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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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2
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Bismantara H, Ahern S, Teede HJ, Liew D. Academic health science centre models across the developing countries and lessons for implementation in Indonesia: a scoping review. BMJ Open 2022; 12:e051937. [PMID: 36691121 PMCID: PMC9453943 DOI: 10.1136/bmjopen-2021-051937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/10/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To describe models of academic health science centres (AHSCs) across developing countries, in order to inform AHSC development in Indonesia. DESIGN Scoping review with systematic methods. DATA SOURCES Ovid MEDLINE, ProQuest Central, Wiley online library, Scopus and Web of Sciences were searched for relevant publications from 1 January 2015 to 1 December 2020. 'Grey literature' was hand searched by targeted website searches, Google searches, as well as personal communication held with stakeholders in Indonesia specifically. Relevant articles regarding AHSCs in developing countries are included. The review would be synthesised to focus on the purpose, structure and core activities of AHSCs. Strategies for success were also considered. RESULTS Twenty-six recognised AHSCs in developing countries were identified, located in Asia (n=13), Europe (n=1), South America (n=7) and Africa (n=5). Innovation, health system improvement and enhancement in academic capacity were the common visions. Most centres are functionally integrated and university-led. Most AHSCs include community health services to complement primary stakeholders such as academic institutions and hospitals. Limited information was identified regarding patient and public involvement and workforce capacity building. Five AHSCs have been piloted in Indonesia since 2018, integrating universities, academic hospitals and provincial health offices. However, information regarding their core activities and successes is limited. CONCLUSIONS The review suggests that limited published data are available on AHSC models in developing countries, but they still provide important insight into AHSC development in Indonesia. Innovation and health systems strengthening are the common visions. Functional integration with university leadership is the most common model of governance. Other than universities and hospitals, community health centres, research centres and regional health offices are common partners. There is a little description of community engagement and workforce capacity building.
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Affiliation(s)
- Haryo Bismantara
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helena J Teede
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Partners Academic Health Science Centre, Melbourne, Victoria, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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Edelman A, Taylor J, Ovseiko PV, Larkins S, Topp SM. The population health role of academic health centres: a multiple-case exploratory study in Australia and England. Health Policy 2022; 126:1051-1061. [PMID: 36031466 DOI: 10.1016/j.healthpol.2022.08.008] [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: 03/25/2022] [Revised: 07/31/2022] [Accepted: 08/14/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Academic health centres (AHCs) are organisations that aim to mobilise knowledge into practice by improving the responsiveness of health systems to emerging evidence. This study aims to explore the population health role of AHCs in Australia and England, where AHCs represent novel organisational forms. METHODS A multiple-case study design using qualitative methods was used to explore population health goals and activities in four discrete AHCs in both countries during 2017 and 2018. Data from 85 interviews with AHC leaders, clinicians and researchers, direct observation, and documentation were analysed within and across the cases. RESULTS Comparison across cases produced four cross-case themes: health care rather than population health; incremental rather than major health system change; different conceptions of "translation" and "innovation"; and unclear pathways to impact. The ability of the AHCs to define and enact a population health role was hindered during the study period by gaps in knowledge mobilisation strategies at a health system and policy level, the biomedical orientation of government designation schemes for AHCs in Australia and England, and competing expectations of the sovereign partner organisations in AHCs against a backdrop of limited operational resources. DISCUSSION The study identifies several institutional elements that are likely to be needed for AHCs in Australia and England to deliver on both internal and external expectations of their population health role.
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Affiliation(s)
- Alexandra Edelman
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
| | - Judy Taylor
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Pavel V Ovseiko
- Radcliffe Department of Medicine, Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
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Edelman A, Clay-Williams R, Fischer M, Kislov R, Kitson A, McLoughlin I, Skouteris H, Harvey G. Mobilising Knowledge in (and About) Academic Health Science Centres: Boundary Spanning, Inter-organisational Governance and Systems Thinking. Int J Health Policy Manag 2022; 11:1238-1240. [PMID: 35490259 PMCID: PMC9808194 DOI: 10.34172/ijhpm.2022.7314] [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: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Alexandra Edelman
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Michael Fischer
- Melbourne Business School, University of Melbourne, Melbourne, VIC, Australia
| | - Roman Kislov
- Manchester Metropolitan University, Manchester, UK
- The University of Manchester, Manchester, UK
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Ian McLoughlin
- Formerly Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Gillian Harvey
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, SA, Australia
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Ferlie E. AHSCs as Health Policy Transfer: Some Emergent Evidence From Australia Comment on "Academic Health Science Centres as Vehicles for Knowledge Mobilisation in Australia? A Qualitative Study". Int J Health Policy Manag 2022; 11:862-864. [PMID: 35184512 PMCID: PMC9309901 DOI: 10.34172/ijhpm.2022.6284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 02/06/2022] [Indexed: 11/09/2022] Open
Abstract
This commentary discusses Edelman et al 2020's recent exploratory study of the early development of 4 Academic Health Services Centres (AHSCs) in Australia. AHSCs were originally invented in the United States, but have then diffused to the United Kingdom and Canada over the last decade or so and now to Australia so they are a good example of health policy transfer. They are dedicated to advancing more speedy knowledge translation (KT)/mobilization ('from bench to bedside') and also the more effective commercialization of scientific inventions. The commentary argues some interesting if preliminary findings are identified in their study. Its limitations will also be considered. Finally, suggestions for future research are made, including more cross national and comparative studies.
