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Savage WM, Saint-Hilaire SA, Shah M, Lugo-Candelas C. Racial disparities in the diagnosis of disruptive behavior disorders: a U.S. national inpatient sample analysis. Front Psychiatry 2024; 15:1425559. [PMID: 39328346 PMCID: PMC11424396 DOI: 10.3389/fpsyt.2024.1425559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/26/2024] [Indexed: 09/28/2024] Open
Abstract
Disruptive behavior disorders (DBDs) are comprised of conduct disorder and oppositional defiant disorder. Limited literature exists on the demographics of patients diagnosed with these conditions. Despite the clinical overlap of DBDs and attention-deficit hyperactivity disorder (ADHD), there is a stark divergence in the treatment and societal accommodation for these two diagnoses, amplifying the importance of this diagnostic challenge. Thus, potential diagnostic differences must be urgently and rigorously explored. Small, regional studies have reported potential "racial" disparities in the diagnosis of DBDs, especially when compared to the diagnosis of ADHD. Our study uses the National Inpatient Sample (NIS) database to provide the largest, most comprehensive investigation of "racial" disparities in the diagnosis of DBDs. Discharge data from 700,770 pediatric inpatients (mean age = 9.32 years) were included in this analysis. To explore potential disparities among children with symptoms in this area of clinical overlap, we assessed the relationship of "race" and the diagnosis of DBDs. Among the subgroup of pediatric inpatients diagnosed with ADHD or a DBD, Native American (OR = 2.18; 95% = 1.76, 2.70), Asian (OR = 1.88, 95% = 1.56, 2.26), Black (OR = 1.40; 95% = 1.32, 1.48), and Hispanic (OR = 1.20; 95% = 1.12, 1.28) "race" correlated with DBD diagnosis. By highlighting these diagnostic disparities, this study raises essential questions about race and the diagnosis of DBDs.
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Affiliation(s)
- William M Savage
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Sidney A Saint-Hilaire
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Mansi Shah
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Claudia Lugo-Candelas
- Department of Psychiatry, Columbia University, New York, NY, United States
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York, NY, United States
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Gordon BA, Azer L, Bennett K, Edelman LS, Long M, Goroncy A, Alexander C, Lee JA, Rosich R, Severance JJ. Agents of Change: Geriatrics Workforce Programs Addressing Systemic Racism and Health Equity. THE GERONTOLOGIST 2024; 64:gnae038. [PMID: 38666608 DOI: 10.1093/geront/gnae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Indexed: 05/22/2024] Open
Abstract
Many factors affect how individuals and populations age, including race, ethnicity, and diversity, which can contribute to increased disease risk, less access to quality healthcare, and increased morbidity and mortality. Systemic racism-a set of institutional policies and practices within a society or organization that perpetuate racial inequalities and discrimination-contributes to health inequities of vulnerable populations, particularly older adults. The National Association for Geriatrics Education (NAGE) recognizes the need to address and eliminate racial disparities in healthcare access and outcomes for older adults who are marginalized due to the intersection of race and age. In this paper, we discuss an anti-racist framework that can be used to identify where an organization is on a continuum to becoming anti-racist and to address organizational change. Examples of NAGE member Geriatric Workforce Enhancement Programs (GWEPs) and Geriatrics Academic Career Awards (GACAs) activities to become anti-racist are provided to illustrate the framework and to guide other workforce development programs and healthcare institutions as they embark on the continuum to become anti-racist and improve the care and health of vulnerable older adults.
