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Morelli V. Social Determinants of Health: An Overview for the Primary Care Provider. Prim Care 2023; 50:507-525. [PMID: 37866828 DOI: 10.1016/j.pop.2023.04.004] [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] [Indexed: 10/24/2023]
Abstract
Social determinants of health (SDoH) are reflected in how people live (access to health care, economic stability, built environment, food security, climate), learn (the educational environment), work (occupational environment), and play/socialize (social context and digital domain). All of these day-to-day conditions play a vital role in a patient's overall health, and a primary care provider should be prepared to understand their role to screen, assess, and address SDoH in clinical practice.
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Affiliation(s)
- Vincent Morelli
- Department of Family & Community Medicine, Meharry Medical College, 3rd Floor, Old Hospital Building, 1005 Dr. D. B. Todd, Jr., Boulevard, Nashville, TN 37208-3599, USA.
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Manstein SM, Laikhter E, Kazei DD, Comer CD, Shiah E, Lin SJ. The Upcoming Pass/Fail USMLE Step 1 Score Reporting: An Impact Assessment From Medical School Deans. Plast Surg (Oakv) 2023; 31:169-176. [PMID: 37188137 PMCID: PMC10170630 DOI: 10.1177/22925503211034838] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/22/2021] [Indexed: 11/15/2022] Open
Abstract
Background: The US Medical Licensing Examination (USMLE) Step 1 change to pass/fail has been met with mixed reviews, and the impact on medical student education and residency match is unknown. We surveyed medical school student affairs deans regarding their thoughts on the upcoming transition of Step 1 to pass/fail. Methods: A questionnaire was emailed to medical school deans. Deans were asked to rank the importance of the following after the Step 1 reporting change: Step 2 Clinical Knowledge (Step 2 CK), clerkship grades, letters of recommendation, personal statement, medical school reputation, class rank, Medical Student Performance Evaluation, and research. They were asked how the score change will affect curriculum, learning, diversity, and student mental health. Deans were asked to select 5 specialties they thought would be most affected. Results: Regarding perceived importance of residency applications following the scoring change, the most frequent number 1 choice was Step 2 CK. The majority of deans (93.5%, n = 43) felt that the change to pass/fail would benefit medical student education/learning environment; however, most (68.2%, n = 30) did not believe their school curriculum would change. Students applying to dermatology, neurosurgery, orthopedic surgery, ENT, and plastic surgery were felt to be most affected by the scoring change; 58.7% (n = 27) felt it would not adequately address future diversity. Conclusion: The majority of deans feel the USMLE Step 1 change to pass/fail would benefit medical student education. Deans feel that students applying to traditionally more competitive specialties (ie, programs with fewer overall residency positions available) will be most affected.
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Affiliation(s)
- Samuel M. Manstein
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elizabeth Laikhter
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Carly D. Comer
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Eric Shiah
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samuel J. Lin
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Draper JK, Feltner C, Vander Schaaf EB, Mieses Malchuk A. Preparing Medical Students to Address Health Disparities Through Longitudinally Integrated Social Justice Curricula: A Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1226-1235. [PMID: 35476779 DOI: 10.1097/acm.0000000000004718] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The education of health care professionals is a contributing factor to persistent health disparities. Although medical students are expected to understand racism, classism, and other social and structural drivers of health (SDH), standardization and best practices for teaching these concepts are lacking. Some medical schools are adopting social justice curricula (SJC) that prioritize health equity in teaching students to recognize SDH and preparing them to address the consequent health disparities. This systematic review sought to evaluate how these schools have integrated SJC into their core teaching; the criteria they have used to measure success and to what extent these criteria are met; and best practices in planning, implementing, and evaluating SJC. METHOD The authors searched 7 databases for English-language studies published between January 2000 and April 2020, reporting on longitudinally integrated SJC at U.S. medical schools intended for all students. Quantitative and qualitative outcomes were synthesized and summarized. RESULTS Searches identified 3,137 articles, of which 11 met inclusion criteria. Results demonstrated schools use a variety of teaching methods over a wide range of didactic hours to teach SJC concepts. Surveys and objective tests indicated students in SJC are generally satisfied and demonstrated improved knowledge and skills related to understanding and mitigating SDH, although findings related to changes in attitudes were equivocal. Evaluations at graduation and in residency demonstrated students who experience SJC are more prepared than their peers to work with patients who are underserved. Best practices in SJC included addressing the hidden curriculum, considering medical mistrust, and using tools like the Racial Justice Report Card and Tool for Assessing Cultural Competence Training. CONCLUSIONS These findings indicated SJC can prepare students to better address the root causes of health disparities. Future research should consider the long-term influences of these curricula on students, patients, and the community.
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Affiliation(s)
- Julia K Draper
- J.K. Draper is a family medicine resident, Mountain Area Health Education Center, Asheville, North Carolina; ORCID: https://orcid.org/0000-0003-3355-8054
| | - Cynthia Feltner
- C. Feltner is assistant professor, Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0002-4773-2570
| | - Emily B Vander Schaaf
- E.B. Vander Schaaf is assistant professor, Division of General Pediatrics and Adolescent Medicine, UNC School of Medicine, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0002-1408-7413
| | - Alexa Mieses Malchuk
- A. Mieses Malchuk is assistant professor, Department of Family Medicine, UNC School of Medicine, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0002-9979-7253
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Murray PM, Sepulveda A, Baird J. Longitudinal impact of a poverty simulation on healthcare practitioners' attitudes towards poverty. J Pediatr Nurs 2022; 64:24-30. [PMID: 35131716 DOI: 10.1016/j.pedn.2022.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Many clinicians have limited knowledge about the challenges of living in poverty, leading to stigma and differential treatment in healthcare settings. A poverty simulation event may help clinicians gain empathy and knowledge about the ways that poverty impacts health and well-being. PURPOSE This study evaluated the impact of a poverty simulation and the effect of personal characteristics on clinicians' attitudes towards poverty. METHODS Using a prospective longitudinal mixed-methods study design, a convenience sampling of clinicians from a freestanding children's hospital was recruited to participate in a poverty simulation event. The 21-item Attitudes Towards Poverty (ATP) tool was administered pre- and post-simulation and at 3 follow-up time points. Multiple linear regression analysis and linear mixed effects models were used to analyze ATP data. Qualitative data were analyzed to identify broad themes. RESULTS Mean scores in the ATP domains of stigma and structural perspective increased post-simulation, but only stigma scores demonstrated sustained improvement. Scores in the personal deficiency domain remained unchanged. Being male, White, and having Liberal political views were associated with lower ATP scores in our data. Qualitative data show participants felt the simulation generated feelings of compassion and empathy. DISCUSSION Simulation participation improved ATP scores in two domains immediately post-event, suggesting the simulation positively impacted clinicians' attitudes towards poverty. Follow-up data suggest the impact of the simulation may be temporary. TRANSLATION TO HEALTH EDUCATION PRACTICE Experiential learning activities, like poverty simulations, help foster awareness and empathy among clinicians but may not have long-term impact. Ongoing education is needed to create a workforce sensitized and equipped to care for families from all backgrounds.
