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Hearld LR, Jennings J, Hubbard D, Lee SY, Hearld KR. The role of patient and family advisory boards in promoting greater attention to patient social needs by U.S. acute care hospitals. Health Care Manage Rev 2024; 49:311-322. [PMID: 39102343 DOI: 10.1097/hmr.0000000000000417] [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: 08/07/2024]
Abstract
BACKGROUND There is growing attention to individual-level patient social needs such as unstable housing and food insecurity. Such considerations, however, have historically been the purview of public health and have not been a priority of more traditional health care delivery organizations, such as acute care hospitals. PURPOSE The purpose of this study was to examine whether the presence of patient and family advisory boards (PFABs) among acute care community hospitals was associated with screening for and programs to address patient social needs. METHODS We used a secondary data set derived from the American Hospital Association's 2020 and 2021 annual surveys, along with multinomial and negative binomial regression models to assess the relationship between the presence/absence of a PFAB and the likelihood of offering and the number of areas addressed by social needs screening programs. RESULTS More than half (55.9%) of all responding hospitals reported having a PFAB in 2020 (55.9%) and 2021 (52.7%). The presence of a PFAB among hospitals was significantly associated with patient social needs screening, more areas addressed by programs, and more types of partners to address these needs. CONCLUSIONS Community hospitals with a PFAB have more robust programs and partnerships to address patient social needs. PRACTICE IMPLICATIONS Hospital leaders should consider going beyond simply establishing programs to address social needs but also consider comprehensiveness of these programs to recognize the intersectionality of social needs. One way to do this is to formally establish a PFAB to help hospitals better identify and prioritize the needs in local communities and design social needs programs/solutions that are patient- and family-centric.
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Naidoo K, Karim R, Rimmel L, Watkins Liu C, Washington K, Privett R, Godsey K, Rucker-Bussie V, Plummer L. Using Structural Competencies for Faculty and Students to Integrate Principles of Social Justice and Health Equity Into a Doctor of Physical Therapy Program. JOURNAL, PHYSICAL THERAPY EDUCATION 2024:00001416-990000000-00124. [PMID: 39116370 DOI: 10.1097/jte.0000000000000367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 07/11/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND AND PURPOSE Integrating principles of social justice and health equity (SJHE) into Doctor of Physical Therapy (DPT) education may be one way to confront the root causes of health inequity. The purpose of this method/model presentation is to highlight structural competencies for faculty and students to integrate SJHE into a 3-year DPT program and a professional development program designed to provide core and clinical faculty with the tools to engage in critical discussions with students and support their development as agents of change. METHOD/MODEL DESCRIPTION AND EVALUATION This presentation highlights how SJHE structural competencies can be integrated into existing course content (as opposed to presented as a standalone course). Researchers interviewed 10 DPT faculty and 10 DPT students about their experience learning about SJHE. Six clinical instructors (CIs) who supervised students during a full-time clinical education experience (CEE) discussed students' ability to apply SJHE concepts during CEEs. OUTCOMES Faculty expressed the need for practice in low-stakes settings such as through simulation. Students valued learning about SJHE over 3 years with the opportunity to integrate content during CEEs but felt that SJHE could be better integrated in classroom content. Some peers were perceived to be resistant to SJHE. Clinical instructors described that although students were prepared to apply foundational SJHE concepts, students were surprised by the complexity of patient need. DISCUSSION AND CONCLUSION Exploratory analysis of faculty, CI, and students' perceptions confirm that SJHE is needed in DPT education but takes time to integrate well with a steep learning curve and additional faculty development needs that must be met.
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Affiliation(s)
- Keshrie Naidoo
- Keshrie Naidoo is an associate professor in the Department of Physical Therapy at the MGH Institute of Health Professions, 36 First Avenue, Charlestown Navy Yard, Boston, MA 02129 . Please address all correspondence to Keshrie Naidoo
- Rania Karim is an assistant professor in the Department of Physical Therapy at the MGH Institute of Health Professions
- Lauren Rimmel is the physical therapist at the Brigham and Women's Hospital
- Callie Watkins Liu is the director of justice, equity, diversity, and inclusion education and programs at the MGH Institute of Health Professions
- Kamaria Washington is the physical therapist and owner at the Pelvic Noire Physical Therapy & Wellness
- Rachel Privett is an adjunct faculty in the Department of Physical Therapy at the MGH Institute of Health Professions
- Keelin Godsey is the physical therapist at the Johns Hopkins Medicine
- Valerie Rucker-Bussie is the physical therapist and owner at the Priority One Wellness
- Laura Plummer is the dean in the School of Health and Rehabilitation Sciences at the MGH Institute of Health Professions
| | - Rania Karim
- Keshrie Naidoo is an associate professor in the Department of Physical Therapy at the MGH Institute of Health Professions, 36 First Avenue, Charlestown Navy Yard, Boston, MA 02129 . Please address all correspondence to Keshrie Naidoo
- Rania Karim is an assistant professor in the Department of Physical Therapy at the MGH Institute of Health Professions
- Lauren Rimmel is the physical therapist at the Brigham and Women's Hospital
- Callie Watkins Liu is the director of justice, equity, diversity, and inclusion education and programs at the MGH Institute of Health Professions
- Kamaria Washington is the physical therapist and owner at the Pelvic Noire Physical Therapy & Wellness
- Rachel Privett is an adjunct faculty in the Department of Physical Therapy at the MGH Institute of Health Professions
- Keelin Godsey is the physical therapist at the Johns Hopkins Medicine
- Valerie Rucker-Bussie is the physical therapist and owner at the Priority One Wellness
- Laura Plummer is the dean in the School of Health and Rehabilitation Sciences at the MGH Institute of Health Professions
| | - Lauren Rimmel
- Keshrie Naidoo is an associate professor in the Department of Physical Therapy at the MGH Institute of Health Professions, 36 First Avenue, Charlestown Navy Yard, Boston, MA 02129 . Please address all correspondence to Keshrie Naidoo
- Rania Karim is an assistant professor in the Department of Physical Therapy at the MGH Institute of Health Professions
- Lauren Rimmel is the physical therapist at the Brigham and Women's Hospital
- Callie Watkins Liu is the director of justice, equity, diversity, and inclusion education and programs at the MGH Institute of Health Professions
- Kamaria Washington is the physical therapist and owner at the Pelvic Noire Physical Therapy & Wellness
- Rachel Privett is an adjunct faculty in the Department of Physical Therapy at the MGH Institute of Health Professions
- Keelin Godsey is the physical therapist at the Johns Hopkins Medicine
- Valerie Rucker-Bussie is the physical therapist and owner at the Priority One Wellness
- Laura Plummer is the dean in the School of Health and Rehabilitation Sciences at the MGH Institute of Health Professions
| | - Callie Watkins Liu
- Keshrie Naidoo is an associate professor in the Department of Physical Therapy at the MGH Institute of Health Professions, 36 First Avenue, Charlestown Navy Yard, Boston, MA 02129 . Please address all correspondence to Keshrie Naidoo
- Rania Karim is an assistant professor in the Department of Physical Therapy at the MGH Institute of Health Professions
- Lauren Rimmel is the physical therapist at the Brigham and Women's Hospital
- Callie Watkins Liu is the director of justice, equity, diversity, and inclusion education and programs at the MGH Institute of Health Professions
- Kamaria Washington is the physical therapist and owner at the Pelvic Noire Physical Therapy & Wellness
- Rachel Privett is an adjunct faculty in the Department of Physical Therapy at the MGH Institute of Health Professions
- Keelin Godsey is the physical therapist at the Johns Hopkins Medicine
- Valerie Rucker-Bussie is the physical therapist and owner at the Priority One Wellness
- Laura Plummer is the dean in the School of Health and Rehabilitation Sciences at the MGH Institute of Health Professions
| | - Kamaria Washington
- Keshrie Naidoo is an associate professor in the Department of Physical Therapy at the MGH Institute of Health Professions, 36 First Avenue, Charlestown Navy Yard, Boston, MA 02129 . Please address all correspondence to Keshrie Naidoo
- Rania Karim is an assistant professor in the Department of Physical Therapy at the MGH Institute of Health Professions
- Lauren Rimmel is the physical therapist at the Brigham and Women's Hospital
- Callie Watkins Liu is the director of justice, equity, diversity, and inclusion education and programs at the MGH Institute of Health Professions
- Kamaria Washington is the physical therapist and owner at the Pelvic Noire Physical Therapy & Wellness
- Rachel Privett is an adjunct faculty in the Department of Physical Therapy at the MGH Institute of Health Professions
- Keelin Godsey is the physical therapist at the Johns Hopkins Medicine
- Valerie Rucker-Bussie is the physical therapist and owner at the Priority One Wellness
- Laura Plummer is the dean in the School of Health and Rehabilitation Sciences at the MGH Institute of Health Professions
| | - Rachel Privett
- Keshrie Naidoo is an associate professor in the Department of Physical Therapy at the MGH Institute of Health Professions, 36 First Avenue, Charlestown Navy Yard, Boston, MA 02129 . Please address all correspondence to Keshrie Naidoo
- Rania Karim is an assistant professor in the Department of Physical Therapy at the MGH Institute of Health Professions
- Lauren Rimmel is the physical therapist at the Brigham and Women's Hospital
- Callie Watkins Liu is the director of justice, equity, diversity, and inclusion education and programs at the MGH Institute of Health Professions
- Kamaria Washington is the physical therapist and owner at the Pelvic Noire Physical Therapy & Wellness
- Rachel Privett is an adjunct faculty in the Department of Physical Therapy at the MGH Institute of Health Professions
- Keelin Godsey is the physical therapist at the Johns Hopkins Medicine
- Valerie Rucker-Bussie is the physical therapist and owner at the Priority One Wellness
- Laura Plummer is the dean in the School of Health and Rehabilitation Sciences at the MGH Institute of Health Professions
| | - Keelin Godsey
- Keshrie Naidoo is an associate professor in the Department of Physical Therapy at the MGH Institute of Health Professions, 36 First Avenue, Charlestown Navy Yard, Boston, MA 02129 . Please address all correspondence to Keshrie Naidoo
- Rania Karim is an assistant professor in the Department of Physical Therapy at the MGH Institute of Health Professions
- Lauren Rimmel is the physical therapist at the Brigham and Women's Hospital
- Callie Watkins Liu is the director of justice, equity, diversity, and inclusion education and programs at the MGH Institute of Health Professions
- Kamaria Washington is the physical therapist and owner at the Pelvic Noire Physical Therapy & Wellness
- Rachel Privett is an adjunct faculty in the Department of Physical Therapy at the MGH Institute of Health Professions
- Keelin Godsey is the physical therapist at the Johns Hopkins Medicine
- Valerie Rucker-Bussie is the physical therapist and owner at the Priority One Wellness
- Laura Plummer is the dean in the School of Health and Rehabilitation Sciences at the MGH Institute of Health Professions
| | - Valerie Rucker-Bussie
- Keshrie Naidoo is an associate professor in the Department of Physical Therapy at the MGH Institute of Health Professions, 36 First Avenue, Charlestown Navy Yard, Boston, MA 02129 . Please address all correspondence to Keshrie Naidoo
- Rania Karim is an assistant professor in the Department of Physical Therapy at the MGH Institute of Health Professions
- Lauren Rimmel is the physical therapist at the Brigham and Women's Hospital
- Callie Watkins Liu is the director of justice, equity, diversity, and inclusion education and programs at the MGH Institute of Health Professions
- Kamaria Washington is the physical therapist and owner at the Pelvic Noire Physical Therapy & Wellness
- Rachel Privett is an adjunct faculty in the Department of Physical Therapy at the MGH Institute of Health Professions
- Keelin Godsey is the physical therapist at the Johns Hopkins Medicine
- Valerie Rucker-Bussie is the physical therapist and owner at the Priority One Wellness
- Laura Plummer is the dean in the School of Health and Rehabilitation Sciences at the MGH Institute of Health Professions
| | - Laura Plummer
- Keshrie Naidoo is an associate professor in the Department of Physical Therapy at the MGH Institute of Health Professions, 36 First Avenue, Charlestown Navy Yard, Boston, MA 02129 . Please address all correspondence to Keshrie Naidoo
- Rania Karim is an assistant professor in the Department of Physical Therapy at the MGH Institute of Health Professions
- Lauren Rimmel is the physical therapist at the Brigham and Women's Hospital
- Callie Watkins Liu is the director of justice, equity, diversity, and inclusion education and programs at the MGH Institute of Health Professions
- Kamaria Washington is the physical therapist and owner at the Pelvic Noire Physical Therapy & Wellness
- Rachel Privett is an adjunct faculty in the Department of Physical Therapy at the MGH Institute of Health Professions
- Keelin Godsey is the physical therapist at the Johns Hopkins Medicine
- Valerie Rucker-Bussie is the physical therapist and owner at the Priority One Wellness
- Laura Plummer is the dean in the School of Health and Rehabilitation Sciences at the MGH Institute of Health Professions
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Dalapati T, George IA, Tracey S, Chukrun T, Brown M, Biederman DJ. WellNest: A Medical Student-Run Housing Support Program. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:852-856. [PMID: 38551945 DOI: 10.1097/acm.0000000000005721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
PROBLEM Being unhoused and facing housing insecurity contribute to poor health outcomes. Medical school curricula may include social determinants of health (SDOH) topics. However, experiential learning opportunities allow students to better contextualize how SDOH impact patients. The WellNest Housing Support Program (WellNest) was conceived and developed by Duke University medical students to learn from and support community members with a history of housing insecurity. APPROACH Under the supervision of community organizations providing housing assistance services, WellNest was created in April 2020. Medical student-volunteers (MSVs) call clients, who are referred to WellNest by the community organizations, to plan move-ins. Local experts provide trainings on topics relevant to health care for individuals experiencing loss of housing. MSVs source and move furniture and clients' belongings into the new homes. Following move-in, MSVs are paired with clients to provide longitudinal tenancy support for at least 1 year. Student-volunteers contemplate their experiences and learning takeaways through debriefing sessions and an optional online survey. OUTCOMES From fall 2021 to spring 2023, 83 student-volunteers from across the university participated in WellNest. Student-volunteers were generally medical students (37, 45%), and 16 MSVs served on the leadership team. WellNest facilitated 29 move-ins, and 26 clients requested to be paired with MSVs for longitudinal tenancy support. Following participation in WellNest, student-volunteers reported increased comfort, awareness, knowledge, and motivation related to caring for, discussing, and advocating for individuals experiencing housing insecurity. NEXT STEPS As students from other programs are also interested in WellNest, there is potential for interprofessional education. Student-volunteers will be encouraged to participate in additional opportunities for reflection and advocacy activities. The impact of WellNest on clients will be explored through a questionnaire and narrative interviews. Long-term financial support was secured from community donations and partnering community organizations.