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Affiliation(s)
- Barbara A Gordon
- University of Louisville Trager Institute Optimal Aging Clinic, University of Louisville, Louisville, Kentucky, USA
| | - Lilian Azer
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, California, USA
| | - Katherine Bennett
- Division of Gerontology & Geriatric Medicine, University of Washington, Seattle, Washington, USA
| | - Linda S Edelman
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Monica Long
- Department of Geriatrics & Palliative Medicine, Share Network, University of Chicago Medicine, Chicago, Illinois, USA
| | - Anna Goroncy
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Charles Alexander
- School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jung-Ah Lee
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
| | - Rosellen Rosich
- Department of Psychology, University of Alaska Anchorage, Anchorage, Alaska, USA
| | - Jennifer J Severance
- Department of Internal Medicine and Geriatrics, Texas College of Osteopathic Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA
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Ruprecht KA, Dunlop WA, Wah E, Phillips C, Martin SJ. Intergroup Contact Improves Medical Student Attitudes and Skill in Transgender Health Care. Transgend Health 2024; 9:162-173. [PMID: 38585241 PMCID: PMC10998020 DOI: 10.1089/trgh.2021.0203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Purpose Poorer health outcomes for transgender and gender diverse (TGD) individuals have been associated with lack of health care provider knowledge and personal bias. Training at all levels of medical education has been positioned as one strategy to combat these inequities. This study sought to characterize preclinical medical student attitude, skill, and knowledge pre- and post-teaching with TGD community volunteers. Methods This matched pre- and post-test study was conducted from July 2020 to August 2021 capturing two preclinical medical student cohorts exposed to the same teaching intervention. Students completed the Transgender Attitudes and Beliefs Scale (TABS) and the Transgender Development of Clinical Skills Scale (T-DOCSS) at baseline, 1 week, and 1 month after the clinical skills session. Tutors' attitudes to TGD health were measured before facilitating teaching, using the Attitudes Toward Transgender Patients and Beliefs and Knowledge about Treating Transgender Patients scales. Results Fifty-nine students completed questionnaires at three time points and were included in this study. Total TABS and T-DOCCS scores increased from preintervention to 1-week follow-up, maintained at 1 month, with significant changes in Interpersonal Comfort and Sex and Gender Beliefs subscales. Scores on the Human Value subscale did not change, remaining consistently high. Postintervention knowledge-question scores were high. Nine of 13 tutors completed surveys, demonstrating overall positive attitudes toward gender diversity and TGD health. Conclusion This study demonstrates improvement in preclinical medical student attitudes and self-reported skill toward gender health care sustained at 1 month after small-group teaching with TGD community volunteers.
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Affiliation(s)
- Ky A. Ruprecht
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - William A. Dunlop
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Estee Wah
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Christine Phillips
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Sarah J. Martin
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
- Canberra Sexual Health Centre, Canberra Health Services, Garran, Australia
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4
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Ryujin D, Dalton D, Yole-Lobe M, DiBiase M, Phelps P, Madden A, Clark J, Barry CL, Rodriguez JE, Honda T. Implicit Association Test Alone Is Not Sufficient to Increase Underrepresented Minority Representation in Physician Assistant Programs. J Physician Assist Educ 2023; 34:295-300. [PMID: 37467215 DOI: 10.1097/jpa.0000000000000523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
PURPOSE Physician assistant (PA) program matriculants are consistently less diverse than the US population. This study evaluates whether administration of an Implicit Association Test (IAT) to PA program admission committees is associated with changes in the likelihood of (1) receiving an admission interview, (2) receiving an offer of admission, and (3) matriculation of individuals underrepresented in medicine (URiM). METHODS Admission committees from 4 PA programs participated in an IAT before the 2019/2020 admissions cycle. Applicant outcome data (n = 5796) were compared with 2018/2019 cycle (n = 6346). Likelihood of URiM students receiving offers to interview, offers of admission, and matriculation were evaluated using random effects multiple logistic regression models. Fully adjusted random effects models included URiM status, year (control vs. intervention), multiplicative interaction terms between URiM and year, applicant age, and undergraduate grade point average (GPA) Secondary analyses examined associations of each race/ethnicity individually. RESULTS Underrepresented in medicine status, age, and GPA were significantly associated with all admission outcomes ( P < .05). The intervention effect was not statistically significant. In sensitivity analyses examining each individual race rather than URiM status, our results did not importantly differ. CONCLUSION Findings suggest admission committee member participation in IAT before admissions had no significant impact on the likelihood of admission of URiM students. This may suggest that making individuals aware of their implicit biases is not, in and of itself, sufficient to meaningfully affect the diversity of PA program admission metrics.