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Affiliation(s)
- Paula M Murray
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, USA
| | - Aviril Sepulveda
- Division of Rehabilitation Medicine, Children's Hospital Los Angeles, Los Angeles, USA
| | - Jennifer Baird
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, USA.
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Klein M, Hanson E, Lichtenstein C, Mogilner L, Falusi O, Tolliver DG, Lungelow L, Chamberlain L. Poverty Related Education in Pediatrics: Current State, Gaps and Call to Action. Acad Pediatr 2021; 21:S177-S183. [PMID: 34740426 DOI: 10.1016/j.acap.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/27/2021] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
Children are the poorest age group in our country, with 1 in 6, or 12 million, living in poverty. This sobering statistic became even more appalling in spring 2020 when COVID-19 magnified existing inequities. These inequities are particularly important to pediatricians, because poverty, along with racism and other interrelated social factors, significantly impact overall child health and well-being. It is imperative that pediatric educators redouble their efforts to train learners to recognize and address health inequities related to poverty and all of its counterparts. In this paper, we describe the current state of poverty-related training in pediatric undergraduate, graduate, and continuing medical education as well as opportunities for growth. We highlight gaps in the current curricula, particularly around the intersectionality between poverty and racism, as well as the need for robust evaluation. Using a logic model framework, we outline content, learning strategies, and outcomes for poverty-related education. We include opportunities for the deployment of best practice learning strategies and the incorporation of newer technologies to deliver the content. We assert that collaboration with community partners is critical to shape the depth and breadth of education. Finally, we emphasize the paramount need for high-quality faculty development and accessible career paths to create the cadre of role models and mentors necessary to lead this work. We conclude with a call for collaboration between institutions, accrediting bodies, and policymakers to promote meaningful, outcome-oriented, poverty-related education, and training throughout the medical education continuum.
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Affiliation(s)
- Melissa Klein
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine (M Klein), Cincinnati, Ohio.
| | - Elizabeth Hanson
- Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio (E Hanson), San Antonio, Tex
| | - Cara Lichtenstein
- The George Washington University School of Medicine and Health Sciences, Children's National Hospital (C Lichtenstein), Washington, DC
| | - Leora Mogilner
- Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital (L Mogilner), New York, NY
| | - Olanrewaju Falusi
- The George Washington University School of Medicine and Health Sciences, Children's National Hospital (O Falusi), Washington, DC
| | - Destiny G Tolliver
- Yale National Clinician Scholars Program, Yale School of Medicine (DG Tolliver), New Haven, Conn
| | - Lisha Lungelow
- Cincinnati Children's Hospital Medical Center (L Lungelow), Cincinnati, Ohio
| | - Lisa Chamberlain
- Stanford University School of Medicine (L Chamberlain), Stanford, Calif
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Sagi D, Spitzer-Shohat S, Schuster M, Rier D, Rudolf MCJ. Learning social determinants of health through a home visiting course in the clinical years. PATIENT EDUCATION AND COUNSELING 2020; 103:2335-2341. [PMID: 32423836 DOI: 10.1016/j.pec.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/02/2020] [Accepted: 05/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the impact of a new experience-based educational program aiming to teach social determinants of health (SDH) and health disparities, through a post-discharge home-visit conducted with patients recruited in hospital. METHODS 105 clinical-year students visited 177 patients living in disadvantaged circumstances. Their home-visit reports were analyzed employing mixed methodology. Content analysis was conducted for classifying issues raised by students, and quantitative analysis to compare reports by level of elaboration, gender and class. RESULTS Fifteen taxonomy items were identified. Social support and patients' medical conditions were most prevalent, followed by personal-related and community-related issues. Analysis demonstrated students' understanding of the relationship between SDH and patient health, and challenges patients face following discharge. Women and mixed couples provided more elaborate reports, which contained significantly greater critique of medical care. CONCLUSIONS Meeting patients both in hospital and at home enhanced awareness of SDH. Students learned to view the patient comprehensively, and to understand the diverse factors affecting their health. Students, who had essentially sole responsibility for the home-visit, successfully integrated their skills to take action when needed. PRACTICE IMPLICATIONS The ETGAR experience provided a means for effective learning about how social determinants impact on health.
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Affiliation(s)
- Doron Sagi
- Department of Population Health, Azrieli Faculty of Medicine, Bar-Ilan University, Israel; MSR- The Israel Center for Medical Simulation, Israel.