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Utomo R, McWatt SC, Talis A, Xiao QY, Saraci K, Waschke J, Sigmund AM, Gill Sagoo M, Wingate R, Brassett C, Chien CL, Traxler H, Sakurai T, Zeroual M, Olsen J, El-Batti S, Viranta-Kovanen S, Yamada Y, Keay KA, Kitahara S, Stewart W, Mao Y, Lang A, Kunzel C, Bernd P, Patel S, Buehler L, Kielstein H, Preker A, Hardy MA, Noël GPJC, Wu A. Health profession students' outlooks on the medical profession during the COVID-19 pandemic: a global perspective. JOURNAL OF COMMUNICATION IN HEALTHCARE 2024; 17:154-168. [PMID: 37213185 DOI: 10.1080/17538068.2023.2214391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND This article summarizes a global study of the effect of the COVID-19 pandemic on junior health professions students' outlook on medicine. The pandemic has significantly affected health professions education. There is limited understanding of how students' pandemic experiences will affect them, and what impact these events may have on their career paths or the future of the professions. This information is important as it impacts the future of medicine. METHODS In the Fall 2020 semester, 219 health professions students at 14 medical universities worldwide responded to the question: 'Has this experience (with COVID-19) changed your outlook on medicine as a profession?'. Short essay responses were semantically coded and organized into themes and subthemes using an inductive approach to thematic analysis. RESULTS 145 responses were submitted. Themes were identified: (1) students reflected on the interaction between politics and healthcare; (2) reported becoming more aware of the societal expectations placed on healthcare professionals, including undertaking high risks and the sacrifices that healthcare professionals must make; (3) found reassurance from the recognized importance of healthcare professionals and expressed pride to be entering the profession; and (4) reflected on the current state of healthcare, including its limitations and future. CONCLUSION Most students, independent of the extent of the pandemic in their respective countries, noted a change in their outlook regarding medicine. An overall positive outlook was noted in most junior students. Educators need to work on nurturing these sentiments and attitudes to help young students maintain a healthy relationship towards their chosen profession.
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Affiliation(s)
- Rachel Utomo
- College of Dental Medicine, Columbia University, New York, NY, USA
| | - Sean C McWatt
- Department of Anatomy and Cell Biology, McGill University, Montreal, Canada
| | - Austin Talis
- College of Dental Medicine, Columbia University, New York, NY, USA
| | - Que Yun Xiao
- College of Dental Medicine, Columbia University, New York, NY, USA
| | - Kerstin Saraci
- Vegetative Anatomy, Faculty of Medicine, Institute of Anatomy, Ludwig Maximilians University, Munich, Germany
| | - Jens Waschke
- Vegetative Anatomy, Faculty of Medicine, Institute of Anatomy, Ludwig Maximilians University, Munich, Germany
| | - Anna Madgalena Sigmund
- Vegetative Anatomy, Faculty of Medicine, Institute of Anatomy, Ludwig Maximilians University, Munich, Germany
| | - Mandeep Gill Sagoo
- Department of Anatomy and Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Richard Wingate
- Department of Anatomy and Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Cecilia Brassett
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Chung-Liang Chien
- Department of Anatomy and Cell Biology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hannes Traxler
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | | | - Mina Zeroual
- Vegetative Anatomy, Faculty of Medicine, Institute of Anatomy, Ludwig Maximilians University, Munich, Germany
| | - Jorgen Olsen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Salma El-Batti
- Department of Cardiovascular Surgery, University of Paris, Paris, France
| | | | - Yukari Yamada
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kevin A Keay
- Discipline of Anatomy and Histology, The University of Sydney, Sydney, Australia
| | - Shuji Kitahara
- Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - William Stewart
- Anatomy Section, Department of Surgery, Yale University, New Haven, CT, USA
| | - Yinghui Mao
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Ariella Lang
- Columbia College, Columbia University, New York, NY, USA
| | - Carol Kunzel
- College of Dental Medicine, Columbia University, New York, NY, USA
| | - Paulette Bernd
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Snehal Patel
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Leo Buehler
- Department of Surgery, University of Fribourg, Fribourg, Switzerland
| | - Heike Kielstein
- Medical Faculty, Institute for Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Alexander Preker
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mark A Hardy
- Department of Surgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Geoffroy P J C Noël
- Anatomy Division, Department of Surgery, University of California San Diego, La Jolla, CA, USA
| | - Anette Wu
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Murillo CL, Díaz DA, Tamanna N, Worthy K, Jenerette C. Social Determinants of Health in Graduate Nursing Simulation Education: An Integrative Review. Nurse Educ 2024; 49:E198-E202. [PMID: 38096799 DOI: 10.1097/nne.0000000000001561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
BACKGROUND This integrative review examined how simulation is being used to teach graduate nursing students about the social determinants of health (SDH). METHODS The literature search focused on studies that included a sample of graduate nursing students who participated in an SDH simulation-based education (SBE). The timeframe used was 2013 to 2023 as this is when SBE emerged in graduate nursing education. Databases searched included Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature, PubMed, and Web of Science. RESULTS Nine studies included a sample of graduate nursing students and were included in this review. Published studies ranged from 2013 to 2023. CONCLUSION The findings of this review highlight the need for graduate nursing faculty to design, implement, and evaluate transformative SDH-specific SBE that prepares students to understand their role as social justice advocates for health equity.
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Affiliation(s)
- Crystal L Murillo
- Authors Affiliations : Assistant Professor (Dr Murillo), Graduate Research Assistant (Dr Tamanna), and Associate Professor (Dr Worthy), University of South Carolina College of Nursing, Columbia; Undergraduate Simulation Coordinator and Associate Professor (Dr Díaz), Department of Nursing Practice, University of Central Florida, Orlando; and Senior Health Equity Scholar, Professor, and Thelma Shobe Endowed Chair (Dr Jenerette), University of California School of Nursing, San Francisco
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Cahn PS. Accounting for agency in structural competency. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:1059-1066. [PMID: 37910288 DOI: 10.1007/s10459-023-10299-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
To emphasize to learners how factors outside individual control impact health, scholars introduced the concept of structural competency. Structural competency refers to the development of analytical skills that reveal the larger societal context beyond the patient-clinician interaction that shapes health outcomes. The growing adoption of structural competency curricula, however, has revealed that prelicensure and early career health professionals can feel overwhelmed by the mismatch between the wide scale of entrenched problems and the limited scope of their therapeutic skills. In this Reflections paper, I draw on theories from Giddens, Bourdieu, and Foucault to restore a role for individual agency in promoting health. Conceiving of structure and agency as mutually constituting suggests that structures are human-made and can be vulnerable to challenge. Structures, however, disperse power to such an extent that people internalize their rules and discipline themselves to follow them without explicit enforcement. It is precisely in those local sites of power that health professions learners and educators can intervene to interrupt the reproduction of structures harmful to health. As I demonstrate with an example from a reproductive health emergency, being structurally competent may also include contesting agreed upon norms at the level of the learning and clinical environments rather than only macro-level societal forces. Rewriting norms within health professions education and clinical practice is not necessarily a simpler task, but it provides learners and educators with more accessible targets for action.
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Affiliation(s)
- Peter S Cahn
- Department of Health Professions Education, MGH Institute of Health Professions, 36 First Avenue, Boston, MA, 02129, United States of America.
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Soklaridis S, Zaheer R, Scully M, Shier R, Williams B, Dang L, Daniel SJ, Sockalingam S, Tremblay M. 'We are in for a culture change': continuing professional development leaders' perspectives on COVID-19, burn-out and structural inequities. BMJ LEADER 2024; 8:142-146. [PMID: 37739772 DOI: 10.1136/leader-2023-000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/09/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION The COVID-19 pandemic positioned healthcare systems in North America at the epicentre of the crisis, placing inordinate stress on clinicians. Concurrently, discussions about structural racism, social justice and health inequities permeated the field of medicine, and society more broadly. The confluence of these phenomena required rapid action from continuing professional development (CPD) leaders to respond to emerging needs and challenges. METHODS In this qualitative study, researchers conducted 23 virtual semistructured interviews with CPD leaders in Canada and the USA. Interview audiorecordings were transcribed, deidentified and thematically analysed. RESULTS This study revealed that the CPD leaders attributed the pandemic as illuminating and exacerbating problems related to clinician wellness; equity, diversity and inclusion; and health inequities already prevalent in the healthcare system and within CPD. Analysis generated two themes: (1) From heroes to humans: the shifting view of clinicians and (2) Melding of crises: an opportunity for systemic change in CPD. DISCUSSION The COVID-19 pandemic increased recognition of burn-out and health inequities creating momentum in the field to prioritise and restrategise to address these converging public health crises. There is an urgent need for CPD to move beyond mere discourse on these topics towards holistic and sustainable actionable measures.
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Affiliation(s)
- Sophie Soklaridis
- Education Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Rabia Zaheer
- Education Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Michelle Scully
- Education Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rowen Shier
- Education Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Betsy Williams
- Department of Psychiatry, University of Kansas School of Medicine, Kansas City, Kansas, USA
- Professional Renewal Centre, Lawrence, Kansas, USA
| | - Linda Dang
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sam J Daniel
- Department of Pediatric Surgery, McGill University, Montreal, Québec, Canada
| | - Sanjeev Sockalingam
- Education Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Martin Tremblay
- Continuing Professional Development Department, Fédération des médecins spécialistes du Québec, Montreal, Québec, Canada
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Hotz KG, Silverstein A, Dalgo A. Novel Integration of a Health Equity Immersion Curriculum in Medical Training. THE JOURNAL OF MEDICAL HUMANITIES 2024; 45:193-199. [PMID: 38504033 DOI: 10.1007/s10912-023-09839-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 03/21/2024]
Abstract
Health disparities education is an integral and required part of medical professional training, and yet existing curricula often fail to effectively denaturalize injustice or empower learners to advocate for change. We discuss a novel collaborative intervention that weds the health humanities to the field of health equity. We draw from the health humanities an intentional focus retraining provider imaginations by centering patient narratives; from the field of health equity, we draw the linkage between stigmatized social identities and health disparities. We describe a longitudinal health equity curriculum for the Hospice and Palliative Medicine fellowship in Memphis, Tennessee, to give trainees exposure to the concept of structural violence and how it affects clinical care. The curriculum was developed in partnership with humanities and social sciences faculty who staff a Health Equity academic program at a small liberal arts college in Memphis. This curriculum has been implemented for the past four years in support of 22 hospice and palliative medicine fellows. Group debriefs and a mixed methods survey have revealed widespread and lasting impact towards understanding health equity concepts, enhanced communication and treatment of patients, and empowerment to address the broader needs and policies affecting patients and the communities in which they live. Ultimately, we model an educational initiative that integrates equity across the full scope of healthcare practice and equips learners with skills for sustaining compassionate practices, focusing on equity-oriented, person-centered care across the full scope of healthcare practice.