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Affiliation(s)
- Darin Ryujin
- Darin Ryujin, MS, MPAS, is an associate professor, Associate Chair for Equity, Diversity and Inclusion, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Doris Dalton, MPA, is a director of admissions, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Menerva Yole-Lobe, MPAS, is an assistant professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Michelle DiBiase, DHSc, is a professor, chair and program director, Department of Physician Assistant Studies, AT Still University, Mesa, Arizona
- Paula Phelps, MHE, MPAS, is a professor, associate program director, Department of Physician Assistant Studies, Idaho State University, Pocatello, Idaho
- Ann Madden, MHS, is an associate clinical professor, director of clinical education Drexel University Physician Assistant Program, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
- Jon Clark, MBA, is an assistant director, Operations, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
- Carey L Barry, MHS, is a department chair, associate clinical professor, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
- José E. Rodriguez, MD, is an associate vice president, Office for Health Equity, Diversity and Inclusion, University of Utah Health. Salt Lake City, Utah
- Trenton Honda, PhD, MMS, is a clinical professor, associate dean, School of Clinical and Rehabilitation Sciences, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
| | - Doris Dalton
- Darin Ryujin, MS, MPAS, is an associate professor, Associate Chair for Equity, Diversity and Inclusion, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Doris Dalton, MPA, is a director of admissions, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Menerva Yole-Lobe, MPAS, is an assistant professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Michelle DiBiase, DHSc, is a professor, chair and program director, Department of Physician Assistant Studies, AT Still University, Mesa, Arizona
- Paula Phelps, MHE, MPAS, is a professor, associate program director, Department of Physician Assistant Studies, Idaho State University, Pocatello, Idaho
- Ann Madden, MHS, is an associate clinical professor, director of clinical education Drexel University Physician Assistant Program, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
- Jon Clark, MBA, is an assistant director, Operations, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
- Carey L Barry, MHS, is a department chair, associate clinical professor, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
- José E. Rodriguez, MD, is an associate vice president, Office for Health Equity, Diversity and Inclusion, University of Utah Health. Salt Lake City, Utah
- Trenton Honda, PhD, MMS, is a clinical professor, associate dean, School of Clinical and Rehabilitation Sciences, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
| | - Menerva Yole-Lobe
- Darin Ryujin, MS, MPAS, is an associate professor, Associate Chair for Equity, Diversity and Inclusion, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Doris Dalton, MPA, is a director of admissions, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Menerva Yole-Lobe, MPAS, is an assistant professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Michelle DiBiase, DHSc, is a professor, chair and program director, Department of Physician Assistant Studies, AT Still University, Mesa, Arizona
- Paula Phelps, MHE, MPAS, is a professor, associate program director, Department of Physician Assistant Studies, Idaho State University, Pocatello, Idaho
- Ann Madden, MHS, is an associate clinical professor, director of clinical education Drexel University Physician Assistant Program, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
- Jon Clark, MBA, is an assistant director, Operations, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
- Carey L Barry, MHS, is a department chair, associate clinical professor, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
- José E. Rodriguez, MD, is an associate vice president, Office for Health Equity, Diversity and Inclusion, University of Utah Health. Salt Lake City, Utah
- Trenton Honda, PhD, MMS, is a clinical professor, associate dean, School of Clinical and Rehabilitation Sciences, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
| | - Michelle DiBiase
- Darin Ryujin, MS, MPAS, is an associate professor, Associate Chair for Equity, Diversity and Inclusion, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Doris Dalton, MPA, is a director of admissions, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Menerva Yole-Lobe, MPAS, is an assistant professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Michelle DiBiase, DHSc, is a professor, chair and program director, Department of Physician Assistant Studies, AT Still University, Mesa, Arizona
- Paula Phelps, MHE, MPAS, is a professor, associate program director, Department of Physician Assistant Studies, Idaho State University, Pocatello, Idaho
- Ann Madden, MHS, is an associate clinical professor, director of clinical education Drexel University Physician Assistant Program, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
- Jon Clark, MBA, is an assistant director, Operations, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
- Carey L Barry, MHS, is a department chair, associate clinical professor, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
- José E. Rodriguez, MD, is an associate vice president, Office for Health Equity, Diversity and Inclusion, University of Utah Health. Salt Lake City, Utah