| | - Sivan Spitzer-Shohat
- Department of Population Health, Azrieli Faculty of Medicine, Bar-Ilan University, Israel; Center for Health and the Social Sciences, University of Chicago, United States
| | - Michal Schuster
- Faculty of hummanities, University of the Free State, South Africa
| | - David Rier
- Department of Sociology & Anthropology, Bar-Ilan University, Israel
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Loyola AB, Palileo-Villanueva LM. A Role-Playing Activity for Medical Students Demonstrates Economic Factors Affecting Health in Underprivileged Communities. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:637-644. [PMID: 32982536 PMCID: PMC7489936 DOI: 10.2147/amep.s259032] [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] [Received: 04/25/2020] [Accepted: 08/03/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Innovative teaching-learning strategies are necessary to promote community orientation and foster awareness of the social determinants of health among millennial learners in the health professions. METHODS The authors designed a role-playing simulation activity that aims to highlight the multidimensional nature of health and develop in students an appreciation of the day-to-day experiences of underserved populations. The current investigation aimed to evaluate the utility of the role-playing activity and guided reflection in terms of the students' appreciation of economic factors that affect health and health-seeking behavior of patients and their recognition of the role of healthcare professionals with respect to issues related to poverty and health. Thematic analyses of the insights and observations of the students immediately after the activity and the anonymized reflection papers were done to identify recurring ideas that made an impression on them. RESULTS The students were able to identify that in a setting with limited employment opportunities and low-income potential, the residents prioritized food and shelter over everything else. They also chose cheaper products over healthier options. Practically everyone forewent out-of-pocket healthcare expenditure in order to minimize its disruptive consequences. In these settings, the students highlighted the role of society and government in the provision of services and in community development. The students also emphasized the necessity for competition among a number of providers of goods and services to reduce prices. When asked if healthcare professionals are contributing to the widening gap between rich and poor, 70% agreed, 9% disagreed, 14% did not give a direct answer, and 7% said that healthcare professionals contributed in some ways and alleviated in other ways. The most commonly cited behavior that contribute to this disparity are the decision to seek highly specialized training, the congregation of practitioners in highly urbanized centers, and inattention to the economic difficulties of most patients. Those who disagreed with the statement cited systemic problems as the driving force that widens the disparity. In particular, these students cited the commodification of healthcare and related services, inappropriate policies, and insufficient funding specifically for services and health human resources. CONCLUSION The evolving landscape in healthcare financing requires more preparation among our medical students and trainees. Innovative strategies such as role-playing activities and guided reflection are useful in demonstrating economic factors that influence health and promote better understanding of externalities that shape the health status of individuals and communities.
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Affiliation(s)
- Aldrin B Loyola
- Department of Medicine, College of Medicine, University of the Philippines – Manila, Manila, Philippines
| | - Lia M Palileo-Villanueva
- Department of Medicine, College of Medicine, University of the Philippines – Manila, Manila, Philippines
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Padmanaban V, Fallah P, Jayaraman S, Peck GL, Sifri Z. Integrating a Novel Global Surgery and Health Inequity Course to the Surgical Clerkship. JOURNAL OF SURGICAL EDUCATION 2020; 77:1106-1112. [PMID: 32534939 DOI: 10.1016/j.jsurg.2020.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Medical students report growing interest in health inequity and global surgery, subjects not currently integrated to their core curriculum. Currently, fundamental tenets of global surgical inequity are only available to students on an elective basis or in special interest groups. Therefore, an hour-long course with emphasis on global surgery was developed for third-year medical students. The aim of this study was to examine student response to this pilot course and to establish whether course content was applicable to clinical rotations. DESIGN A 1-hour structured curriculum was delivered to third-year medical students (MS3s) during the 2-day orientation phase of each rotation of an 8-week surgery clerkship from August 2018 to May 2019. The course targeted approximately 30 students per session in the preclinical orientation at Rutgers-New Jersey Medical School. Upon completion of the 8-week clerkship rotation, a paper survey was administered to evaluate student's exposure to previous content, attitudes toward global health, interest and engagement in course materials, and applicability of learned course content to local environments. SETTING Rutgers-New Jersey Medical School, an urban medical school located in Newark, New Jersey. PARTICIPANTS A total of 191 students attended the global surgery and health equity course; 146 participants participated in the postcourse survey. RESULTS When asked about baseline interest in global or public health, the majority (51%) were extremely interested or very interested. Nearly all participants found the course to be valuable (94%). When asked which educational modality was preferred, 23% of participants favored the traditional lecture component and 29% favored case-based discussions. Nearly half (48%) the respondents found both modalities to be valuable. Fifty students (34% of respondents) reported encounters with patients affected by barriers in access to surgical care during their clerkships. CONCLUSIONS Medical students responded favorably to this health inequity and global surgery pilot course and requested supplemental lectures. Additionally, course content was applicable to local clinical experiences. Therefore, 1 modality of integrating global surgery to the established curriculum is under the framework of health inequity and social determinants of health during surgical clerkships. This study demonstrates that meaningful inclusion of global surgery and health inequity can be implemented within the existing curricular structure.
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Affiliation(s)
- Vennila Padmanaban
- Department of Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey.
| | | | - Sudha Jayaraman
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Gregory L Peck
- Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Ziad Sifri
- Department of Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey
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Lax Y, Braganza S, Patel M. Three-Tiered Advocacy: Using a Longitudinal Curriculum to Teach Pediatric Residents Advocacy on an Individual, Community, and Legislative Level. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519859300. [PMID: 31312721 PMCID: PMC6614944 DOI: 10.1177/2382120519859300] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/30/2019] [Indexed: 05/02/2023]
Abstract
BACKGROUND Pediatricians play a critical role as health advocates. Teaching residents to advocate for their patients on an individual, community, and legislative level is a priority for residency training programs. This study examined the effects of a longitudinal curriculum teaching 3-tiered advocacy on pediatric residents' attitudes, knowledge, and practice. METHODS This was a prospective pre- and postintervention study using an anonymous survey of pediatric residents (N = 78) in an urban academic children's hospital. The survey assessed advocacy on an individual level through comfort and experience in discussing social determinants of health (SDH), on a community level through comfort and practice referring patients to community resources, and on a legislative level through comfort and practice with legislative advocacy. Descriptive statistics and chi-square tests were used to analyze the data. RESULTS Postimplementation, pediatric residents reported the curriculum changed their clinical practice (66%), encouraged them to take a more in-depth social history (46%), and helped them guide patients to more community resources (38%). Comfort in discussing SDH with patients in the ambulatory clinic increased (27% vs 76%; P = .001). Reported frequency in inquiring about SDH significantly improved in the following areas: income (39% vs 60%; P = .025), education (71% vs 93%; P = .008), and legal issues (13% vs 26%; P = .012). CONCLUSIONS Most of the residents reported that the curriculum changed their clinical practice. Residents reported knowledge and comfort with advocating for their patients on an individual level improved. However, there was no significant difference on the community or legislative level. This curriculum raised awareness and armed residents with practical skills to be health advocates on an individual level. Further research is needed to explore effective means of creating 3-tiered advocates.