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Affiliation(s)
- Kendra G Hotz
- Health Equity Program, Rhodes College, Memphis, TN, USA
| | - Allison Silverstein
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA.
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Austin Dalgo
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
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Nour N, Onchonga D, Neville S, O'Donnell P, Abdalla ME. Integrating the social determinants of health into graduate medical education training: a scoping review. BMC MEDICAL EDUCATION 2024; 24:565. [PMID: 38783280 PMCID: PMC11119707 DOI: 10.1186/s12909-024-05394-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 04/04/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The social determinants of health (SDH) play a key role in the health of individuals, communities, and populations. Academic institutions and clinical licensing bodies increasingly recognize the need for healthcare professionals to understand the importance of considering the SDH to engage with patients and manage their care effectively. However, incorporating relevant skills, knowledge, and attitudes relating to the SDH into curricula must be more consistent. This scoping review explores the integration of the SDH into graduate medical education training programs. METHODS A systematic search was performed of PubMed, Ovid MEDLINE, ERIC, and Scopus databases for articles published between January 2010 and March 2023. A scoping review methodology was employed, and articles related to training in medical or surgical specialties for registrars and residents were included. Pilot programs, non-SDH-related programs, and studies published in languages other than English were excluded. RESULTS The initial search produced 829 articles after removing duplicates. The total number of articles included in the review was 24. Most articles were from developed countries such as the USA (22), one from Canada, and only one from a low- and middle-income country, Kenya. The most highly represented discipline was pediatrics. Five papers explored the inclusion of SDH in internal medicine training, with the remaining articles covering family medicine, obstetrics, gynecology, or a combination of disciplines. Longitudinal programs are the most effective and frequently employed educational method regarding SDH in graduate training. Most programs utilize combined teaching methods and rely on participant surveys to evaluate their curriculum. CONCLUSION Applying standardized educational and evaluation strategies for SDH training programs can pose a challenge due to the diversity of the techniques reported in the literature. Exploring the most effective educational strategy in delivering these concepts and evaluating the downstream impacts on patient care, particularly in surgical and non-clinical specialties and low- and middle-income countries, can be essential in integrating and creating a sustainable healthcare force.
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Affiliation(s)
- Nehal Nour
- Faculty of Education & Health Services, School of Medicine, University of Limerick, Garraun, Castletroy, Co., Limerick, V94 T9PX, Ireland.
| | - David Onchonga
- Faculty of Education & Health Services, School of Medicine, University of Limerick, Garraun, Castletroy, Co., Limerick, V94 T9PX, Ireland
| | - Siobhan Neville
- Faculty of Education & Health Services, School of Medicine, University of Limerick, Garraun, Castletroy, Co., Limerick, V94 T9PX, Ireland.
| | - Patrick O'Donnell
- Faculty of Education & Health Services, School of Medicine, University of Limerick, Garraun, Castletroy, Co., Limerick, V94 T9PX, Ireland
| | - Mohamed Elhassan Abdalla
- Faculty of Education & Health Services, School of Medicine, University of Limerick, Garraun, Castletroy, Co., Limerick, V94 T9PX, Ireland
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10
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Burra TA, Soong C, Wong BM. Taking action on inequities: a structural paradigm for quality and safety. BMJ Qual Saf 2024; 33:351-353. [PMID: 38688709 DOI: 10.1136/bmjqs-2023-017027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2024] [Indexed: 05/02/2024]
Affiliation(s)
- Tara A Burra
- Department of Psychiatry, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Christine Soong
- General Internal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Brian M Wong
- Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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11
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Bockrath R, Osman C, Trainor J, Wang HC, Phatak UP, Richards DG, Keeley M, Chung EK. Education Scholarship Assessment Reconsidered: Expansion of Glassick's Criteria to Incorporate Health Equity. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:487-492. [PMID: 38306582 DOI: 10.1097/acm.0000000000005654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
ABSTRACT Recent events have ignited widespread attention to structural racism and implicit bias throughout the U.S. health care system and medical institutions, resulting in a call for antiracism approaches to advance health equity. Medical education leaders are well positioned to advance health equity, not only through their training of fellows, residents, and medical students, but also in their approach to scholarship. Education scholarship drives innovation and critical evaluation of current practices; it impacts and intersects with multiple factors that have the potential to reduce health inequities. Thus, it is critical to prioritize the assessment of education scholarship through a health equity lens. Medical education scholarly dissemination has markedly expanded over the past 2 to 3 decades, yet medical educators have continued to embrace Boyer's and Glassick and colleagues' definitions of scholarship. The authors propose an approach to medical education scholarship assessment that expands each of Glassick's 6 existing criteria to address health inequities and adds health equity as a seventh criterion. With this, medical educators, researchers, reviewers, and others can consider how education scholarship affects diverse populations and settings, direct educational products and scholarship to address health inequities, and raise the importance of advancing health equity in medical education scholarship. By expanding and standardizing the assessment of scholarship to incorporate health equity, the medical education community can foster a cultural shift that brings health equity to the forefront of education scholarship.
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12
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Schwartz BD, Rogers SL, Michels N, Van Winkle LJ. Substantial Increases in Healthcare Students' State Empathy Scores Owing to Participation in a Single Improvisation Session. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:531. [PMID: 38791746 PMCID: PMC11120652 DOI: 10.3390/ijerph21050531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/12/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE To determine whether the 12-item state empathy scale could be modified reliably to measure empathy in healthcare professions students and to detect changes in their empathy owing to a single improvisation (improv) session. METHODS Three cohorts of students from two healthcare professions programs (total = 165 students) participated in an improv session. During the session, one of the researchers (BS) tasked the students with several improv activities. Participants' self-reported state empathy scores were assessed at three time points (pre-improv, post-improv, and end of semester) using revised, in-class paper versions of the State Empathy Scale. RESULTS The exploratory factor analysis revealed a single factor solution for the revised scale, justifying the creation of an overall state empathy score from the questionnaire. Cronbach's alpha reliability values averaged 0.87. Students' mean empathy scores were higher directly after the improv session than directly prior to the session (p < 0.0001; effect size = r = 0.67, 0.55, and 0.79 for cohorts 1, 2, and 3, respectively). CONCLUSIONS These findings show that a single one- or two-hour improv session can foster substantial increases in healthcare professional students' state empathy for one another. Greater healthcare professional empathy and compassion foster better healthcare team cooperation and patient outcomes, so healthcare professionals and their students should engage in such empathy-enhancing activities at regular intervals throughout their training and careers.
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Affiliation(s)
- Brian D. Schwartz
- Department of Medical Humanities, Rocky Vista University, Englewood, CO 80112, USA; (B.D.S.); (N.M.)
| | - Shane L. Rogers
- School of Arts and Humanities, Edith Cowan University, Joondalup, WA 6027, Australia;
| | - Nicole Michels
- Department of Medical Humanities, Rocky Vista University, Englewood, CO 80112, USA; (B.D.S.); (N.M.)
| | - Lon J. Van Winkle
- Department of Medical Humanities, Rocky Vista University, Englewood, CO 80112, USA; (B.D.S.); (N.M.)
- Department of Biochemistry, Midwestern University, Downers Grove, IL 60515, USA
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13
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Hernandez MI, Miller EC, Biese KM, Columna L, Andreae S, McGuine TA, Snedden TR, Eberman LE, Bell DR. Secondary School Athletic Trainers' Perceptions of the Influence of Social Determinants of Health and Socioeconomic Status on Clinical Management Decisions. J Athl Train 2024; 59:388-393. [PMID: 37459372 PMCID: PMC11064109 DOI: 10.4085/1062-6050-0445.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
CONTEXT Evidence suggests that lower socioeconomic status (SES) and negative social determinants of health (SDOH) contribute to health care disparities. Due to their accessibility in the high school setting, secondary school athletic trainers (SSATs) may encounter patients who are historically underserved in health care, such as patients with low SES. However, a significant gap in knowledge exists regarding how SDOH and SES may influence SSATs' clinical management decisions. OBJECTIVES To describe SSATs' perceptions of how patient SDOH and SES influence clinical management decisions and to identify barriers to athletic health care. DESIGN Cross-sectional study. SETTING Online survey. PARTICIPANTS OR OTHER PARTICIPANTS National Athletic Trainers' Association SSATs (6.7% response rate). MAIN OUTCOME MEASURE(S) Secondary school athletic trainers were asked about their perceptions of patient SDOH and SES (content validity index = 0.83 for relevancy). The levels of relevance and agreement were answered on a 4-point Likert scale. Data were summarized using means and SDs, frequencies and proportions (%), and median scores. RESULTS A total of 380 SSATs participated (mean years of experience = 14.9 ± 11.7 years). When providing care, most (71.3%) SSATs believed their patients' health or health care access to be the most relevant of the 5 SDOH, whereas the other 4 SDOH were less than 60% relevant. Most SSATs agreed or strongly agreed that patient SES affected both referral (67.4%) and the reliance on conservative treatment before referral (71.2%). Secondary school athletic trainers identified patient or guardian compliance (70.2%) and type of health insurance (61.5%) as barriers to providing care to patients with low SES. CONCLUSIONS Secondary school athletic trainers perceived health or health care access as the most relevant social determinant when providing care to patients with low SES. When SSATs further considered the SES of patients, they identified all SDOH as barriers that they were ill equipped to navigate as they delivered care and engaged in patient referral.
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Affiliation(s)
| | | | - Kevin M Biese
- Kinesiology and Athletic Training, University of Wisconsin-Oshkosh
| | - Luis Columna
- Department of Kinesiology, University of Wisconsin-Madison
| | - Susan Andreae
- Department of Kinesiology, University of Wisconsin-Madison
| | - Timothy A McGuine
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison
| | | | - Lindsey E Eberman
- Neuromechanics, Interventions, and Continuing Education Research (NICER) Laboratory, Indiana State University, Terre Haute
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Tillman F, Liu I, Lovince J, Mays E, Musick K, Sato J, Rao KV. Healthcare Equity and Leadership: Implementation of Diversity, Equity, and Inclusion Training for Pharmacy Residents. J Pharm Pract 2024; 37:422-428. [PMID: 36446745 DOI: 10.1177/08971900221142684] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
BackgroundPharmacy training programs infrequently include formal training in the areas of diversity, equity, and inclusion (DEI). Hence, the purpose of this report is to offer perspectives gained from the delivery of a DEI curriculum within a pharmacy residency program aimed at expanding experiential learning focused on DEI and health equity. Program Implementation: Pharmacy residents at an academic medical center were invited to participate in a longitudinal DEI/equity seminar series that was thoughtfully and strategically developed by a team of residents and program leadership based on a six-step process. Residents were offered 9 individual seminars covering 4 major focus areas to facilitate enhanced awareness, learning, and vulnerability. Participants were invited to provide evaluations of each seminar and the overall series. Program Assessment: A total of 41 residents (100%) participated in at least one of the 9 seminars that were offered and approximately 50% completed the post-series survey. Resident-perceived benefit of each individual session was consistently favorable. Additionally, greater than 70% of participants responded favorably when asked about the impact of each session on their awareness, resources provided, and ability to apply the learnings to their practice. Conclusion: Our inaugural experience with the integration of a DEI seminar series into a pharmacy residency program suggests that there is a clear benefit to including DEI/health equity into pharmacy residency training. This data may suggest that adoption of DEI-focused experiential training may increase cultural awareness and the availability of resources to better equip pharmacy residents in applying concepts of DEI into their practice.