- Trenton Honda, PhD, MMS, is a clinical professor, associate dean, School of Clinical and Rehabilitation Sciences, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
| | - Paula Phelps
- Darin Ryujin, MS, MPAS, is an associate professor, Associate Chair for Equity, Diversity and Inclusion, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Doris Dalton, MPA, is a director of admissions, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Menerva Yole-Lobe, MPAS, is an assistant professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Michelle DiBiase, DHSc, is a professor, chair and program director, Department of Physician Assistant Studies, AT Still University, Mesa, Arizona
- Paula Phelps, MHE, MPAS, is a professor, associate program director, Department of Physician Assistant Studies, Idaho State University, Pocatello, Idaho
- Ann Madden, MHS, is an associate clinical professor, director of clinical education Drexel University Physician Assistant Program, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
- Jon Clark, MBA, is an assistant director, Operations, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
- Carey L Barry, MHS, is a department chair, associate clinical professor, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
- José E. Rodriguez, MD, is an associate vice president, Office for Health Equity, Diversity and Inclusion, University of Utah Health. Salt Lake City, Utah
- Trenton Honda, PhD, MMS, is a clinical professor, associate dean, School of Clinical and Rehabilitation Sciences, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
| | - Ann Madden
- Darin Ryujin, MS, MPAS, is an associate professor, Associate Chair for Equity, Diversity and Inclusion, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Doris Dalton, MPA, is a director of admissions, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Menerva Yole-Lobe, MPAS, is an assistant professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Michelle DiBiase, DHSc, is a professor, chair and program director, Department of Physician Assistant Studies, AT Still University, Mesa, Arizona
- Paula Phelps, MHE, MPAS, is a professor, associate program director, Department of Physician Assistant Studies, Idaho State University, Pocatello, Idaho
- Ann Madden, MHS, is an associate clinical professor, director of clinical education Drexel University Physician Assistant Program, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
- Jon Clark, MBA, is an assistant director, Operations, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
- Carey L Barry, MHS, is a department chair, associate clinical professor, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
- José E. Rodriguez, MD, is an associate vice president, Office for Health Equity, Diversity and Inclusion, University of Utah Health. Salt Lake City, Utah
- Trenton Honda, PhD, MMS, is a clinical professor, associate dean, School of Clinical and Rehabilitation Sciences, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
| | - Jon Clark
- Darin Ryujin, MS, MPAS, is an associate professor, Associate Chair for Equity, Diversity and Inclusion, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Doris Dalton, MPA, is a director of admissions, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Menerva Yole-Lobe, MPAS, is an assistant professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Michelle DiBiase, DHSc, is a professor, chair and program director, Department of Physician Assistant Studies, AT Still University, Mesa, Arizona
- Paula Phelps, MHE, MPAS, is a professor, associate program director, Department of Physician Assistant Studies, Idaho State University, Pocatello, Idaho
- Ann Madden, MHS, is an associate clinical professor, director of clinical education Drexel University Physician Assistant Program, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
- Jon Clark, MBA, is an assistant director, Operations, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
- Carey L Barry, MHS, is a department chair, associate clinical professor, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
- José E. Rodriguez, MD, is an associate vice president, Office for Health Equity, Diversity and Inclusion, University of Utah Health. Salt Lake City, Utah
- Trenton Honda, PhD, MMS, is a clinical professor, associate dean, School of Clinical and Rehabilitation Sciences, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
| | - Carey L Barry
- Darin Ryujin, MS, MPAS, is an associate professor, Associate Chair for Equity, Diversity and Inclusion, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Doris Dalton, MPA, is a director of admissions, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Menerva Yole-Lobe, MPAS, is an assistant professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Michelle DiBiase, DHSc, is a professor, chair and program director, Department of Physician Assistant Studies, AT Still University, Mesa, Arizona
- Paula Phelps, MHE, MPAS, is a professor, associate program director, Department of Physician Assistant Studies, Idaho State University, Pocatello, Idaho
- Ann Madden, MHS, is an associate clinical professor, director of clinical education Drexel University Physician Assistant Program, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
- Jon Clark, MBA, is an assistant director, Operations, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
- Carey L Barry, MHS, is a department chair, associate clinical professor, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