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Affiliation(s)
- Yonit Lax
- Department of Pediatrics, Pediatric
Community Health, Maimonides Children’s Hospital, Brooklyn, NY, USA
- Yonit Lax, Pediatric Community Health,
Maimonides Children’s Hospital, 1301 57th Street, Brooklyn, NY 11219, USA.
| | - Sandra Braganza
- Social Pediatrics Program, Children’s
Hospital at Montefiore, Departments of Pediatrics and Family and Social Medicine,
Albert Einstein College of Medicine, Bronx, NY, USA
| | - Milani Patel
- Lincoln Community Health Center, Durham,
NC, USA
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Brooks EM, Magee ML, Ryan M. 'Fostering transformative learning, self-reflexivity and medical citizenship through guided tours of disadvantaged neighborhoods'. MEDICAL EDUCATION ONLINE 2018; 23:1537431. [PMID: 30384820 PMCID: PMC6225432 DOI: 10.1080/10872981.2018.1537431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/03/2018] [Accepted: 10/11/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Medical school curricula increasingly seek to promote medical students' commitment to redressing health disparities, but traditional pedagogical approaches have fallen short of this goal. The objective of this work was to assess the value of using community-based guided tours of disadvantaged neighborhoods to fill this gap. METHODS A total of 50 second-year medical students participated in a guided tour of disadvantaged public housing neighborhoods in Richmond, Virginia. Students completed self-reflexive writing exercises during a post-tour debriefing session. Student writings were analyzed to assess the tour's effect on their awareness of poverty's impact on vulnerable populations' health and wellbeing, and their personal reactions to the tour. RESULTS Student writings indicated that the activity fostered transformative learning experiences around the issue of poverty and its effects on health and stimulated a personal commitment to working with underserved populations. Themes from qualitative analysis included: increased awareness of the extent of poverty, enhanced self-reflexive attitude towards personal feelings, biases and misperceptions concerning the poor, increased intentional awareness of the effects of poverty on patient health and well-being, and, encouragement to pursue careers of medical service. CONCLUSIONS This pilot demonstrated that incorporating self-reflexive learning exercises into a brief community-based guided tour can enhance the social consciousness of medical students by deepening understandings of health disparities and promoting transformative learning experiences.
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Affiliation(s)
- E. Marshall Brooks
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Mary Lee Magee
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Mark Ryan
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, USA
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Lange BCL, Dáu ALBT, Goldblum J, Alfano J, Smith MV. A Mixed Methods Investigation of the Experience of Poverty Among a Population of Low-Income Parenting Women. Community Ment Health J 2017; 53:832-841. [PMID: 28168431 PMCID: PMC5599442 DOI: 10.1007/s10597-017-0093-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/09/2017] [Indexed: 11/26/2022]
Abstract
This study sought to operationalize poverty in the context of parenting specific to a sample of low-income mothers; to examine how mothers describe sources of stress related to poverty; and to explore how these experiences affect mothers' parenting practices. Mothers trained in research methods administered surveys to other mothers in community settings assessing parenting stressors, mental wellbeing, basic needs, and goals. Women reported difficulty obtaining basic needs. Qualitatively, women described financial hardship, housing, employment status, and transportation as sources of stress, which influenced their parenting practices. These findings connect a mother's inability to meet her basic needs with parenting quality, and suggest that programs promoting early childhood development through building the capacity of parents must focus on basic needs and strategies to alleviate poverty. Healthcare providers may be able to glean specific terminology utilized by women when they inquire about basic needs and form partnerships with basic needs providers.
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Affiliation(s)
- Brittany C L Lange
- Department of Social Policy and Intervention, Oxford University, Barnett House, 32 Wellington Square, Oxford, OX1 2ER, UK.
| | - Ana Luísa B T Dáu
- Child Study Center, Yale School of Medicine, 40 Temple Street, Suite #6B, New Haven, CT, USA
| | - Joanne Goldblum
- National Diaper Bank Network, 155 East Street, Suite 101, New Haven, CT, USA
| | - Janet Alfano
- The Diaper Bank, P.O. Box 9017, New Haven, CT, USA
| | - Megan V Smith
- Child Study Center, Yale School of Medicine, 40 Temple Street, Suite #6B, New Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
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Hu T, Cox KA, Nyhof-Young J. Investigating student perceptions at an interprofessional student-run free clinic serving marginalised populations. J Interprof Care 2017; 32:75-79. [PMID: 28956683 DOI: 10.1080/13561820.2017.1363724] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Many health profession schools have student-run free clinics (SRFCs), but their educational relevance has not been well studied. The aim of this study was to evaluate the learning experiences and skills developed among interprofessional healthcare students at an SRFC serving marginalised populations, in order to provide data for ongoing programme improvement and recommendations for other SRFCs based on lessons learned. Under 1:1 supervision with a preceptor, interprofessional students completed three clinical shifts at an SRFC and attended a reflection session. A total of 101 out of 105 participants answered semi-structured pre- and post-programme surveys (response rate: 96%). Descriptive statistics and descriptive thematic analyses were used for quantitative and qualitative data, respectively. Numerous skills derived from learning objectives common to many healthcare professions were addressed while participating at the SRFC. Valued programme elements included working with and learning about inner city populations in an interprofessional care model. Interprofessional SRFCs encourage student learning about resources for inner city populations and interprofessional collaboration while providing an opportunity to develop skills related to the formal curriculum. This may provide a workable strategy to address an interprofessional education gap in the healthcare professional curriculum.