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Affiliation(s)
- Frank Tillman
- Durham Veterans Affairs Healthcare System, Durham, NC, USA
- University of North Carolina Healthcare System, Chapel Hill, NC, USA
| | - Ina Liu
- University of North Carolina Healthcare System, Chapel Hill, NC, USA
| | | | - Erin Mays
- Duke University Healthcare System, Durham, NC, USA
| | - Kaitlin Musick
- University of Kentucky Healthcare System, Lexington, KY, USA
| | - Jennifer Sato
- University of North Carolina Healthcare System, Chapel Hill, NC, USA
| | - Kamakshi V Rao
- University of North Carolina Healthcare System, Chapel Hill, NC, USA
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15
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Hallowell R, Saluja S, Lewis L, Novak DA, Valentine W, Batch E, Clayton Johnson MA, Bluthenthal RN, Cousineau MR, Ben-Ari R. Advocacy for Health Justice: An Innovative Pilot Course for MD and Master of Public Policy Students. TEACHING AND LEARNING IN MEDICINE 2024; 36:198-210. [PMID: 36519450 DOI: 10.1080/10401334.2022.2155169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 11/15/2022] [Indexed: 06/17/2023]
Abstract
Problem: U.S. medical schools are searching for ways to address issues of health justice in undergraduate medical education. Physicians have not typically received training in how to be effective advocates for systemic change and individuals in policy fields are not usually equipped to understand the complex issues of health science and their intersection with the health system and society. To address this gap, medical school faculty partnered with school of public policy faculty on a collaborative learning model that engaged MD and Master of Public Policy students together to strengthen their collective knowledge of the healthcare landscape, and to build skills to work for health justice. Intervention: We hypothesized that pairing medical students with public policy students to learn about the intersections of health justice and advocacy could enhance the efficacy of each group and provide a new model of collaboration between medical and policy professionals. The students collaborated on a health justice advocacy project through which they provided consultation to an established community organization. Context: The 8-week course took place in the spring of 2021 in Los Angeles, California. Due to Covid-19 the course was taught online and included asynchronous learning modules and live Zoom sessions. The project also served as a pilot for the post-clerkship phase of a new longitudinal health justice curriculum for MD students that launched in August 2021. Impact: Analysis of student work products, course evaluations, partner interviews, and student focus groups showed that students valued learning through their interdisciplinary collaborative work which gave them new perspectives on health justice issues. The community partners indicated that the students consultative work products were useful for their initiatives, and that they found working with MD and MPP students to be a valuable way to think about how to build stronger and more inclusive coalitions to advocate for health justice. This project has the potential for national impact as it aligns with the Association of American Medical Colleges' renewed focus on the responsibility of academic medicine to partner with communities for health justice. The project also contributed to the national conversation on how to align health systems science education with the aims of health justice through our participation in the American Medical Association Accelerating Change in Medical Education Consortium. Lessons Learned: Leveraging faculty relationships with community partners was crucial for developing meaningful projects for students. Cultivating and expanding community partner networks is necessary to sustain and scale up this type of intervention. Centering the needs of communities and supporting their on-going work for health justice is essential for becoming an effective advocate. Learning communities that bring interdisciplinary students, healthcare providers, policy professionals, and community partners together to learn from one another can create key opportunities for ameliorating health inequities.
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Affiliation(s)
- Ronan Hallowell
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sonali Saluja
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - LaVonna Lewis
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
| | - Daniel A Novak
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Eric Batch
- American Heart Association, Los Angeles, California, USA
| | | | - Ricky N Bluthenthal
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael R Cousineau
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ron Ben-Ari
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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16
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Brown EA, Jones R. Discussing systemic racism and racial privilege at a large, academic health center using a modified privilege walk. BMC MEDICAL EDUCATION 2024; 24:327. [PMID: 38520020 PMCID: PMC10960397 DOI: 10.1186/s12909-024-05302-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 03/12/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND There is a motivation for organizations to understand race and racism from the perspective of minoritized individuals. Academic health centers (AHC) are ideal organizations to have these conversations as they educate healthcare providers, support research in health disparities, and care for diverse patients. METHODS We piloted and evaluated a virtual Modified Privilege Walk (MPW) with faculty, staff, and students at an AHC in July 2020 to promote difficult conversations about race/racism, social class, and privilege. Each MPW session was voluntary, held virtually over Zoom, and lasted one hour and thirty minutes. Before attending, participants answered questions based on their race/ethnicity and social class to calculate a "privilege score." After each session, attendees were asked to complete an evaluation survey. RESULTS There were five virtual MPWs with 132 attendees, and 74 participants completed an evaluation survey (56% response rate). Many respondents were students (n = 29, 39.2%). Most respondents either agreed (n = 36, 48.6%) or strongly agreed (n = 32, 43.2%) that the virtual MPW positively impacted how they will interact with those of a different race/ethnicity. Attendees requested having more virtual MPWs with leadership, incorporating virtual MPWs in various program curricula, and requiring new employees to participate. CONCLUSIONS American organizations, particularly AHCs, should provide safe spaces and support these discussions surrounding race and racism as many were founded, built, or operated during a time of free labor and segregation that exerted power and control over minoritized individuals. Authors provide recommendations to dismantle organizational racism and support minoritized employees, patients, and students.
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Affiliation(s)
- Elizabeth A Brown
- School of Community & Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA, 23529, USA.
| | - Rosemarie Jones
- Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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17
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Abdalla ME, Taha MH, Onchonga D, Magzoub ME, Au H, O'Donnell P, Neville S, Taylor D. Integrating the social determinants of health into curriculum: AMEE Guide No. 162. MEDICAL TEACHER 2024; 46:304-316. [PMID: 37677074 DOI: 10.1080/0142159x.2023.2254920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
The World Health Organization (WHO) defines the Social Determinants of Health (SDOH) as the non-medical factors influencing health outcomes. SDOH is associated with conditions in which people are born, grow, work, and live. Medical schools and licensing bodies are increasingly recognizing the need for doctors and healthcare professionals to be aware of their patient's social context and how it impacts their states of health and disease. However, there is considerable variation in the approaches of different institutions and countries to incorporating SDOH into their curricula. In order to allow clinicians to adopt a holistic approach to patient health, equipping them with extensive knowledge of SDOH would give learners the confidence, skills, knowledge, and attitudes needed to effectively engage with patients and their families. This approach aids health professionals with knowledge of the influence of the social context and cultural factors that affect patients' behaviors in relation to health. Incorporating the SDOH in medical and health professional school curricula would contribute towards adequately preparing future healthcare practitioners to provide effective, comprehensive, and equitable care, especially to marginalized and underserved populations. The Guide will take an evidence-based approach grounded in the available contemporary literature and case studies. The focus will be on integrating SDOH into undergraduate and postgraduate medical curricula to promote an understanding of the social factors that influence patients' and communities' health. Ultimately, this guide seeks to contribute to the reduction of inequalities in health.
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Affiliation(s)
| | - Mohamed Hassan Taha
- College of Medicine and Medical Education Center, University of Sharjah, Sharjah, UAE
| | - David Onchonga
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Hosanna Au
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Siobhán Neville
- School of Medicine, University of Limerick, Limerick, Ireland
| | - David Taylor
- Gulf Medical University, Al Jurf, Ajman, United Arab Emirates
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18
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van Schalkwyk S, Blitz J. Curriculum renewal towards critically conscious graduates: Implications for faculty development. MEDICAL EDUCATION 2024; 58:299-307. [PMID: 37699795 DOI: 10.1111/medu.15216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/24/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Globally, faculty development initiatives in support of health professions (HP) educators continue to extend their remit. This work becomes more critical as HP curriculum renewal activities are influenced by needing to move beyond a biomedical focus attending to issues such as social accountability, social justice and health equity. This raises questions about how best to support our HP educators who may need to change their teaching practice as they embrace these more complex, social constructs. METHODS The research question for this qualitative study was: What implications are there for faculty development that can support HP educators as they are expected to incorporate the principles of critical consciousness and social accountability into their teaching as part of a curriculum renewal process? Data from 11 focus group discussions and 11 subsequent individual interviews with HP educators from two undergraduate programmes were thematically analysed after which further analysis focussed on the implications of these findings for faculty development. Transformative learning theory and models about change provided a sensitising framework. RESULTS Our findings pointed to an expanded role for HP educators and consequently also for those responsible for faculty development. Three main ideas were highlighted: Curriculum renewal catalyses a renewed need for faculty development, the nature of faculty development that can enable change and new foci for faculty development. CONCLUSIONS Faculty development can make a significant contribution to enabling change, including in the context of curriculum renewal that often extends the roles and responsibilities of HP educators. When renewal seeks to shift fundamental curriculum principles, providing support to embrace this expanded remit results in an equally expanded remit for faculty developers-one that calls for initiatives that enable critical, dialogic encounters that might foster critical consciousness, leading to change in HP education. This challenges us, as faculty developers, to turn the mirror on ourselves to consider the nature of such expanded support.
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Affiliation(s)
- Susan van Schalkwyk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Julia Blitz
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Gadhoke P, Brenton BP, Sadeghzadeh S, Huang SY, Lane L, Mathieu D, Rafa T, Albano X, Noble G. The Intersectionality of Food Insecurity, Job Insecurity, Healthcare Insecurity, and Mental Health Challenges in NYC Households During Covid-19. Ecol Food Nutr 2024; 63:112-134. [PMID: 38421255 DOI: 10.1080/03670244.2024.2308669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Our intersectional research explored food insecurity and job insecurity as predictors of healthcare insecurity and mental health challenges among households living in economic instability since the COVID19 pandemic began. The New York City COVID19 Research Team adapted a validated, web based, anonymous survey questionnaire using a Social Determinants of Health Framework. The study oversampled underserved populations with a total of 2,099 participants. We report strong associations between food insecurity and job insecurity among healthcare insecure households, and significant mental health challenges among food insecure and healthcare insecure households. This underscores the need for integrated social policies to protect underserved urban populations.
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Affiliation(s)
- Preety Gadhoke
- Public Health, College of Pharmacy and Health Sciences, St. John's University, Queens, NY, USA
| | - Barrett P Brenton
- Engagement Associate, Binghamton University, Center for Civic Engagement - UU 137, Binghamton, New York, USA
| | - Saloumeh Sadeghzadeh
- Operations and Business Analytics, School of Management, Binghamton University, Binghamton, New York, USA
| | - Sammy Y Huang
- Public Health, College of Pharmacy and Health Sciences, St. John's University, Queens, NY, USA
| | - Liam Lane
- Department of Anthropology, Binghamton University, Binghamton, New York, USA
| | - David Mathieu
- Public Health, College of Pharmacy and Health Sciences, St. John's University, Queens, NY, USA
| | - Tashnim Rafa
- Public Health, College of Pharmacy and Health Sciences, St. John's University, Queens, NY, USA
| | - Xavier Albano
- Public Health, College of Pharmacy and Health Sciences, St. John's University, Queens, NY, USA
| | - Gabriela Noble
- Public Health, College of Pharmacy and Health Sciences, St. John's University, Queens, NY, USA
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20
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Cruz TM. Racing the Machine: Data Analytic Technologies and Institutional Inscription of Racialized Health Injustice. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2024; 65:110-125. [PMID: 37572020 DOI: 10.1177/00221465231190061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Abstract
Recent scientific and policy initiatives frame clinical settings as sites for intervening upon inequality. Electronic health records and data analytic technologies offer opportunity to record standard data on education, employment, social support, and race-ethnicity, and numerous audiences expect biomedicine to redress social determinants based on newly available data. However, little is known on how health practitioners and institutional actors view data standardization in relation to inequity. This article examines a public safety-net health system's expansion of race, ethnicity, and language data collection, drawing on 10 months of ethnographic fieldwork and 32 qualitative interviews with providers, clinic staff, data scientists, and administrators. Findings suggest that electronic data capture institutes a decontextualized racialization within biomedicine as health practitioners and data workers rely on biological, cultural, and social justifications for collecting racial data. This demonstrates a critical paradox of stratified biomedicalization: The same data-centered interventions expected to redress injustice may ultimately reinscribe it.
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Van Liew JR, Lai C, Streyffeler L. Twelve tips for teaching culturally and socially responsive care to medical students. MEDICAL TEACHER 2024:1-6. [PMID: 38422994 DOI: 10.1080/0142159x.2024.2322713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
In recent years, discourse on topics like cultural humility, social determinants of health (SDOH), and health disparities and inequities has greatly increased in medical education as attention to their impact on health has magnified. Unfortunately, traditional medical education models may fail to optimize learning in this area. To address these complex social health issues, we must find innovative ways to engage students in an educational partnership in which they are challenged to critically think and reflect on their attitudes, role, and actions in health equity and culturally responsive care. Through reviews of existing literature coupled with our own experience with iterative implementation of a model that includes interpersonal engagement paired with individual self-directed learning, we assembled 12 tips on how to prepare diverse students to practice lifelong cultural humility and provide culturally and socially responsive care in an ever-changing social landscape.