- José E. Rodriguez, MD, is an associate vice president, Office for Health Equity, Diversity and Inclusion, University of Utah Health. Salt Lake City, Utah
- Trenton Honda, PhD, MMS, is a clinical professor, associate dean, School of Clinical and Rehabilitation Sciences, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
| | - José E Rodriguez
- Darin Ryujin, MS, MPAS, is an associate professor, Associate Chair for Equity, Diversity and Inclusion, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Doris Dalton, MPA, is a director of admissions, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Menerva Yole-Lobe, MPAS, is an assistant professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Michelle DiBiase, DHSc, is a professor, chair and program director, Department of Physician Assistant Studies, AT Still University, Mesa, Arizona
- Paula Phelps, MHE, MPAS, is a professor, associate program director, Department of Physician Assistant Studies, Idaho State University, Pocatello, Idaho
- Ann Madden, MHS, is an associate clinical professor, director of clinical education Drexel University Physician Assistant Program, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
- Jon Clark, MBA, is an assistant director, Operations, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
- Carey L Barry, MHS, is a department chair, associate clinical professor, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
- José E. Rodriguez, MD, is an associate vice president, Office for Health Equity, Diversity and Inclusion, University of Utah Health. Salt Lake City, Utah
- Trenton Honda, PhD, MMS, is a clinical professor, associate dean, School of Clinical and Rehabilitation Sciences, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
| | - Trenton Honda
- Darin Ryujin, MS, MPAS, is an associate professor, Associate Chair for Equity, Diversity and Inclusion, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Doris Dalton, MPA, is a director of admissions, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Menerva Yole-Lobe, MPAS, is an assistant professor, Division of Physician Assistant Studies, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
- Michelle DiBiase, DHSc, is a professor, chair and program director, Department of Physician Assistant Studies, AT Still University, Mesa, Arizona
- Paula Phelps, MHE, MPAS, is a professor, associate program director, Department of Physician Assistant Studies, Idaho State University, Pocatello, Idaho
- Ann Madden, MHS, is an associate clinical professor, director of clinical education Drexel University Physician Assistant Program, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
- Jon Clark, MBA, is an assistant director, Operations, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
- Carey L Barry, MHS, is a department chair, associate clinical professor, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
- José E. Rodriguez, MD, is an associate vice president, Office for Health Equity, Diversity and Inclusion, University of Utah Health. Salt Lake City, Utah
- Trenton Honda, PhD, MMS, is a clinical professor, associate dean, School of Clinical and Rehabilitation Sciences, Department of Medical Sciences, Northeastern University, Boston, Massachusetts
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5
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van der Velden GJ, Meeuwsen JAL, Fox CM, Stolte C, Dilaver G. Peer-mentorship and first-year inclusion: building belonging in higher education. BMC MEDICAL EDUCATION 2023; 23:833. [PMID: 37936158 PMCID: PMC10629167 DOI: 10.1186/s12909-023-04805-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND An inclusive academic environment is pivotal to ensure student well-being and a strong sense of belonging and authenticity. Specific attention for an inclusive learning environment is particularly important during a student's transition to higher education. At Utrecht University's Medical School, explorative interviews with students from minority groups indicated they did not always feel included during the orientation programme of their academic education. We, therefore, developed a bias awareness training with theoretical and practical components on diversity and inclusion for peer-mentors who are assigned to each first-year student at the start of university. METHODS At the end of the orientation programme, we investigated the effectiveness of the training for two consecutive years using two measurements. Firstly, we investigated the behavioural changes in the peer-mentors through a (self-reporting) questionnaire. Additionally, we measured the perceived inclusion of the first-year students, divided into belonging and authenticity, using a validated questionnaire. RESULTS Our results show that peer-mentors found the training useful and indicated it enabled them to create an inclusive atmosphere. Overall, students experienced a high level of inclusion during the orientation programme. After the first year, the bias training was adjusted based on the evaluations. This had a positive effect, as mentors felt they were significantly more able to provide an inclusive orientation in the second year of this study. In line with this, students experienced an increased level of authenticity specifically due to the peer-mentor in the second year as compared to the first. CONCLUSIONS We conclude that training peer-mentors is an effective way to increase awareness and to ensure an inclusive atmosphere during the start of higher education.