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Affiliation(s)
- Tina Hu
- a Faculty of Medicine , University of Toronto , Toronto , Ontario , Canada
| | - Kelly Anne Cox
- a Faculty of Medicine , University of Toronto , Toronto , Ontario , Canada
| | - Joyce Nyhof-Young
- a Faculty of Medicine , University of Toronto , Toronto , Ontario , Canada.,b Office of Evaluations, Faculty of Medicine , University of Toronto , Toronto , Ontario , Canada.,c Centre for Ambulatory Care Education , Women's College Hospital , Toronto , Ontario , Canada
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Are We Missing the Mark? The Implementation of Community Based Participatory Education in Cancer Disparities Curriculum Development. J Racial Ethn Health Disparities 2016; 2:237-43. [PMID: 26085978 DOI: 10.1007/s40615-014-0072-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The Chicago south side, even more so than national populations, continues to be burdened with widening gaps of disparities in cancer outcomes. Therefore, Chicago community members were engaged in addressing the following content areas for a cancer disparities curriculum: (1) the south side Chicago community interest in participating in curriculum design, (2) how community members should be involved in designing cancer disparities curriculum, and (3) what community members believe the curriculum should address to positively impact their community. METHODS Eighty-six community members from 19 different zip code areas of Chicago attended the deliberative session. A survey composed of three quantitative and three short-answer content questions was analyzed. RESULTS The majority of participants were from the south side of Chicago (62 %) and females (86 %). Most, 94 %, believed community members should be involved in cancer disparities curriculum development. Moreover, 56 % wanted to be involved in designing the curriculum, and 61 % reported an interest in taking a course in cancer disparities. Three categorical themes were derived from the qualitative questions: (1) community empowerment through disparities education-"a prescription for change," (2) student skill development in community engagement and advocacy training, and (3) community expression of shared experiences in cancer health disparities. CONCLUSION The community provided valuable input for curricular content and has an interest in collaborating on cancer disparities curriculum design. Community participation must be galvanized to improve disparities curricular development and delivery to successfully address the challenges of eliminating disparities in health.
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Asgary R, Naderi R, Gaughran M, Sckell B. A collaborative clinical and population-based curriculum for medical students to address primary care needs of the homeless in New York City shelters : Teaching homeless healthcare to medical students. PERSPECTIVES ON MEDICAL EDUCATION 2016; 5:154-162. [PMID: 27277430 PMCID: PMC4908037 DOI: 10.1007/s40037-016-0270-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Background Millions of Americans experience homelessness annually. Medical providers do not receive adequate training in primary care of the homeless.Methods Starting in 2012, a comprehensive curriculum was offered to medical students during their family medicine or ambulatory clerkship, covering clinical, social and advocacy, population-based, and policy aspects. Students were taught to: elicit specific social history, explore health expectations, and assess barriers to healthcare; evaluate clinical conditions specific to the homeless and develop plans for care tailored toward patients' medical and social needs; collaborate with shelter staff and community organizations to improve disease management and engage in advocacy efforts. A mixed methods design was used to evaluate students' knowledge, attitudes, and skills including pre- and post-curriculum surveys, debriefing sessions, and observed clinical skills.Results The mean age of the students (n = 30) was 26.5 years; 55 % were female. The overall scores improved significantly in knowledge, attitude, and self-efficacy domains using paired t‑test (p < 0.01). Specific skills in evaluating mental health, substance abuse, and risky behaviours improved significantly (p < 0.05). In evaluation of communication skills, the majority were rated as having 'outstanding rapport with patients.'Conclusions Comprehensive and ongoing clinical component in shelter clinics, complementary teaching, experienced faculty, and working relationship and collaboration with community organizations were key elements.
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Affiliation(s)
- Ramin Asgary
- Department of Medicine, New York University School of Medicine, New York, USA.
- NYU Lutheran Family Health Centers, New York, NY, USA.
| | | | | | - Blanca Sckell
- NYU Lutheran Family Health Centers, New York, NY, USA
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Hudon C, Loignon C, Grabovschi C, Bush P, Lambert M, Goulet É, Boyer S, De Laat M, Fournier N. Medical education for equity in health: a participatory action research involving persons living in poverty and healthcare professionals. BMC MEDICAL EDUCATION 2016; 16:106. [PMID: 27066826 PMCID: PMC4828813 DOI: 10.1186/s12909-016-0630-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 04/06/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Improving the knowledge and competencies of healthcare professionals is crucial to better address the specific needs of persons living in poverty and avoid stigmatization. This study aimed to explore the needs and expectations of persons living in poverty and healthcare professionals in terms of medical training regarding poverty and its effects on health and healthcare. METHODS We conducted a participatory action research study using photovoice, a method using photography, together with merging of knowledge and practice, an approach promoting dialogue between different sources of knowledge. Nineteen healthcare professionals and persons from an international community organization against poverty participated in the study. The first phase included 60 meetings and group sessions to identify the perceived barriers between persons living in poverty and healthcare teams. In the second phase, sub-committees deployed action plans in academic teaching units to overcome barriers identified in the first phase. Data were analysed through thematic analysis, using NVivo, in collaboration with five non-academic co-researchers. RESULTS Four themes in regard to medical training were highlighted: improving medical students' and residents' knowledge on poverty and the living conditions of persons living in poverty; improving their understanding of the reality of those people; improving their relational skills pertaining to communication and interaction with persons living in poverty; improving their awareness and capacity for self-reflection. At the end of the second phase, actions were undertaken such as improving knowledge of the living conditions of persons living in poverty by posting social assistance rates, and tailoring interventions to patients' reality by including sociodemographic information in electronic medical records. Our findings also led to a participatory research project aiming to improve the skills and competency of residents and health professionals in regard to the quality of healthcare provided to persons living in poverty. CONCLUSIONS Medical training and residency programs should aim to improve students' and residents' relational skills, more specifically their communication skills, as well as their awareness and capacity for self-reflection, by helping them to identify and recognize their biases, and limitations.