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Affiliation(s)
- Julia R Van Liew
- Department of Behavioral Medicine, Medical Humanities, and Bioethics, Des Moines University, West Des Moines, IA, USA
| | - Cassandra Lai
- College of Osteopathic Medicine, Des Moines University, Des Moines, IA, USA
| | - Lisa Streyffeler
- Department of Behavioral Medicine, Medical Humanities, and Bioethics, Des Moines University, West Des Moines, IA, USA
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Brito S, Rau A, Escobar C, Garza P, Sriprasert I, Mitchell Chadwick N. Raising patient voices in medical education: an assessment of patient perceived effect of social determinants of health conversations and the patient-physician relationship on quality of obstetric care, to inform the development of patient driven medical education curricula. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1283390. [PMID: 38435087 PMCID: PMC10905965 DOI: 10.3389/frph.2024.1283390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
Background Conventional medical education lacks the lived experiences of patients which may authentically convey the social determinants of health (SDOH) and resulting health disparities. Videos of first-person patient narratives may prove a valuable education tool in this regard. The objective of this study is to investigate how patient demographics, satisfaction with care, and patient-physician relationships influence obstetric patient interest and willingness to contribute to a SDOH video curriculum by sharing their lived experiences through first-person narratives. Methods Study design included an anonymous, cross-sectional survey and an optional semi-structured telephone interview. Participants were 18 years old with a live-birth delivery <8 weeks prior to recruitment and received care during their pregnancy at Los Angeles General Medical Center (LAGMC). Variables surveyed included demographics, satisfaction with care, aspects of the patient-physician relationship, perceived utility, and personal interest in contributing to an educational SDOH video. A bivariate analysis was conducted to compare participants' characteristics and responses on interest in contributing and perceived helpfulness of first-person patient SDOH videos. Results 72.43% of participants (N = 70) believed a patient's first-person video on SDOH would be "Helpful" in preparing physicians to provide competent medical care; however, 71.43% responded "No" to "Interest" in sharing with physicians their experiences with SDOH. English preference and being U.S. born were factors significantly associated with viewing first-person SDOH video as "Helpful" (P > 0.001). Major themes from telephone interviews reflected enthusiasm for first-person patient narratives and perceived benefits of using patient experiences to educate physicians on SDOH. However, participants cited barriers to disclosing SDOH including brief and strictly clinical interactions with physicians, lack of continuity of care, and fear of being judged by physicians. Conclusion While most participants recognized the utility of addressing social needs in medical education and reported satisfaction with their obstetricians and care, these factors did not uniformly translate into willingness to contribute first-person patient narratives. To improve the representation of patients from racial, ethnic, gender, linguistic, and sexual minorities into medical curricula, further research and strategies are needed to overcome the barriers discouraging patient disclosure of social needs to physicians.
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Affiliation(s)
- S. Brito
- Department of Obstetrics and Gynecology, Keck School of Medicine of USC, Los Angeles, CA, United States
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Cleland J, Zachariah A, David S, Pulimood A, Poobalan A. A qualitative study of social accountability translation: from mission to living it. BMC MEDICAL EDUCATION 2024; 24:145. [PMID: 38355545 PMCID: PMC10868042 DOI: 10.1186/s12909-024-05093-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Medical schools are increasingly adopting socially accountable mission and curricula, the realisation of which are dependent on engaging individuals to embody the mission's principles in their everyday activities as doctors. However, little is known about how graduates perceive the efforts taken by their medical school to sensitise them to social accountability values, and how they translate this into their working lives. Our aim was to explore and understand graduate perceptions of how their medical school influenced them to embody a social accountability mission in their working lives. METHODS This was a qualitative interview study carried out with graduates/alumni [n = 51] of Christian Medical College, Vellore [CMCV], India, a school with a long-established and explicit social-accountability mission. Data coding and analysis were initially inductive and thematic using Braun and Clarke's six step framework. MacIntyre's virtue ethics theory framed secondary analysis, allowing us to consider the relationships between individual and contextual factors. RESULTS Our participants perceived that CMCV invested heavily in selecting personal qualities aligned with the CMCV mission. They saw that these qualities were reinforced through various practices: [e.g., placements in resource limited and/or remote and rural settings]; community engagement and expectations [e.g., student self-governance]; role modelling [staff and more senior students]. Much emphasis was placed on sustaining these traditions and practices over time, creating a strong sense of identity and belonging among participants, traditions which were fostered further by the alumni network and continued engagement with CMCV post-graduation. CONCLUSIONS Ensuring social accountable medical education depends on alignment and interactions over time between context and structures, systems and human agents. Further studies are needed to extend understanding of how students from diverse contexts experience socially accountable medical education and translate their educational experience into their thinking and practice after graduation.
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Affiliation(s)
- Jennifer Cleland
- Medical Education Research and Scholarship Unit, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore.
| | - Anand Zachariah
- Christian Medical College, M.G.R Medical University, Vellore, India
| | - Sarah David
- Christian Medical College, M.G.R Medical University, Vellore, India
| | - Anna Pulimood
- Christian Medical College, M.G.R Medical University, Vellore, India
| | - Amudha Poobalan
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Thomas JK, Colbert-Getz J, Bonnett R, Sakaeda M, Hurtado JM, Chow C. "What's Next in My Arc of Development?": An Exploratory Study of What Medical Students Need to Care for Patients of Different Backgrounds. TEACHING AND LEARNING IN MEDICINE 2024:1-11. [PMID: 38258421 DOI: 10.1080/10401334.2023.2298860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 12/07/2023] [Indexed: 01/24/2024]
Abstract
PHENOMENON Medical schools must equip future physicians to provide equitable patient care. The best approach, however, is mainly dependent on a medical school's context. Graduating students from our institution have reported feeling ill-equipped to care for patients from "different backgrounds" on the Association of American Medical Colleges' Graduation Questionnaire. We explored how medical students interpret "different patient backgrounds" and what they need to feel prepared to care for diverse patients. APPROACH We conducted an exploratory qualitative case study using focus groups with 11, Year 2 (MS2) and Year 4 (MS4) medical students at our institution. Focus groups were recorded, transcribed, and coded using thematic analysis. We used Bobbie Harro's cycles of socialization and liberation to understand how the entire medical school experience, not solely the curriculum, informs how medical students learn to interact with all patients. FINDINGS We organized our findings into four major themes to characterize students' medical education experience when learning to care for patients of different backgrounds: (1) Understandings of different backgrounds (prior to medical school); (2) Admissions process; (3) Curricular socialization; and (4) Co-curricular (or environmental) socialization. We further divided themes 2, 3, and 4 into two subthemes when learning how to care for patients of different backgrounds: (a) the current state and (b) proposed changes. We anticipate that following the proposed changes will help students feel more prepared to care for patients of differing backgrounds. INSIGHTS Our findings show that preparing medical students to care for diverse patient populations requires a multitude of intentional changes throughout medical students' education. Using Harro's cycles of socialization and liberation as an analytic lens, we identified multiple places throughout medical students' educational experience that are barriers to learning how to care for diverse populations. We propose changes within medical students' education that build upon each other to adequately prepare students to care for patients of diverse backgrounds. Each proposed change culminates into a systemic shift within an academic institution and requires an intentional commitment by administration, faculty, admissions, curriculum, and student affairs.
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Affiliation(s)
- Julie K Thomas
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Jorie Colbert-Getz
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Rachel Bonnett
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Mariah Sakaeda
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Jessica M Hurtado
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Candace Chow
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
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Sagalowsky ST, Woodward H, Agnant J, Bailey B, Duncan E, Grad J, Kessler DO. Structural Competency in Simulation-Based Health Professions Education: A Call to Action and Pragmatic Guide. Simul Healthc 2024:01266021-990000000-00097. [PMID: 38197665 DOI: 10.1097/sih.0000000000000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
SUMMARY STATEMENT Simulation-based health professions educators can advance diversity, equity, and inclusion by cultivating structural competency, which is the trained ability to discern inequity not only at an individual level, but also at organizational, community, and societal levels. This commentary introduces Metzl and Hansen's Five-Step Model for structural competency and discusses its unique applicability to the metacognitive underpinnings of simulation-based health professions education. We offer a pragmatic guide for simulation-based health professions educators to collaboratively design learning objectives, simulation cases, character sketches, and debriefs in which structural competency is a simulation performance domain, alongside patient management, resource usage, leadership, situational awareness, teamwork, and/or communication. Our overall goal is to promote a paradigm shift in which educators are empowered to partner with patients, colleagues, and communities to recognize, learn about, and challenge the factors driving health inequities; a skill that may be applied to a broad range of health professions education within and outside of simulation.
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Affiliation(s)
- Selin T Sagalowsky
- From the New York University Grossman School of Medicine (S.T.S., J.A., E.D., J.G.), New York, NY; NewYork-Presbyterian Morgan Stanley Children's Hospital (H.W.), New York, NY; Family Advisory Council (B.B.), NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY; and Columbia University College of Physicians & Surgeons (D.O.K.), New York, NY
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Basco H, Switzer T, Davis K, Lam C, Sawin EM, Robins J, Zurakowski T, Taloma A. Broadening their horizons: A rural and urban nursing student exchange program in primary care. J Prof Nurs 2024; 50:121-128. [PMID: 38369367 DOI: 10.1016/j.profnurs.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 02/20/2024]
Abstract
Educational strategies that allow students to experience patient care in both rural and urban settings are imperative to the recruitment and retention of nurses for medically underserved populations or health professional shortage areas. Two state schools of nursing (one urban-oriented and one rural-oriented) in the Mid-Atlantic region were awarded Health Resources and Service Administration (HRSA) project funding to educate nursing students and registered nurses in community-based primary care settings. This article will discuss an innovative rural-urban baccalaureate nursing student exchange model intended to increase understanding of enhanced RN roles in community-based primary care settings. Two project teams collaborated to create a new learning model, a rural-urban exchange, by implementing a Primary Care Camp. The camp included shared didactic content, reflection exercises, historical and cultural considerations, and clinical immersion to allow students in both programs to have on-site rural and urban learning experiences. Faculty collected informal voluntary student feedback through a debrief after their Primary Care Camp experience to assess their understanding of the enhanced RN Role in primary care and how it may affect their future nursing practice. Student feedback suggests that the students met project goals and appreciated the rural and urban exchange experience. This project is an innovative approach that offers guidance for implementing primary care education in a way that supports the current primary care RN role, builds the future workforce, and provides suggestions for replicability.
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Affiliation(s)
- Hallel Basco
- Virginia Commonwealth University School of Nursing, 1100 East Leigh St, Richmond, VA 23298, United States of America.
| | - Tina Switzer
- James Madison University School of Nursing, MSC 4305, 235 Martin Luther King Jr. Way, Harrisonburg, VA 22807, United States of America.
| | - Kimberly Davis
- Virginia Commonwealth University School of Nursing, 1100 East Leigh St, Richmond, VA 23298, United States of America.
| | - Christina Lam
- James Madison University School of Nursing, MSC 4305, 235 Martin Luther King Jr. Way, Harrisonburg, VA 22807, United States of America.
| | - Erika Metzler Sawin
- James Madison University School of Nursing, MSC 4305, 235 Martin Luther King Jr. Way, Harrisonburg, VA 22807, United States of America.
| | - Jo Robins
- Virginia Commonwealth University School of Nursing, 1100 East Leigh St, Richmond, VA 23298, United States of America.
| | - Tamara Zurakowski
- St. Catherine University, 2004 Randolph Avenue, St. Paul, MN 55105, United States of America.
| | - Amy Taloma
- Virginia Area Health Education Centers & Programs, 7818 E. Parham Road, Richmond, VA 23294, United States of America.
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Mathieu IP, Martin BJ. The art of equity: critical health humanities in practice. Philos Ethics Humanit Med 2023; 18:19. [PMID: 38087361 PMCID: PMC10716923 DOI: 10.1186/s13010-023-00149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/13/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The American Association of Medical Colleges has called for incorporation of the health humanities into medical education, and many medical schools now offer formal programs or content in this field. However, there is growing recognition among educators that we must expand beyond empathy and wellness and apply the health humanities to questions of social justice - that is, critical health humanities. In this paper we demonstrate how this burgeoning field offers us tools for integrating social justice into medical education, utilizing the frameworks of critical consciousness and structural competency. PRACTICE OF HEALTH HUMANITIES Critical health humanities can be applied at multiple levels of learners, and in a variety of contexts. We are two physician-writers who have developed several educational programs that demonstrate this. We taught a seminar that introduced first-year and second-year undergraduates to concepts such as social determinants of health, intergenerational trauma, intersectionality, resilience, and cross-cultural care through works of fiction, poetry, film, podcasts, stand-up comedy, and more. Through creative projects and empathic reflection, students engaged with the complexities of structural forces that create and maintain health disparities. Medical students in their clinical years can engage in critical health humanities learning experiences as well. We teach several multidisciplinary electives that address social (in)justice in medicine, as well as mentor fourth-year students engaged in independent electives that foster critical awareness around health equity and ethics. Beyond the classroom, we have actively engaged in critical health humanities practices through story slams, literary journal clubs, conference presentations, and Grand Rounds. Through these activities we have included learners at GME and CME levels. These examples also demonstrate how community engagement and multidisciplinary partnerships can contribute to the practice of critical health humanities. CONCLUSION In this paper, we explore the growing field of critical health humanities and its potential for teaching health equity through narrative practices. We provide concrete examples of educational activities that incorporate critical consciousness and structural competency - frameworks we have found useful for conceptualizing critical health humanities as a pedagogical practice. We also discuss the strengths and challenges of this work and suggest future directions.