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Affiliation(s)
- Gisela J van der Velden
- Education Center, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, HB 4.05, Utrecht, 3584 CX, The Netherlands.
| | - John A L Meeuwsen
- Education Center, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, HB 4.05, Utrecht, 3584 CX, The Netherlands
| | - Christine M Fox
- Education Center, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, HB 4.05, Utrecht, 3584 CX, The Netherlands
| | - Cecily Stolte
- Education Center, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, HB 4.05, Utrecht, 3584 CX, The Netherlands
| | - Gönül Dilaver
- Education Center, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, HB 4.05, Utrecht, 3584 CX, The Netherlands
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6
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Ruprecht K, Dunlop W, Wah E, Phillips C, Martin S. 'A human face and voice': transgender patient-educator and medical student perspectives on gender-diversity teaching. BMC MEDICAL EDUCATION 2023; 23:621. [PMID: 37658319 PMCID: PMC10472656 DOI: 10.1186/s12909-023-04591-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/16/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Transgender and gender diverse (TGD) people face many obstacles in accessing health care, including discrimination, institutional bias, and clinician knowledge deficits. We developed a clinical skills and education module on gender-affirming care for pre-clinical medical students, in collaboration with a TGD-led civil society organisation. The module consisted of an educational session followed by preceptor-facilitated small group tutorials, led by TGD patient-educators (n = 22) who used their lived experience to explore medical history-taking and broader issues related to TGD healthcare with students (n = 199). This study aimed to explore the views of students and TGD patient-educators on the structure, delivery and impact of the module. METHODS Analysis of responses of TGD patient-educators and students to the module (2020 and 2021), in post-intervention surveys using open-ended questions for TGD patient-educators (18 responses from 22 educators) and free text comments as part of a quantitative survey for medical students (89 responses). RESULTS Responses from students and patient-educators to the session were highly positive. Students and patient-educators emphasised that the teaching session succeeded through elevating the centrality of shared experience and creating a safe space for learning and teaching. Safety was experienced by patient-educators through the recognition of their own expertise in a medical environment, while students reported a non-judgemental teaching space which allowed them to explore and redress recognised limitations in knowledge and skill. Patient-educators described their motivation to teach as being driven by a sense of responsibility to their community. Preceptor attitudes may function as a barrier to the effectiveness of this teaching, and further attention should be paid to supporting the education of clinical facilitators in TGD health. CONCLUSION The experiences of TGD patient-educators and medical students in this study suggest that this model of teaching could serve as a transferable template for TGD health and the inclusion of other historically marginalised groups in medical education.
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Affiliation(s)
- Ky Ruprecht
- Medical School, Australian National University, Canberra, ACT 2600, Australia
| | - William Dunlop
- Medical School, Australian National University, Canberra, ACT 2600, Australia
| | - Estee Wah
- Medical School, Australian National University, Canberra, ACT 2600, Australia
| | - Christine Phillips
- School of Medicine and Psychology, Australian National University, Canberra, ACT 2600, Australia
| | - Sarah Martin
- School of Medicine and Psychology, Australian National University, Canberra, ACT 2600, Australia.
- Canberra Sexual Health Centre, Canberra Health Services, Yamba Drive, Garran, ACT 2605, Australia.