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Affiliation(s)
- Catherine Hudon
- />Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001 12e avenue Nord, Sherbrooke, QC Canada
| | - Christine Loignon
- />Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001 12e avenue Nord, Sherbrooke, QC Canada
| | - Cristina Grabovschi
- />Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001 12e avenue Nord, Sherbrooke, QC Canada
| | - Paula Bush
- />Department of Family Medicine, McGill University, 5858 chemin de la Côte des Neiges, Montreal, QC Canada
| | - Mireille Lambert
- />Centre de santé et de services sociaux de Chicoutimi, 305 rue Saint-Vallier, Chicoutimi, QC Canada
| | - Émilie Goulet
- />Charles-LeMoyne Research Centre, 150 Place Charles-LeMoyne, Longueuil, QC Canada
| | - Sophie Boyer
- />ATD (All Together in Dignity) Fourth World Movement, an international community organization against poverty, 6747 rue Drolet, Montreal, QC Canada
| | - Marianne De Laat
- />ATD (All Together in Dignity) Fourth World Movement, an international community organization against poverty, 6747 rue Drolet, Montreal, QC Canada
| | - Nathalie Fournier
- />Academic Primary Care Unit Charles-LeMoyne, 299 boulevard Sir-Wilfrid-Laurier, Saint-Lambert, QC Canada
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Girotti JA, Loy GL, Michel JL, Henderson VA. The Urban Medicine Program: Developing Physician-Leaders to Serve Underserved Urban Communities. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:1658-1666. [PMID: 26488566 DOI: 10.1097/acm.0000000000000970] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Medical school graduates are poorly prepared to address health care inequities found in urban, underserved communities. The University of Illinois College of Medicine developed the Urban Medicine Program (UMed) to prepare students for the roles of advocate, researcher, policy maker, and culturally competent practitioner through a four-year curriculum integrating principles of public health with direct interventions in local, underserved communities. This study assessed the program's effectiveness and evaluated early outcomes. METHOD The authors analyzed data for UMed students (graduating classes 2009-2013) from pre- and postseminar assessments and longitudinal community project progress reports. They also compared UMed and non-UMed outcomes from the same classes, using graduation data and data from two surveys: Medical Students' Attitudes Toward the Underserved (MSATU) and the Intercultural/Professional Assessment. RESULTS UMed students were more likely than non-UMed students to endorse MSATU constructs ("Universal medical care is a right" [P = .01], "Access to basic medical care is a right" [P = .03], "Access is influenced by social determinants" [P = .03]); to be selected for the Gold Humanism Honor Society (P < .0001); to complete joint degrees (P < .0001); and to enter primary care residencies (P = .002). CONCLUSIONS Early outcomes reveal that a longitudinal, experiential curriculum can provide students with competencies that may prepare them for leadership roles in advocacy, research, and policy making. Contact with diverse communities inculcates-in medical students with predispositions toward helping underserved populations-the self-efficacy and skills to positively influence underserved, urban communities.
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Affiliation(s)
- Jorge A Girotti
- J.A. Girotti is assistant professor, Department of Medical Education, and associate dean, Admissions and Special Curricular Programs, University of Illinois College of Medicine at Chicago, Chicago, Illinois. G.L. Loy is professor, Department of Obstetrics and Gynecology, Rush Medical College, Chicago, Illinois. J.L. Michel is adjunct assistant professor of medical education and associate director, Urban Medicine Program, University of Illinois College of Medicine at Chicago, Chicago, Illinois. V.A. Henderson is a doctoral student, Division of Community Health Sciences, School of Public Health, University of Illinois, Chicago, Illinois
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Kulkarni A, Francis ER, Clark T, Goodsmith N, Fein O. How we developed a locally focused Global Health Clinical Preceptorship at Weill Cornell Medical College. MEDICAL TEACHER 2014; 36:573-7. [PMID: 24597684 PMCID: PMC8052984 DOI: 10.3109/0142159x.2014.886764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND Global health educational programs within U.S. medical schools have the opportunity to link their "global" focus with local circumstances by examining the challenges underserved communities face in the United States. AIM Students in Weill Cornell Medical College's Global Health Clinical Preceptorship (GHCP) learn history-taking and physical examination skills while gaining exposure to local health care disparities and building cultural competency. METHODS First-year medical students in the program are placed in the office of a physician who works with underserved patient populations in New York City. Students receive an orientation session, shadow their preceptors one afternoon per week for seven weeks, complete weekly readings and assignments on topics specific to underserved populations, attend a reflection session, and write a reflection paper. RESULTS In three years, 36% of first-year students (112 of 311) opted into the elective GHCP program. Students reported gaining a better understanding of the needs of underserved patient populations, being exposed to new languages and issues of cultural competency, and having the opportunity to work with role model clinicians. CONCLUSIONS The GHCP is a successful example of how global health programs within medical schools can incorporate a domestic learning component into their curricula.
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Affiliation(s)
| | | | | | - Nichole Goodsmith
- Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program
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Haq C, Stearns M, Brill J, Crouse B, Foertsch J, Knox K, Stearns J, Skochelak S, Golden RN. Training in Urban Medicine and Public Health: TRIUMPH. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2013; 88:352-63. [PMID: 23348092 DOI: 10.1097/acm.0b013e3182811a75] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE The number of U.S. medical school graduates who choose to practice in health professional shortage areas (HPSAs) has not kept pace with the needs of society. The University of Wisconsin School of Medicine and Public Health has created a new program that prepares medical students to reduce health disparities for urban medically underserved populations in Milwaukee. The authors describe the Training in Urban Medicine and Public Health (TRIUMPH) program and provide early, short-term outcomes. METHOD TRIUMPH integrates urban clinical training, community and public health curricula, longitudinal community and public health projects, mentoring, and peer support for select third- and fourth-year medical students. The authors tracked and held focus groups with program participants to assess their knowledge, skills, satisfaction, confidence, and residency matches. The authors surveyed community partners to assess their satisfaction with students and the program. RESULTS From 2009 to 2012, 53 students enrolled in the program, and 45 have conducted projects with community organizations. Participants increased their knowledge, skills, confidence, and commitment to work with urban medically underserved populations. Compared with local peers, TRIUMPH graduates were more likely to select primary care specialties and residency programs serving urban underserved populations. Community leaders have reported high levels of satisfaction and benefits; their interest in hosting students exceeds program capacity. CONCLUSIONS Early, short-term outcomes confirm that TRIUMPH is achieving its desired goals: attracting and preparing medical students to work with urban underserved communities. The program serves as a model to prepare physicians to meet the needs of urban HPSAs.
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Affiliation(s)
- Cynthia Haq
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705, USA.
