender non-conforming (TGGNC) patients and healthcare personnel experience service delivery in Emergency Departments (EDs), and how this experience can be improved upon. Between October 2016 and June 2017, we undertook 31 semi-structured interviews with TGGNC patients (n = 11) and physicians (n = 6), nurses (n = 7), and non-clinical staff (n = 7) in four community-based EDs in New Mexico. Our iterative coding and analysis process resulted in eight sets of findings: (1) reasons why TGGNC patients seek care from EDs; (2) perceptions about and experiences of TGGNC patients; (3) relevance of gender identity and sex at birth; (4) bureaucracy and communication; (5) spatial considerations; (6) preparing providers and staff to care for TGGNC patients; (7) the lack of resources for structural prescriptions; and (8) respect, humanity, and sameness. Findings suggest that structural issues adversely impact the health and wellbeing of TGGNC patients and service-delivery practices in the ED. We describe study implications for training ED personnel and modifying this practice setting to prevent delayed care and ensure appropriate services for TGGNC patients in need of structurally competent emergency medicine.
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Affiliation(s)
- Cathleen Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106, USA; Department of Anthropology, University of New Mexico, MSC01-1040, 1 University of New, Mexico, Albuquerque, NM, 87131, USA.
| | - Lara Gunderson
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106, USA; Department of Anthropology, University of New Mexico, MSC01-1040, 1 University of New, Mexico, Albuquerque, NM, 87131, USA.
| | - Daniel Shattuck
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106, USA; Department of Anthropology, University of New Mexico, MSC01-1040, 1 University of New, Mexico, Albuquerque, NM, 87131, USA.
| | - Robert Sturm
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106, USA; New Mexico Community AIDS Partnership, 903 West Alameda #764, Santa Fe, NM, 87501, USA.
| | - Adrien Lawyer
- Transgender Resource Center of New Mexico, 149 Jackson Street, NE, Albuquerque, NM, 87108, USA.
| | - Cameron Crandall
- Department of Emergency Medicine, University of New Mexico, MSC11-6025, 700 Camino de Salud, Albuquerque, NM, 87131, USA.
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Kumagai AK, Richardson L, Khan S, Kuper A. Dialogues on the Threshold: Dialogical Learning for Humanism and Justice. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1778-1783. [PMID: 29901659 DOI: 10.1097/acm.0000000000002327] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Given the constant pressures of overflowing clinics, hospital wards, and emergency departments; shortened duty hours; and increased accreditation requirements, overburdened clinician teachers ask, "How does one teach for humanism and justice?" How does one step away-even momentarily-and focus teaching on the individual in front of us, the person who requires our attention and care? This approach must not only involve content (the patient's perspective of illness, social context, and life story) but also must be tightly linked with the ways in which these lessons in living are learned and taught. In this article, the authors propose recognition and use of a style of communication that is already implicitly present in clinical conversations and that is uniquely capable of stimulating reflection on the human dimensions of medicine: that of dialogue.Dialogue involves committing one's whole self to communicative exchange and emphasizes interpersonal relationships and trust. Its result is often not a specific answer; rather, it is enhanced understanding through the generation of new questions and possibilities and action in implementing solutions. It requires a reorientation of the teacher-learner relationship from top-down to one of open exchange and shared authority and responsibility. In the context of professional identity development, these conversations become dialogues on the threshold of transformative change. Through an exploration of dialogical teaching, the authors envision clinical education as constantly stepping in and out of goal-oriented discussions and reflective dialogues, all with the overall goal to educate physicians who practice with excellence, compassion, and justice.
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Affiliation(s)
- Arno K Kumagai
- A.K. Kumagai is professor and vice chair for education, University of Toronto Faculty of Medicine, Department of Medicine, and researcher, Wilson Centre. He holds the F.M. Hill Chair in Humanism Education, Women's College Hospital and University of Toronto, Toronto, Ontario, Canada. L. Richardson is assistant professor and faculty co-lead in person-centred care, University of Toronto Faculty of Medicine, Department of Medicine, and researcher and Indigenous Health Scholar, Wilson Centre, University of Toronto, Toronto, Ontario, Canada. S. Khan is a third-year resident in medicine, University of Toronto Faculty of Medicine, Department of Medicine, Toronto, Ontario, Canada. A. Kuper is associate professor of medicine and faculty co-lead in person-centred care, University of Toronto Faculty of Medicine, Department of Medicine, scientist and associate director, Wilson Centre for Research in Education, University Health Network, University of Toronto, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Murphy KA, Ellison-Barnes A, Johnson EN, Cooper LA. The Clinical Examination and Socially At-Risk Populations: The Examination Matters for Health Disparities. Med Clin North Am 2018; 102:521-532. [PMID: 29650073 DOI: 10.1016/j.mcna.2017.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Data from the United States show that persons from low socioeconomic backgrounds, those who are socially isolated, belong to racial or ethnic minority groups, or identify as lesbian, gay, bisexual, or transgender experience health disparities at a higher rate. Clinicians must transition from a biomedical to a biopsychosocial framework within the clinical examination to better address social determinants of health that contribute to health disparities. We review the characteristics of successful patient-clinician interactions. We describe strategies for relationship-centered care within routine encounters. Our goal is to train clinicians to mitigate differences and reduce disparities in health care delivery.
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Affiliation(s)
- Karly A Murphy
- Department of Medicine, Johns Hopkins Hospital, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21287, USA.
| | - Alejandra Ellison-Barnes
- Osler Medical Residency Training Program, Department of Medicine, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Erica N Johnson
- Johns Hopkins Bayview Internal Medicine Residency, Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Mason F. Lord Building, Center Tower Suite 381, 5200 Eastern Avenue, Baltimore, MD 21224, USA
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins Center for Health Equity, Johns Hopkins University School, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21287, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Center for Health Equity, Johns Hopkins University, 2024 East Monument Street, Suite 2-500, Baltimore, MD 21287, USA
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