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Affiliation(s)
- Ewan Ferlie
- King’s Business School, King’s College London, London, UK
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Saadi A, Sanchez Molina U, Franco-Vasquez A, Inkelas M, Ryan GW. Barriers and Facilitators to Implementation of Health System Interventions Aiming to Welcome and Protect Immigrant Patients: a Qualitative Study. J Gen Intern Med 2021; 36:3071-3079. [PMID: 33987786 PMCID: PMC8118102 DOI: 10.1007/s11606-021-06788-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 04/01/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND At the same time that federal policymakers have enforced restrictive immigration policies, healthcare systems across the USA are developing, and have implemented, interventions aimed at addressing immigration-related stressors faced by immigrant communities. Yet, little is known about the contextual determinants that influence their implementation success. Using the Consolidated Framework for Implementation Research (CFIR), this study identifies factors enabling or challenging the implementation of interventions aimed at mitigating immigration-related stressors in the healthcare context. METHODS We used a qualitative research design to conduct 38 semi-structured interviews with stakeholders involved in implementation of interventions at 25 healthcare facilities across 5 states with the highest undocumented immigrant populations (California, Texas, New York, Florida, and Illinois). Interviews were conducted from May through August 2018. Constant comparative analysis was used to identify barrier and facilitator themes. Deductive coding was thereafter used to categorize themes according to CFIR domain. RESULTS Barriers to implementation included perceptions of legal complexity and challenges to adopting such systemic strategies. Facilitators included a national policy climate that had brought immigrant health to the forefront, allowing for leveraging momentum towards institutional change; communication among healthcare personnel; existing community partnerships with immigrant rights and service organizations; and a shared sense of mission centering health equity. Local variation in immigration-related policies (e.g., local law agencies enforcing federal immigration laws) and heterogeneity of local immigrant communities also impacted implementation. Champions and informal leaders were integral to institutional efforts but not sufficient for sustainability. Perceived urgency to act superseded evaluation considerations, with all interventions in initial phases of implementation. Future iterations and evaluations of these interventions are needed to establish best practices and implementation determinants. CONCLUSION This is the first systematic study describing implementation determinants of immigration-related interventions across health systems. Identifying these determinants provides guidance to other healthcare organizations to effectively strategize and ensure implementation success.
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Affiliation(s)
- Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | | | - Andrée Franco-Vasquez
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Moira Inkelas
- University of California Los Angeles Fielding School of Public Health, Los Angeles, CA, USA
| | - Gery W Ryan
- Department of Health Systems Science, Kaiser Permanente Medical School, Pasadena, CA, USA
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Alaniz L, Billimek J, Figueroa C, Nahmias JT, Barrios C. Increased Mortality in Underinsured Penetrating Trauma Patients. Am Surg 2021; 87:1594-1599. [PMID: 34128407 DOI: 10.1177/00031348211024974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION It remains unclear whether an increased mortality risk in uninsured patients exists across Injury Severity Score (ISS) classifications. We hypothesized that penetrating trauma self-pay patients would have a similarly increased mortality risk across all ISS categories. METHODS The National Trauma Data Bank (2013-2015) was queried for patients presenting with penetrating firearm, explosive, or stab wound injuries. 115 651 patients were identified and a stratified multivariable logistic regression model was used. RESULTS In the >15 ISS group, self-pay patients had a lower median total hospital Length of Stay (LOS) (3 vs 8, P < .001), lower median Intensive Care Unit LOS (1 vs 3, P < .001), and lower median ventilator days (0 vs 1, P < .001). Self-pay patients had an increased risk for mortality compared to patients with private insurance in both the ≤15 ISS group (OR 2.68, P < .001) and >15 ISS group (OR 1.56, P < .001). CONCLUSION Uninsured patients have an increased mortality risk in both low and high ISS groups. A higher mortality risk among uninsured patients in the high ISS group can be explained by decreased resource availability and lower ICU days and ventilator time. However, more studies are needed to determine why there is an even greater mortality risk among uninsured patients with mild ISS.