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Welsh KJ, Patel CB, Fernando RC, Torres JD, Medrek SK, Schnapp WB, Brown CA, Buck DS. Prevalence of bipolar disorder and schizophrenia in Houston Outreach Medicine, Education, and Social Services (HOMES) Clinic patients: implications for student-managed clinics for underserved populations. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2012; 87:656-661. [PMID: 22450177 DOI: 10.1097/acm.0b013e31824d4540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE Psychiatric conditions require aggressive management that is challenging to provide in free clinics. The purpose of this study was to determine the prevalence of certain mental illnesses and comorbid conditions among the patients of a student-managed free clinic for the homeless. METHOD The authors conducted a retrospective analysis of the records of patients who visited the student-run Houston Outreach Medicine, Education, and Social Services (HOMES) Clinic from May 2007 through May 2008. They assessed the prevalence of bipolar disorder and schizophrenia among patients. They compared demographics, health insurance status, comorbid medical conditions, and social habit data of patients with these mental illnesses with those of other clinic patients. RESULTS Of 286 patients (74.5% male, mean age 45.8 years), 25 (8.7%) had a diagnosis of schizophrenia and 45 (15.7%) had bipolar disorder. Compared with other clinic patients, patients with bipolar disorder or schizophrenia were less likely to be male (P < .0001) and were more likely to have publicly funded insurance (P = .024). They were also more likely to have certain comorbid conditions, including asthma (P = .0004), seizures (P = .0007), kidney disease (P = .01), and heart disease (P = .02). CONCLUSIONS The high prevalence of these mental illnesses combined with the increased burden of medical comorbidity among HOMES Clinic patients has implications for student-managed free clinics, which often operate on limited budgets. Strategies for providing care for these patients in this setting include integrated care, street medicine, and case management.
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Ladhani Z, Scherpbier AJJA, Stevens FCJ. Competencies for undergraduate community-based education for the health professions--a systematic review. MEDICAL TEACHER 2012; 34:733-43. [PMID: 22905658 DOI: 10.3109/0142159x.2012.700742] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Community-based education (CBE) along with competency approach is increasingly becoming popular. However, there appears to be lack of evidence on CBE competencies for undergraduate curriculum, therefore this systematic review attempted to identify and categorize CBE competencies to determine the ones used frequently. AIMS The systematic review aimed at identifying and categorizing CBE competencies implemented in nursing and medical schools to inform all stakeholders of health professional's education. METHOD A systematic review of electronic databases including MEDLINE, CINAHL, and ERIC and manual search of four medical education journals was carried out. Search was restricted to original research, published in English language between January 2000 and December 2009. RESULTS Nineteen studies fulfilled the search criteria. The competencies identified were categorized under six themes: Public Health; Cultural Competence; Leadership and Management; Community Development; Research; and Generic Competencies. Moreover, a number of clinical competencies were also found to be overlapping with CBE. CONCLUSIONS The literature on CBE competencies is limited in number and in its geographical span as most of the studies found was from developed countries; to expand the efforts to other institutions and countries, core competencies for CBE must be recognized and disseminated widely for its integration in health professionals' curriculum.
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Wieland ML, Beckman TJ, Cha SS, Beebe TJ, McDonald FS. Residents' attitudes and behaviors regarding care for underserved patients: a multi-institutional survey. J Grad Med Educ 2011; 3:337-44. [PMID: 22942959 PMCID: PMC3179238 DOI: 10.4300/jgme-03-03-41] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 11/02/2010] [Accepted: 11/10/2010] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Resident physicians often encounter underprivileged patients before other providers, yet little is known about residents' attitudes and behaviors regarding these patients. OBJECTIVE To measure US resident physician attitudes regarding topics relevant to medically underserved patients, their behaviors (volunteerism) with underserved patients, and the association between attitudes and behaviors. METHODS In 2007 and 2008, 956 surveys on resident attitudes and behaviors about underserved patients were distributed to 18 residency programs in the United States. Survey content was based on existing literature and an expert needs assessment. The attitude assessment had 15 items with 3-point scales (range 0-1). The behavior assessment evaluated volunteering for underserved patients in the past, present, and future. RESULTS A total of 498 surveys (response rate = 52%) were completed. Attitudes regarding underserved patients were generally positive and more favorable for women than men (overall attitude score 0.83 versus 0.74; P = < .001). Rates of volunteering for underserved patients were high in medical school (N = 375, 76%) and anticipated future practice (N = 409, 84%), yet low during residency (N = 95, 19%). Respondents who volunteered regularly had more favorable attitudes than those who did not volunteer (overall average attitude score of 0.81 versus 0.73; P = <.001). Relationships between hours volunteered per-week and favorable attitudes about topics related to the underserved were significant across all 15 items in medical school and anticipated future practice (P value range of .035 to <.0001). CONCLUSIONS This survey revealed that US residents' attitudes towards topics regarding medically underserved populations are generally favorable. Rates of volunteerism for underserved patients were higher in medical school than during residency, and resident's anticipated rates of volunteerism in future practice volunteerism were approximately the same as rates of volunteerism in medical school. Resident attitudes are strongly correlated with volunteerism.
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Affiliation(s)
- Mark L Wieland
- Corresponding author: Mark L. Wieland, MD, MPH, 200 First Street SW, Rochester, MN 55904, 507-255-8715, 507-255-9189,
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Jones CA, Perera A, Chow M, Ho I, Nguyen J, Davachi S. Cardiovascular disease risk among the poor and homeless - what we know so far. Curr Cardiol Rev 2011; 5:69-77. [PMID: 20066152 PMCID: PMC2803292 DOI: 10.2174/157340309787048086] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 08/26/2008] [Accepted: 08/26/2008] [Indexed: 11/22/2022] Open
Abstract
Homelessness [and poverty] is rapidly escalating across North America and is associated with dire implications for public health and our health care systems. Both are compelling states of existence affecting all ages, ethnicities and both genders. Homelessness frequently evolves through a complex interaction of factors that are both internal and external to the individual themselves. Once homeless, equitable access to both preventative and remedial health care is lacking and is associated with a higher than average burden of cardiovascular disease [CVD] risk factors, morbidity and mortality and is accompanied by disproportionately high health care costs. The emergence of limited, small scale programs aimed at addressing the unique health and social needs of the homeless is encouraging. However, there has been inadequate commitment at the National, State or Provincial and local levels to implement policies and dedicate funding and resources to the expansion of such “individual level” interventions into comprehensive programs that deliver sustainable, integrated prevention and services, especially with regard to CVD. The long-term solutions that address the links between homelessness and CVD lie in preventing homelessness and reversing the trends in our health care system that create disparities for lower socioeconomic status [SES] and homeless individuals.