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Affiliation(s)
- Irène P Mathieu
- Department of Pediatrics; Program in Health Humanities, Center for Health Humanities & Ethics, University of Virginia School of Medicine, PO Box 800386, Charlottesville, VA, 22908, USA.
| | - Benjamin J Martin
- Department of Internal Medicine; Program in Health Humanities, Center for Health Humanities & Ethics, University of Virginia School of Medicine, PO Box 800386, Charlottesville, VA, 22908, USA
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George RE, Sidhu MS. Promoting inclusivity in health professions education. CLINICAL TEACHER 2023; 20:e13606. [PMID: 37475641 DOI: 10.1111/tct.13606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/23/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Riya E George
- Clinical Communication Skills & Diversity Education, Institute of Health Sciences Education, Queen Mary University of London, London, UK
| | - Manbinder S Sidhu
- Health Services Management Centre, University of Birmingham, Birmingham, UK
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Sheehan K, Bartell TR, Doobay-Persaud AA, Adler MD, Mangold KA. Where in the world: Mapping medical student learning using the Social and Structural Determinants of Health Curriculum Assessment Tool (SSDH CAT). MEDICAL EDUCATION ONLINE 2023; 28:2178979. [PMID: 36908060 PMCID: PMC10013438 DOI: 10.1080/10872981.2023.2178979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Addressing the Social and Structural Determinants of Health (SSDH) is a primary strategy for attaining health equity. Teaching and learning about SSDH has increased across medical schools throughout the world; however, the published literature describing these efforts continues to be limited and many unknowns persist including what should be taught and by whom, what teaching methods and settings should be used, and how medical learners should be assessed. MATERIALS AND METHODS Based on published studies, input from experts in the field, and elements from the framework developed by the National Academy of Medicine, we created a universal Social and Structural Determinants of Health Curriculum Assessment Tool (SSDH CAT) to assist medical educators to assess existing SSDH curricular content, ascertain critical gaps, and categorize educational methods, delivery, and assessment techniques and tools that could help inform curricular enhancements to advance the goal of training a health care workforce focused on taking action to achieve health equity. To test the usefulness of the tool, we applied the SSDH CAT to map SSDH-related curriculum at a US-based medical school. RESULTS By applying the SSDH CAT to our undergraduate medical school curriculum, we recognized that our SSDH curriculum relied too heavily on lectures, emphasized knowledge without sufficient skill building, and lacked objective assessment measures. As a result of our curricular review, we added more skill-based activities such as using evidence-based tools for screening patients for social needs, and created and implemented a universal, longitudinal, experiential community health curriculum. DISCUSSION We created a universal SSDH CAT and applied it to assess and improve our medical school's SSDH curriculum. The SSDH CAT provides a starting point for other medical schools to assess their SSDH content as a strategy to improve teaching and learning about health equity, and to inspire students to act on the SSDH.
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Affiliation(s)
- Karen Sheehan
- Departments of Pediatrics, Medical Education, and Preventive Medicine, Feinberg School of Medicine, Northwestern University; Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Tami R. Bartell
- Research Project Manager, Patrick M. Magoon Institute for Healthy Communities, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, Chicago
| | - Ashti A. Doobay-Persaud
- Departments of Medicine and Medical Education, Feinberg School of Medicine, Northwestern University
| | - Mark D. Adler
- Departments of Pediatrics and Medical Education, Feinberg School of Medicine, Northwestern University; Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
| | - Karen A. Mangold
- Departments of Pediatrics and Medical Education, Feinberg School of Medicine, Northwestern University; Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
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Ye A, Gray E, Bennis S, Rho M, Hwang S. Physical medicine & rehabilitation residents' perspectives on women's musculoskeletal health. PM R 2023; 15:1436-1444. [PMID: 36882609 DOI: 10.1002/pmrj.12969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Women are either disproportionately or uniquely affected by certain musculoskeletal conditions but have limited access to providers of sex-specific musculoskeletal care. Few physical medicine & rehabilitation (PM&R) residencies offer women's musculoskeletal health training, and it is unknown whether PM&R residents feel prepared to care for women's musculoskeletal health concerns. OBJECTIVE To examine PM&R residents' perspectives and experiences in women's musculoskeletal health. DESIGN Cross-sectional survey developed through clinical expertise and consistent with sports medicine guidelines. SETTING Electronic survey sent to all accredited PM&R residency programs within the United States, distributed through program coordinators and resident representatives. PARTICIPANTS PM&R residents. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The primary outcome was residents' perspective of comfort with women's musculoskeletal health. Secondary outcomes were exposure to formal education on women's musculoskeletal health topics, exposure to various learning formats for these topics; and residents' perspectives on desire for further education, access to field-specific mentors, and interest in incorporating women's musculoskeletal health into future practice. RESULTS Two hundred eighty-eight responses were included for analysis (20% response rate, 55% female sex residents). Only 19% of residents self-reported feeling comfortable providing care for women's musculoskeletal health conditions. Comfort did not significantly differ by postgraduate year, program region, or sex. However, with regression modeling, the number of topics learned formally in their curriculum had an increased odds of residents self-reporting comfort (odds ratio [OR] 1.18, confidence interval [CI] 1.08-1.30, adjusted p value .01). The majority of residents viewed learning women's musculoskeletal health as important (94%) and requested more exposure to the field (89%). CONCLUSIONS Many PM&R residents do not feel comfortable in caring for women's musculoskeletal health conditions despite their interest in the field. To improve health care access for patients seeking care for these sex-predominant or sex-specific conditions, residency programs may want to consider increasing exposure to women's musculoskeletal health for residents.
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Affiliation(s)
- Alice Ye
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine & Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Elizabeth Gray
- Biostatistics Collaboration Center, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Stacey Bennis
- Departments of Physical Medicine & Rehabilitation and Orthopedic Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Monica Rho
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine & Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah Hwang
- Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine & Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA
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Peebles ER, Pack R, Goldszmidt M. From helplessness to transformation: An analysis of clinician narratives about the social determinants of health and their implications for training and practice. MEDICAL EDUCATION 2023; 57:1054-1067. [PMID: 37621235 DOI: 10.1111/medu.15184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/15/2023] [Accepted: 07/12/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Medical curricula are attempting to prepare trainees to address the social determinants of health, however the life circumstances of patients are often beyond physician control. Little is known about how physicians cope with this dilemma; we sought to examine their perspectives when faced with this challenge to help better prepare trainees for practice. METHODS We undertook a critical analysis of physician narratives from January 2018 to June 2020. In total, 268 physician-written narrative social determinant of health pieces from four high impact medical journals were screened and 47 met the inclusion criteria and were analysed. RESULTS We identified four storylines that described the physician experience and strategies for coping with the social determinants of health. While Helplessness stories described authors' experiences of emotional distress when unable to support their patients, the other story types described ways they could make a difference. In Shortcoming and Transformation stories, the realisations about shortcomings led to transformation. In Doctor-patient relationship stories, authors described its importance in theirs and patients' lives, and in System advocacy stories, they described the need for greater advocacy to help change broken systems. CONCLUSIONS Current approaches to teaching the social determinants of health often focus on the role of physicians in recognising and altering social circumstances. However, the realities of practice do not easily allow physicians to do so and, for some, may lead to distress and burnout. There are other ways to cope and make a difference by improving ourselves, investing in getting to know our patients, and advocating. These results can help better support trainees and physicians for the realities of practice.
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Affiliation(s)
- Erin R Peebles
- Division of General Pediatrics, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Rachael Pack
- Centre for Education Research & Innovation (CERI), Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Mark Goldszmidt
- Centre for Education Research & Innovation (CERI), Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Division of General Internal Medicine, Department of Medicine, Western University, London, ON, Canada
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Melro CM, Landry J, Matheson K. A scoping review of frameworks utilized in the design and evaluation of courses in health professional programs to address the role of historical and ongoing colonialism in the health outcomes of Indigenous Peoples. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1311-1331. [PMID: 37067638 DOI: 10.1007/s10459-023-10217-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/19/2023] [Indexed: 06/19/2023]
Abstract
Indigenous education curriculum has been implemented in health professional programs as a potential solution to addressing commonly held false beliefs, as well as negative social attitudes and behaviours. As such it is important to map and analyze the current literature on educational initiatives that teach about historical and ongoing colonialism as a determinant of health to identify commonly used theoretical frameworks and outcomes assessed, as well as the intended and unintended short- and long-term outcomes on health professional learner's beliefs, attitudes and behaviours. This scoping review follows the framework by (Peters et al., JBI Evidence Synthesis 18:2119-2126, 2020). Six databases (MEDLINE, CINAHL, PsychInfo, Sociological Abstracts, ERIC, and ProQuest Dissertations and Theses) were searched with grey literature included through hand-searching of Indigenous journals and citation searching for papers published up until 2022 based on an established search criterion. Two reviewers independently screened articles. In total, 2731 records were identified and screened; full text was assessed for 72 articles; 14 articles were identified as meeting all the inclusion criteria and included in the final review. Commonly- used theoretical frameworks were transformative learning and cultural safety, with a variety of evaluation tools used and post-intervention outcomes measured across the studies (e.g., knowledge, beliefs, attitudes, behaviour and general learner feedback). Indigenous education interventions require longitudinal evaluation studies to address shortcomings in the design and evaluation of outcomes associated with teaching about colonialism as a structural determinant of health. It is critical that we identify and monitor the intended and unintended consequences of such curriculum as we look to develop solutions to changing health professional learners' false beliefs and attitudes, in hopes to inform their future care practices.
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Affiliation(s)
- Carolyn M Melro
- Faculty of Health, Dalhousie University, 5869 University Avenue, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Jyllenna Landry
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Kimberly Matheson
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
- The Royal Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
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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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Wright SR, Boyd VA, Okafor I, Sharma M, Giroux R, Richardson L, Brosnan C. 'First in family' experiences in a Canadian medical school: A critically reflexive study. MEDICAL EDUCATION 2023; 57:980-990. [PMID: 37226410 DOI: 10.1111/medu.15116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/17/2023] [Accepted: 04/22/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Medical students from affluent and highly educated backgrounds remain overrepresented in Canadian medical schools despite widespread efforts to improve diversity. Little is known of the medical school experiences of students who are first in their family (FiF) to attend university. Drawing on Bourdieu and a critically reflexive lens, this study explored the experiences of FiF students in a Canadian medical school to better understand the ways in which the medical school environment can be exclusive and inequitable to underrepresented students. METHODS We interviewed 17 medical students who self-identified as being FiF to attend university. Utilising theoretical sampling, we also interviewed five students who identified as being from medical families to test our emerging theoretical framework. Participants were asked to discuss what 'first in family' meant to them, their journey into medical school and their experiences at medical school. Bourdieu's theories and concepts were used as sensitising concepts to explore the data. RESULTS FiF students discussed the implicit messages they received about who belongs in medical school, challenges in shifting from their pre-medical lives to a medical identity and competing with peers for residency programmes. They reflected on the advantages they perceived they had over their fellow students due to their less 'typical' social backgrounds. CONCLUSION While medical schools continue to make strides when it comes to increasing diversity, inclusivity and equity require increased attention. Our findings highlight the ongoing need for structural and cultural change at admissions and beyond-change that recognises the much-needed presence and perspectives that underrepresented medical students, including those who are FiF, bring to medical education and healthcare. Engaging in critical reflexivity represents a key way that medical schools can continue to address issues of equity, diversity and inclusion.
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Affiliation(s)
- Sarah R Wright
- Toronto East Health Network, Michael Garron Hospital, Toronto, Ontario, Canada
- The Wilson Centre, The University Health Network, Toronto, Ontario, Canada
- The Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Victoria A Boyd
- The Wilson Centre, The University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ike Okafor
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Malika Sharma
- St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ryan Giroux
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Lisa Richardson
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Wise Practices in Indigenous Health, Women's College Hospital, Toronto, Ontario, Canada
| | - Caragh Brosnan
- School of Humanities, Creative Industries & Social Sciences, College of Human and Social Futures, University of Newcastle, Callaghan, Australia
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Hansen A, Engel-Hills P, Jacobs C, Blitz J, Cooke R, Hess-April L, Leisegang K, Naidoo N, Volschenk M, van Schalkwyk S. Understandings and practices: Towards socially responsive curricula for the health professions. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1131-1149. [PMID: 36732399 PMCID: PMC9894667 DOI: 10.1007/s10459-023-10207-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/03/2023] [Indexed: 05/21/2023]
Abstract
Global health inequities have created an urgency for health professions education to transition towards responsive and contextually relevant curricula. Such transformation and renewal processes hold significant implications for those educators responsible for implementing the curriculum. Currently little is known about how health professions educators across disciplines understand a responsive curriculum and how this understanding might influence their practice. We looked at curricula that aim to deliver future health care professionals who are not only clinically competent but also critically conscious of the contexts in which they serve and the health care systems within which they practice. We conducted a qualitative study across six institutions in South Africa, using focus group discussions and in-depth individual interviews to explore (i) how do health professions educators understand the principles that underpin their health professions education curriculum; and (ii) how do these understandings of health professions educators shape their teaching practices? The transcripts were analysed thematically following multiple iterations of critical engagement to identify patterns of meaning across the entire dataset. The results reflected a range of understandings related to knowing, doing, and being and becoming; and a range of teaching practices that are explicit, intentionally designed, take learning to the community, embrace a holistic approach, encourage safe dialogic encounters, and foster reflective practice through a complex manner of interacting. This study contributes to the literature on health professions education as a force for social justice. It highlights the implications of transformative curriculum renewal and offers insights on how health professions educators embrace notions of social responsiveness and health equity to engage with these underlying principles within their teaching.