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Affiliation(s)
- Leonardo Alaniz
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA.,School of Medicine, University of California, Irvine, CA, USA
| | - John Billimek
- School of Medicine, University of California, Irvine, CA, USA
| | - Cesar Figueroa
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Jeffry T Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
| | - Cristobal Barrios
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, University of California, Irvine, Orange, CA, USA
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Leaune E, Rey-Cadilhac V, Oufker S, Grot S, Strowd R, Rode G, Crandall S. Medical students attitudes toward and intention to work with the underserved: a systematic review and meta-analysis. BMC MEDICAL EDUCATION 2021; 21:129. [PMID: 33627102 PMCID: PMC7905612 DOI: 10.1186/s12909-021-02517-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/26/2021] [Indexed: 06/10/2023]
Abstract
BACKGROUND Experts in the field of medical education emphasized the need for curricula that improve students' attitudes toward the underserved. However, some studies have shown that medical education tends to worsen these attitudes in students. We aimed at systematically reviewing the literature assessing the change in medical students' attitudes toward the underserved and intention to work with the underserved throughout medical education, the sociodemographic and educational factors associated with favorable medical student attitudes toward and/or intention to work with the underserved and the effectiveness of educational interventions to improve medical student attitudes toward and/or intention to work with the underserved. METHOD We conducted a systematic review on MEDLINE, Scopus, and Web of Science databases. Three investigators independently conducted the electronic search. We assessed the change in medical students attitudes toward the underserved by computing a weighted mean effect size of studies reporting scores from validated scales. The research team performed a meta-analysis for the sociodemographic and educational factors associated with medical students attitudes toward and/or intention to work with the underserved. RESULTS Fifty-five articles met the inclusion criteria, including a total of 109,647 medical students. The average response rate was 73.2%. Most of the studies were performed in the USA (n = 45). We observed a significant decline of medical students attitudes toward the underserved throughout medical education, in both US and non-US studies. A moderate effect size was observed between the first and fourth years (d = 0.51). Higher favorable medical students attitudes toward or intention to work with the underserved were significantly associated with female gender, being from an underserved community or ethnic minority, exposure to the underserved during medical education and intent to practice in primary care. Regarding educational interventions, the effectiveness of experiential community-based learning and curricula dedicated to social accountability showed the most positive outcome. CONCLUSIONS Medical students attitudes toward the underserved decline throughout medical education. Educational interventions dedicated to improving the attitudes or intentions of medical students show encouraging but mixed results. The generalizability of our results is impeded by the high number of studies from the global-North included in the review.
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Affiliation(s)
- Edouard Leaune
- Faculté de Médecine Lyon-Est, Université de Lyon, Lyon, France.
- Centre Hospitalier le Vinatier, 95 boulevard Pinel BP 300 39 -, 69 678, Bron cedex, France.
- INSERM, U1028; CNRS, UMR5292, Lyon Neuroscience Research Center, F-69000, Lyon, France.
| | | | - Safwan Oufker
- Faculté de Médecine Lyon-Est, Université de Lyon, Lyon, France
| | - Stéphanie Grot
- Centre de recherche, Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Roy Strowd
- Wake Forrest School of Medicine, Winston-Salem, North Carolina, USA
| | - Gilles Rode
- Faculté de Médecine Lyon-Est, Université de Lyon, Lyon, France
- INSERM, U1028; CNRS, UMR5292, Lyon Neuroscience Research Center, F-69000, Lyon, France
| | - Sonia Crandall
- Wake Forrest School of Medicine, Winston-Salem, North Carolina, USA
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Edelman A, Taylor J, Ovseiko PV, Topp SM. "'Academic' is a dirty word": Intended impact pathways of an emerging academic health centre in tropical regional Australia. Int J Health Plann Manage 2019; 34:e661-e678. [PMID: 30311953 PMCID: PMC6559162 DOI: 10.1002/hpm.2681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The Tropical Australian Academic Health Centre (TAAHC) is being established in northern Queensland across a vast rural geography. The study aim is to identify intended impact pathways and beneficiaries of TAAHC as well as experienced and anticipated challenges. METHODOLOGY The study is an empirical case study nested within a comparative multi-case study on academic health centres (AHCs). Data were collected from documents, observation, and interviews with 24 health system and university stakeholders. Intended impact pathways were identified abductively from analysis of aspirations and challenges. RESULTS Aspirations of TAAHC reflect an ultimate aim to improve the health of the northern Queensland population. Challenges were trust and communication, understanding value and return on investment, health system receptiveness to building a research culture, prioritising and influencing the research agenda, and structure of the health system. DISCUSSION The study identifies three interdependent transitions that comprise the main intended impact pathway in TAAHC. Stakeholders expected TAAHC to effect health systems change and improvement rather than drive discovery-oriented academic research associated with AHCs elsewhere. CONCLUSION The findings contribute to the empirical evidence base on the role of AHCs internationally and to ongoing initiatives to establish and resource AHCs in Australia.
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Affiliation(s)
- Alexandra Edelman
- College of Public Health, Medical and Veterinary SciencesJames Cook UniversityTownsvilleQueenslandAustralia
| | - Judy Taylor
- College of Medicine and Dentistry, Division of Tropical Health and MedicineJames Cook UniversityTownsvilleQueenslandAustralia
| | - Pavel V. Ovseiko
- Radcliffe Department of Medicine, Medical Sciences Division, University of OxfordJohn Radcliffe HospitalOxfordUK
| | - Stephanie M. Topp
- College of Public Health, Medical and Veterinary SciencesJames Cook UniversityTownsvilleQueenslandAustralia
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