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Ross PT, Williams BC, Doran KM, Lypson ML. First-Year Medical Students’ Perceptions of Physicians’ Responsibilities Toward the Underserved: An Analysis of Reflective Essays. J Natl Med Assoc 2010; 102:761-5. [DOI: 10.1016/s0027-9684(15)30672-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wieland ML, Beckman TJ, Cha SS, Beebe TJ, McDonald FS. Resident physicians' knowledge of underserved patients: a multi-institutional survey. Mayo Clin Proc 2010; 85:728-33. [PMID: 20675511 PMCID: PMC2912734 DOI: 10.4065/mcp.2009.0703] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To measure actual and perceived resident physician knowledge of underserved patient populations. PARTICIPANTS AND METHODS Using the existing literature on vulnerable patient populations and interviews with experts in the field, we designed a cross-sectional, multi-institutional survey to assess actual and perceived resident knowledge of topics related to underserved populations. The survey of actual knowledge consisted of 30 multiple-choice questions, and the survey of perceived knowledge consisted of 15 items based on 3-point Likert scales of confidence. RESULTS A total of 498 surveys were completed at 18 residency programs representing 7 different specialties at 10 US institutions. Assessment of perceived knowledge demonstrated that residents were very confident only 14.0% of the time, somewhat confident 66.4% of the time, and not at all confident 19.6% of the time. Assessment of actual knowledge revealed that the average percent correct across all 30 questions was 38%. Women scored better than men (average score, 40.6% vs 36.0%; P=.01), and African Americans scored higher than members of other racial or ethnic groups (average score, 43.5% vs 38.0%; P=.04). Associations between residents' perceived and actual knowledge were generally high. CONCLUSION For the US residents surveyed, the actual and perceived knowledge about most topics relating to underserved populations was low, whereas associations between actual and perceived knowledge were high. These findings suggest the need to improve resident education regarding underserved patient populations.
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Affiliation(s)
- Mark L Wieland
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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Abstract
BACKGROUND Educating medical students about health disparities may be one step in diminishing the disparities in health among different populations. According to adult learning theory, learners' opinions are vital to the development of future curricula. DESIGN Qualitative research using focus group methodology. OBJECTIVES Our objectives were to explore the content that learners value in a health disparities curriculum and how they would want such a curriculum to be taught. PARTICIPANTS Study participants were first year medical students with an interest in health disparities (n = 17). APPROACH Semi-structured interviews consisting of 12 predetermined questions, with follow-up and clarifying questions arising from the discussion. Using grounded theory, codes were initially developed by the team of investigators, applied, and validated through an iterative process. MAIN RESULTS The students perceived negative attitudes towards health disparities education as a potential barrier towards the development of a health disparities curriculum and proposed possible solutions. These solutions centered around the learning environment and skill building to combat health disparities. CONCLUSIONS While many of the students' opinions were corroborated in the literature, the most striking differences were their opinions on how to develop good attitudes among the student body. Given the impact of the provider on health disparities, how to develop such attitudes is an important area for further research.
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Affiliation(s)
- Cristina M Gonzalez
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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Klein M, Vaughn LM. Teaching social determinants of child health in a pediatric advocacy rotation: small intervention, big impact. MEDICAL TEACHER 2010; 32:754-759. [PMID: 20795806 DOI: 10.3109/01421591003690320] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Traditionally, medical education does not specifically address the social determinants of health or how to advocate for families' cultural, social or economic needs in spite of our increasingly diverse society. AIM This article describes a new social-legal curriculum added to a Pediatric Resident's Advocacy course. METHODS Pediatric interns completed 'Memos To Myself' after the Advocacy rotation. RESULTS The curriculum impacted residents' (1) realization regarding family circumstances; (2) reflections regarding self and personal practice; and (3) knowledge about advocacy issues and community partnerships for solutions. CONCLUSIONS This curriculum raised awareness about topics that are traditionally not covered in medical education.
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Affiliation(s)
- Melissa Klein
- Cincinnati Children's Hospital Medical Center, Division of General and Community Pediatrics, Cincinnati, OH 45229-3039, USA.
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Masi CM, Gehlert S. Perceptions of breast cancer treatment among African-American women and men: implications for interventions. J Gen Intern Med 2009; 24:408-14. [PMID: 19101776 PMCID: PMC2642574 DOI: 10.1007/s11606-008-0868-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 10/27/2008] [Accepted: 11/18/2008] [Indexed: 12/01/2022]
Abstract
BACKGROUND While breast cancer mortality has declined in recent years, the mortality gap between African-American and white women continues to grow. Current strategies to reduce this disparity focus on logistical and information needs, but contextual factors, such as concerns about racism and treatment side effects, may also represent significant barriers to improved outcomes. OBJECTIVE To characterize perceptions of breast cancer treatment among African-American women and men. DESIGN A qualitative study of African-American adults using focus group interviews. PARTICIPANTS Two hundred eighty women and 165 men who live in one of 15 contiguous neighborhoods on Chicago's South Side. APPROACH Transcripts were systematically analyzed using qualitative techniques to identify emergent themes related to breast cancer treatment. RESULTS The concerns expressed most frequently were mistrust of the medical establishment and federal government, the effect of racism and lack of health insurance on quality of care, the impact of treatment on intimate relationships, and the negative effects of surgery, radiation therapy, and chemotherapy. CONCLUSIONS In addition to providing logistical and information support, strategies to reduce the breast cancer mortality gap should also address contextual factors important to quality of care. Specific interventions are discussed, including strategies to enhance trust, reduce race-related treatment differences, minimize the impact of treatment on intimate relationships, and reduce negative perceptions of breast cancer surgery, radiation therapy, and chemotherapy.
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Affiliation(s)
- Christopher M Masi
- Section of General Internal Medicine, University of Chicago, 5841 S. Maryland Avenue, M/C 2007, Chicago, IL 60637, USA.
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