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Affiliation(s)
- Anthea Hansen
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Penelope Engel-Hills
- Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Cecilia Jacobs
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Julia Blitz
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Richard Cooke
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucia Hess-April
- Department of Occupational Therapy, Faculty of Community and Health Sciences, University of Western Cape, Cape Town, South Africa
| | - Kristian Leisegang
- School of Natural Medicine, Faculty of Community and Health Sciences, University of Western Cape, Cape Town, South Africa
| | - Niri Naidoo
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mariette Volschenk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan van Schalkwyk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Cerdeña JP, Tsai JW, Warpinski C, Rosencrans RF, Gravlee CC. Racial, Gender, and Size Bias in a Medical Graphical Abstract Gallery: A Content Analysis. Health Equity 2023; 7:631-643. [PMID: 37786527 PMCID: PMC10541937 DOI: 10.1089/heq.2023.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 10/04/2023] Open
Abstract
Introduction Graphical abstracts may enhance dissemination of scientific and medical research but are also prone to reductionism and bias. We conducted a systematic content analysis of the Journal of Internal Medicine (JIM) Graphical Abstract Gallery to assess for evidence of bias. Materials and Methods We analyzed 140 graphical abstracts published by JIM between February 2019 and May 2020. Using a combination of inductive and deductive approaches, we developed a set of codes and code definitions for thematic, mixed-methods analysis. Results We found that JIM graphical abstracts disproportionately emphasized male (59.5%) and light-skinned (91.3%) bodies, stigmatized large body size, and overstated genetic and behavioral causes of disease, even relative to the articles they purportedly represented. Whereas 50.7% of the graphical surface area was coded as representing genetic factors, just 0.4% represented the social environment. Discussion Our analysis suggests evidence of bias and reductionism promoting normative white male bodies, linking large bodies with disease and death, conflating race with genetics, and overrepresenting genes while underrepresenting the environment as a driver of health and illness. These findings suggest that uncritical use of graphical abstracts may distort rather than enhance our understanding of disease; harm patients who are minoritized by race, gender, or body size; and direct attention away from dismantling the structural barriers to health equity. Conclusion We recommend that journals develop standards for mitigating bias in the publication of graphical abstracts that (1) ensure diverse skin tone and gender representation, (2) mitigate weight bias, (3) avoid racial or ethnic essentialism, and (4) attend to sociostructural contributors to disease.
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Affiliation(s)
- Jessica P. Cerdeña
- Department of Family Medicine, Middlesex Health, Middletown, Connecticut, USA
- Institute for Collaboration on Health, Implementation, and Policy (InCHIP), University of Connecticut, Storrs, Connecticut, USA
- Department of Anthropology, University of Connecticut, Storrs, Connecticut, USA
| | - Jennifer W. Tsai
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Chloe Warpinski
- Department of Anthropology, University of Florida, Gainesville, Florida, USA
- MD-PhD Training Program, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Robert F. Rosencrans
- Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Clarence C. Gravlee
- Department of Anthropology, University of Florida, Gainesville, Florida, USA
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Agrawal S, Nicoll G, Carr RH, Cooper RB, Fefergrad M, Hanson MD, Munro L. Collaborating With Service Users to Select Psychiatry Residents Committed to Health Equity and Social Justice. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1022-1025. [PMID: 37797302 DOI: 10.1097/acm.0000000000005285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PROBLEM Advocates have called for health services to be delivered equitably to all. Academic psychiatry must play a role in this work, given its history of creating and perpetuating the marginalization of people experiencing mental health issues. While medical educators have started teaching concepts such as structural competency and cultural safety, careful consideration of who enters the medical workforce and what values they bring is also important. APPROACH The authors report on the first 5 years (2016-2021) of a collaboration with individuals who have used mental health or addiction services or identify as having lived experiences of mental health and/or substance use issues (i.e., service users) to select residents to the general adult psychiatry residency program at the University of Toronto who are committed to working toward health equity and social justice and who bring diverse personal, academic, and community-based experiences. Starting in 2016, a working group of service users and faculty iteratively refined the selection process to add personal letter and interview day writing sample prompts centered on social justice and advocacy. OUTCOMES The working group, coled by service users since 2019, defined the problem (lack of attention to health equity and social justice in resident selection) and codesigned the solution by revising writing prompts used in the selection process and their assessment rubrics to emphasize these missing areas. Further, service users directly participated in the implementation by reviewing candidates' personal letters and interview day writing samples alongside faculty and residents. This work serves as an example of meaningful service user engagement in action. NEXT STEPS To ensure the needs of service users are prioritized, future work must aim for long-term institutional commitment to strengthen service user involvement and power sharing with service user communities in resident selection and at other points along the medical education pathway.
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Affiliation(s)
- Sacha Agrawal
- S. Agrawal is assistant professor, Department of Psychiatry, University of Toronto, and psychiatrist, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-2007-7289
| | - Gina Nicoll
- G. Nicoll is a research student, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rachel H Carr
- R.H. Carr is a geriatric psychiatry subspecialty resident, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Rachel B Cooper
- R.B. Cooper is an independent researcher, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0001-5368-8927
| | - Mark Fefergrad
- M. Fefergrad is associate professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Mark D Hanson
- M.D. Hanson is child and adolescent psychiatrist, Hospital for Sick Children, and professor, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-0820-4521
| | - Lauren Munro
- L. Munro is a limited-term faculty member, Toronto Metropolitan University, Toronto, Ontario, Canada, and a PhD candidate, Wilfrid Laurier University, Waterloo, Ontario, Canada
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Plasse MJ, Peterson KS. Incorporating social justice learning into competency-based graduate nursing: A discussion of integrating pedagogies. J Prof Nurs 2023; 48:119-127. [PMID: 37775226 DOI: 10.1016/j.profnurs.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The impact of social inequity on the collective health of a society is well documented and, despite decades of research, the problem persists on a global scale. Nurse practitioners are competent to treat the downstream health effects of social inequity, but nursing students may lack the structural awareness to accurately target primary prevention efforts. OBJECTIVE The authors discuss faculty preparation and pedagogical considerations when incorporating social justice learning into a graduate and post-graduate psychiatric nurse practitioner course. DESIGN/METHODS Guided by Walter's Emancipatory Nursing Praxis model, several pedagogical strategies were developed to enhance graduate nursing students' awareness of oppressive and unjust realities in the healthcare setting. CONCLUSION Emancipatory pedagogical strategies in competency-based graduate nursing education can enhance the transformative social learning essential for the development of health equity praxis.
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Affiliation(s)
- Mechelle J Plasse
- UMass Chan Medical School Tan Chingfen Graduate School of Nursing, S1-853, UMass Chan Medical School, 55 Lake Avenue, North, Worcester, MA 01655, USA.
| | - Kenneth S Peterson
- UMass Chan Medical School Tan Chingfen Graduate School of Nursing, S1-853, UMass Chan Medical School, 55 Lake Avenue, North, Worcester, MA 01655, USA.
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Burcheri A, Coutin A, Bigham BL, Kruse MI, Lien K, Lim R, MacCormick H, Morris J, Ng V, Primiani N, Odorizzi S, Poirier V, Upadhye S, Primavesi R. Exploring a case for education about sexual and gender minorities in postgraduate emergency medicine training: forming recommendations for change. Postgrad Med 2023; 135:623-632. [PMID: 37310186 DOI: 10.1080/00325481.2023.2225329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/12/2023] [Indexed: 06/14/2023]
Abstract
Social medicine and health advocacy curricula are known to be uncommon in postgraduate medical education. As justice movements work to unveil the systemic barriers experienced by sexual and gender minority (SGM) populations, it is imperative that the emergency medicine (EM) community progress in its efforts to provide equitable, accessible, and competent care for these vulnerable groups. Given the paucity of literature on this subject in the context of EM in Canada, this commentary borrows evidence from other specialties across North America. Trainees across specialties and of all stages are caring for an increasing number of SGM patients. Lack of education at all levels of training is identified as a significant barrier to adequately caring for these populations, thereby precipitating significant health disparities. Cultural competency is often mistakenly attributed to a willingness to treat rather than the provision of quality care. However, positive attitudes do not necessarily correlate with trainee knowledge. Barriers to creating and implementing culturally competent curricula are plentiful, yet facilitating policies and resources are rare. While international bodies continuously publish position statements and calls to action, concrete change is seldom made. The scarcity of SGM curricula can be attributed to the universal absence of formal acknowledgment of SGM health as a required competency by accreditation boards and professional membership associations. This commentary synthesizes hand-picked literature in an attempt to inform healthcare professionals on their journey toward developing culturally competent postgraduate medical education. By thematically organizing evidence into a stepwise approach, the goal of this article is to borrow ideas across medical and surgical specialties to inform the creation of recommendations and make a case for an SGM curriculum for EM programs in Canada.
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Affiliation(s)
- Adam Burcheri
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Alexandre Coutin
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Blair L Bigham
- Department of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Michael I Kruse
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Kelly Lien
- Departments of Emergency Medicine and Family Medicine, Western University, London, ON, Canada
| | - Rodrick Lim
- Department of Pediatrics and Medicine, Western University, London, ON, Canada
| | - Hilary MacCormick
- Departments of Anesthesia, Pain Management, & Perioperative Medicine, Women's & Obstetric Anesthesia, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Judy Morris
- Departments of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, QC, Canada
| | - Victor Ng
- Division of Emergency Medicine, Western University, London, ON, Canada
| | - Nadia Primiani
- Department of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Scott Odorizzi
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Vincent Poirier
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada
| | - Suneel Upadhye
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Robert Primavesi
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada
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Huang JY. Complexity Epidemiology in Practice: A Tale of Two Simplicities. Epidemiology 2023; 34:515-519. [PMID: 37042975 DOI: 10.1097/ede.0000000000001623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Affiliation(s)
- Jonathan Yinhao Huang
- From the Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology, and Research (A*STAR), Singapore, Singapore
- Center for Quantitative Medicine (CQM), Duke-NUS Medical School, Singapore, Singapore
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Kaplan TB, Doughty C, Budhu J. Incorporating health equity in the neurology curriculum: Our experience. J Neurol Sci 2023; 449:120665. [PMID: 37146543 DOI: 10.1016/j.jns.2023.120665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Social determinants of health (SDoH) are responsible for 80-90% of modifiable contributors to health, yet this material may not be covered in preclinical medical school neuroscience courses. OBJECTIVE To describe how topics related to SDoH and inclusion, diversity, equity, anti-racism, and social justice (IDEAS) were incorporated into a preclinical neuroscience course. METHODS IDEAS concepts and guided discussions were added to our existing case-based curriculum, and guest speakers were invited to discuss how these concepts are relevant in the field of neurology. RESULTS Most students felt that content and discussions were integrated thoughtfully. Students also found it helpful to learn and observe how faculty address these topics in real-world cases. CONCLUSION The additional content related to SDoH and IDEAS is feasible. Faculty with or without expertise in IDEAS concepts were able to utilize these cases and generate discussion without detracting from the neuroscience course material.
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Affiliation(s)
- T B Kaplan
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - C Doughty
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - J Budhu
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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Hausmann LR, Lamorte C, Estock JL. Understanding the Context for Incorporating Equity into Quality Improvement Throughout a National Health Care System. Health Equity 2023; 7:312-320. [PMID: 37284535 PMCID: PMC10240324 DOI: 10.1089/heq.2023.0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 06/08/2023] Open
Abstract
Purpose Although health care systems aspire to deliver equitable care, practical tools that empower the health care workforce to weave equity throughout quality improvement (QI) processes are lacking. In this article, we report findings from context of use interviews that informed the development of a user-centered tool to support equity-focused QI. Methods Semistructured interviews were conducted from February to April of 2019. Participants included 14 medical center administrators, departmental or service line leaders, and clinical staff involved in direct patient care from three Veterans Affairs (VA) Medical Centers within a single region. Interviews covered existing practices for monitoring health care quality (i.e., priorities, tasks, workflow, and resources) and explored how equity data might fit into current processes. Themes extracted through rapid qualitative analysis were used to draft initial functional requirements for a tool to support equity-focused QI. Results Although the potential value of examining disparities in health care quality was clearly recognized, the data necessary for examining disparities were lacking for most quality measures. Interviewees also desired guidance on how inequities could be addressed through QI. The ways in which QI initiatives were selected, carried out, and supported also had important design implications for tools to support equity-focused QI. Discussion The themes identified in this work guided the development of a national VA Primary Care Equity Dashboard to support equity-focused QI within VA. Understanding the ways in which QI was carried out across multiple levels of the organization provided a successful foundation upon which to build functional tools to support thoughtful engagement around equity in clinical settings.
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Affiliation(s)
- Leslie R.M. Hausmann
- Center for Health Equity Research and Promotion (CHERP), Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Carolyn Lamorte
- Center for Health Equity Research and Promotion (CHERP), Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Jamie L. Estock
- Center for Health Equity Research and Promotion (CHERP), Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Durham Walker C, McCray GG, Wimes A, Levine D, Rivers D. Training Medical Students to Recognize, Understand, and Mitigate the Impact of Racism in a Service-Learning Course. Prev Chronic Dis 2023; 20:E41. [PMID: 37200501 DOI: 10.5888/pcd20.220367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
The Morehouse School of Medicine's Community Health Course (CHC) trains first-year medical students to work with people of racial and ethnic minorities and economically and medically disadvantaged communities. This service-learning course includes the diagnosis/assessment of the health of a community and the development, implementation, and evaluation of a plan to improve some aspect of the community's health. The CHC teaches about the impact of racism on the health of communities through lectures, educational games, and videos focused on social determinants of health, cultural competence, and effective community engagement. Students complete small group assessments, interventions, and service activities at assigned sites. This pedagogical approach integrates the Association of Medical Colleges' Diversity, Equity, and Inclusion competencies and engages many community partners. The course's strengths include a multidisciplinary faculty, a culturally and educationally diverse student body, and community partners with varied backgrounds and resources. Opportunities exist for collaborations with other degree programs to sustain and increase the impact of community interventions and link this community-based educational activity to clinical training years. Course evaluations, exams, and short essays assess students' awareness of racism and the extent to which unconscious bias affects students' completion and interpretation of community assessment data and their engagement with community partners.
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Affiliation(s)
- Carla Durham Walker
- Morehouse School of Medicine, Department of Community Health and Preventive Medicine, 720 Westview Drive, Atlanta, GA 30310-1495
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Centeno JG, Obler LK, Collins L, Wallace G, Fleming VB, Guendouzi J. Focusing Our Attention on Socially Responsive Professional Education to Serve Ethnogeriatric Populations With Neurogenic Communication Disorders in the United States. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-11. [PMID: 37099740 DOI: 10.1044/2023_ajslp-22-00325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
PURPOSE This viewpoint discusses a plausible framework to educate future speech-language pathologists (SLPs) as socially responsive practitioners who serve and advocate for the burgeoning vulnerable ethnogeriatric populations with neurogenic communication disorders. METHOD We provide an overview of the demographic, epidemiological, and biopsychosocial context that supports the implementation of equity-based, population-grounded educational approaches for speech-language pathology services in ethnogeriatric neurorehabilitation caseloads and discuss a plausible perspective based on the educational social determinants of health (SDOH) framework by the National Academies of Sciences, Engineering, and Medicine. RESULTS The NASEM's three-domain SDOH educational perspective integrates education, community, and organization to create a self-reinforcing pedagogical coproduction that, grounded in the synergized partnerships of educational institutions, engaged communities, and organizational leadership, aims to address systemic drivers of health perpetuating ethnoracial disparities in health, care, and outcomes. CONCLUSION Exponentially growing vulnerable ethnogeriatric populations with age-related neurogenic communication disorders warrant the implementation of health equity education strategies to train technically prepared, socially conscious SLPs as service providers and advocates.
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Affiliation(s)
- José G Centeno
- Department of Rehabilitation and Movement Sciences, Rutgers School of Health Professions, Newark, NJ
| | - Loraine K Obler
- Department of Speech-Language-Hearing Sciences, City University of New York, New York
| | - Linda Collins
- Department of Health and Human Sciences, Southeastern Louisiana University, Hammond
| | - Gloriajean Wallace
- Department of Communication Sciences and Disorders, Chapman University, Irvine, CA
| | - Valarie B Fleming
- Department of Communication Disorders, Texas State University, San Marcos
| | - Jacqueline Guendouzi
- Department of Health and Human Sciences, Southeastern Louisiana University, Hammond
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Sagalowsky ST, Rudinsky SL, Gray JM, Edgar L. What to know about 2.0: Revisions to the pediatric emergency medicine milestones. AEM EDUCATION AND TRAINING 2023; 7:e10865. [PMID: 37064491 PMCID: PMC10090486 DOI: 10.1002/aet2.10865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/01/2023] [Indexed: 06/19/2023]
Abstract
Introduction The Accreditation Council for Graduate Medical Education (ACGME) adopted educational milestones for trainee assessment in 2013, as a key component of the Next Accreditation System. Two years later, the ACGME, American Board of Pediatrics (ABP), and American Board of Emergency Medicine (ABEM) collaborated to create specialty-specific subcompetencies in pediatric emergency medicine (PEM). Since that time, emerging data have demonstrated the need to revise specialty milestones. Consequently, the ACGME summoned a working group to revise the original PEM milestones. Methods The PEM Milestones 2.0 Working Group convened in April 2021, comprising diverse representation from ACGME staff, PEM and EM attendings, PEM fellowship program directors, PEM fellows, and community members, overseen by the ACGME's vice president for milestones development. The group met virtually six times over 3 months, with concurrent independent and subgroup work, to draft the PEM Milestones 2.0 and supplemental guide. Results The working group's revisions generated concise descriptions of behavioral anchors to define skill acquisition more accurately; attention to the transition from residency to fellowship training; incorporation of harmonized milestones for non-patient care and non-medical knowledge domains; and increased emphasis on diversity, equity, and inclusion. A supplemental guide was also designed to aid programs in designing programmatic assessment related to specialty-specific milestones. Conclusions The PEM Milestones 2.0 provide an updated, specialty-specific framework to guide the development and assessment of PEM fellows and training programs. Future work may focus on faculty and learner development, advancing validity evidence, strengthening content expertise, and integrating milestones with specialty-specific entrustable professional activities.
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Affiliation(s)
- Selin T. Sagalowsky
- Department of Emergency MedicineNew York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Sherri L. Rudinsky
- Military and Emergency MedicineUniformed Services UniversityBethesdaMarylandUSA
| | - James M. Gray
- Department of PediatricsUniversity of CincinnatiCincinnatiOhioUSA
- Division of Emergency MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Laura Edgar
- Accreditation Council for Graduate Medical EducationChicagoIllinoisUSA
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Brown EA, Kinder H, Stang G, Shumpert W. Using adult learning characteristics and the humanities to teach undergraduate healthcare students about social determinants of health. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2023; 10:114. [PMID: 36969313 PMCID: PMC10024284 DOI: 10.1057/s41599-023-01599-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
Authors used an andragogy framework to help undergraduate allied health students better understand social determinants of health (SDOH) using a photo essay assignment. The study examined students' perceptions of SDOH in various communities, description of health outcomes associated with their chosen SDOH, and lessons learned and suggestions to improve the assignment for future cohorts. Data were extracted from photo essays from 2019-2021 and entered in Microsoft Excel and Word for data analysis after course completion. Conventional qualitative content analysis was used to analyze student evaluation data from open-ended questions. Data were extracted from 53 student essays from 2019 to 2021. Most photo essays described communities in South Carolina (n = 42, 79.2%), urban areas (n = 37, 69.8%), or intermediary SDOH (75.5%). Several themes emerged concerning lessons learned (awareness and empathy are key to addressing SDOH), health equity (collaboration is necessary to provide resources, especially for underserved populations), and constructive feedback for the instructor (more time to discuss SDOH and assignment with peers and instructor). Faculty must work with students to think about more upstream factors like policy and cultural and societal values. Collecting evaluation data, specifically lessons learned and constructive feedback for faculty, can help faculty continuously improve course topics and assignments. Following a transparency framework can support student success and help faculty become effective leaders in the classroom while teaching subjects like SDOH and social justice.
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Affiliation(s)
- Elizabeth A. Brown
- Old Dominion University, Norfolk, VA USA
- Medical University of South Carolina (MUSC), Charleston, SC USA
| | - Hannah Kinder
- Medical University of South Carolina (MUSC), Charleston, SC USA
| | - Garrett Stang
- Medical University of South Carolina (MUSC), Charleston, SC USA
| | - Wendy Shumpert
- Medical University of South Carolina (MUSC), Charleston, SC USA
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McGowan DA, Mather C, Stirling C. Use of Social Determinants of Health Screening among Primary Health Care Nurses of Developed Countries: An Integrative Review. NURSING REPORTS 2023; 13:194-213. [PMID: 36810271 PMCID: PMC9944459 DOI: 10.3390/nursrep13010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
The aims of the study are to evaluate and synthesise research that has investigated social determinants of health screening by primary healthcare nurses; how and when primary health care nurses perform social determinants of health screening; and implications for advancing nursing practice. Systematic searches in electronic databases identified fifteen published studies which met the inclusion criteria. Studies were synthesised using reflexive thematic analysis. This review found little evidence of primary health care nurses using standardised social determinants of health screening tools. Eleven subthemes were identified and collapsed into three main themes: organisation and health system supports are required to enable primary health care nurses; primary health care nurses are often reluctant to perform social determinants of health screening; and the importance of interpersonal relationships for social determinants of health screening. The social determinants of health screening practices of primary health care nurses are poorly defined and understood. Evidence suggests that primary health care nurses are not routinely using standardised screening tools or other objective methods. Recommendations are made for valuing therapeutic relationships, social determinants of health education and the promotion of screening by health systems and professional bodies. Overall, further research examining the best social determinant of health screening method is required.
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Affiliation(s)
- Deirdre A. McGowan
- School of Nursing, College of Health and Medicine, University of Tasmania, Glebe, TAS 7000, Australia
- Correspondence:
| | - Carey Mather
- Australian Institute of Health Services Management, College of Business and Economics, University of Tasmania, Launceston, TAS 7250, Australia
| | - Christine Stirling
- School of Nursing, College of Health and Medicine, University of Tasmania, Glebe, TAS 7000, Australia
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George RE, Brown MEL. Understanding integrated care through patient journeys. CLINICAL TEACHER 2023:e13561. [PMID: 36717203 DOI: 10.1111/tct.13561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/06/2023] [Indexed: 02/01/2023]
Affiliation(s)
- Riya E George
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Megan E L Brown
- University of Buckingham & Research Fellow at Medical Education Innovation and Research Centre, Imperial College London, London, UK
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Kelly I. A Response to "Integration of Case-Based Dialogue to Enhance Medical Students' Understanding of Using Health Communication to Address Social Determinants of Health" [Letter]. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:371-372. [PMID: 37077877 PMCID: PMC10108877 DOI: 10.2147/amep.s413413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/09/2023] [Indexed: 05/03/2023]
Affiliation(s)
- Isabelle Kelly
- UCL Medical School, University College London, London, UK
- Correspondence: Isabelle Kelly, UCL Medical School, University College London, London, UK, Tel +447807482907, Email
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Szoko N, Ragunanthan B, Radovic A, Garrison JL, Torres O. Antiracist Curriculum Implementation for Pediatric Residents. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231162986. [PMID: 37123077 PMCID: PMC10134181 DOI: 10.1177/23821205231162986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Objectives Racism has been recognized as a public health crisis, with calls for greater focus on antiracism in medical training. We sought to evaluate a longitudinal antiracist curriculum among pediatric residents. Methods In 2020-2021, we delivered seven educational sessions to pediatric trainees in a single residency program. We administered pre-/post-surveys to assess changes in awareness of structural racism, knowledge of health inequities, antiracist clinical skills, and individual/institutional advocacy behaviors. Awareness was measured with 27 Likert-type items spanning five conceptual domains (schools, healthcare, justice system, employment, and housing/transportation). We evaluated knowledge with 18 true/false or multiple-choice questions. Participants indicated comfort with clinical skills using 13 Likert-type items drawn from national toolkits and policy statements. Individual/institutional advocacy behaviors were measured with 14 items from the Antiracism Behavioral Inventory. McNemar or paired Wilcoxon signed-rank tests compared measures before and after implementation. Results Out of 121 residents, 79 (65%) completed pre-surveys, 47 (39%) completed post-surveys, and 37 (31%) were eligible for matching across responses. 78% of respondents were female and 68% identified as White. We found significant increases in awareness across several conceptual domains (schools: p = 0.03; healthcare: p = 0.004; employment: p = 0.003; housing/transportation: p = 0.02). Mean knowledge score increased after implementation (p = 0.03). Self-reported clinical skills improved significantly (p < 0.001). Individual advocacy behaviors increased (p < 0.001); there were no changes in institutional advocacy. Conclusion We demonstrate improvements in several educational constructs with a novel antiracist curriculum. Efforts to scale and sustain this work are ongoing, and additional teaching and evaluation methodologies may be incorporated in the future.
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Affiliation(s)
- Nicholas Szoko
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Nicholas Szoko, Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, 120 Lytton Avenue, Second Floor, Pittsburgh PA, 15213, USA.
| | | | - Ana Radovic
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica L. Garrison
- Division of Pediatric Hospital Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Orquidia Torres
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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