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7
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Gonzalez CM, Onumah CM, Walker SA, Karp E, Schwartz R, Lypson ML. Implicit bias instruction across disciplines related to the social determinants of health: a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:541-587. [PMID: 36534295 DOI: 10.1007/s10459-022-10168-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/27/2022] [Indexed: 05/11/2023]
Abstract
One criticism of published curricula addressing implicit bias is that few achieve skill development in implicit bias recognition and management (IBRM). To inform the development of skills-based curricula addressing IBRM, we conducted a scoping review of the literature inquiring, "What interventions exist focused on IBRM in professions related to social determinants of health: education, law, social work, and the health professions inclusive of nursing, allied health professions, and medicine?"Authors searched eight databases for articles published from 2000 to 2020. Included studies: (1) described interventions related to implicit bias; and (2) addressed knowledge, attitude and/or skills as outcomes. Excluded were interventions solely focused on reducing/neutralizing implicit bias. Article review for inclusion and data charting occurred independently and in duplicate. Investigators compared characteristics across studies; data charting focused on educational and assessment strategies. Fifty-one full-text articles for data charting and synthesis, with more than 6568 learners, were selected. Educational strategies included provocative/engagement triggers, the Implicit Association Test, reflection and discussion, and various active learning strategies. Most assessments were self-report, with fewer objective measures. Eighteen funded studies utilized federal, foundation, institutional, and private sources. This review adds to the literature by providing tangible examples of curricula to complement existing frameworks, and identifying opportunities for further research in innovative skills-based instruction, learner assessment, and development and validation of outcome metrics. Continued research addressing IBRM would enable learners to develop and practice skills to recognize and manage their implicit biases during clinical encounters, thereby advancing the goal of improved, equitable patient outcomes.
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Affiliation(s)
- Cristina M Gonzalez
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA.
| | - Chavon M Onumah
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sydney A Walker
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Elisa Karp
- Department of Pediatrics, North Central Bronx Hospital, Bronx, NY, USA
| | | | - Monica L Lypson
- Columbia University Irving Medical Center, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
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McKimm J, Ramani S, Forrest K, Bishop J, Findyartini A, Mills C, Hassanien M, Al-Hayani A, Jones P, Nadarajah VD, Radu G. Adaptive leadership during challenging times: Effective strategies for health professions educators: AMEE Guide No. 148. MEDICAL TEACHER 2023; 45:128-138. [PMID: 35543323 DOI: 10.1080/0142159x.2022.2057288] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Leadership and management are becoming increasingly recognised as vital for high-performing organisations and teams in health professions education. It is often difficult for those embarking on leadership activities (as well as more experienced leaders) to find their way through the volume of literature and generic information on the topic. This guide aims to provide a framework for developing educators' understanding of leadership, management, and followership in the context of health professions education. It explains many relevant approaches to leadership and suggests various strategies through which educators can develop their practice to become more effective.
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Affiliation(s)
- Judy McKimm
- Swansea University Medical School, Wales, UK
- Department of Internal Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Subha Ramani
- Harvard Medical School, Boston, USA
- Massachusetts General Hospital Institute for Health Professions Education, Boston, USE
- Honorary Professor of Medical Education, University of Manchester, Manchester, UK
| | - Kirsty Forrest
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Jo Bishop
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Ardi Findyartini
- Head of Medical Education Unit and Head of Cluster, Centre for Medical Education, Indonesia Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Chloe Mills
- Department of Applied Linguistics, Swansea University, Swansea, UK
| | - Mohammed Hassanien
- Department of Clinical Biochemistry & Medicasl Education, College of Pharmacy Practice, King Abdulaziz University, Jeddah, Saudi Arabia
- College of Medicine, Tanta University, Tanta, Egypt
| | - Abdulmonem Al-Hayani
- Anatomy, Department of Anatomy, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Paul Jones
- Faculty of Medicine & Health Sciences, Swansea University, Swansea, UK
| | - Vishna Devi Nadarajah
- Institutional Development at the International Medical University, Kuala Lumpur, Malaysia
| | - Greg Radu
- Departement of Psychiatry, Memorial University, St. Clare's Hospital, St. John's, Canada
- Department of Health and Community Services, Government of Newfoundland and Labrador, St John's, Canada
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9
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Hernandez R. "It's Always among Us. I Can't Act Like It's Not.": Women College Students' Perceptions of Physicians' Implicit Bias. HEALTH COMMUNICATION 2023; 38:50-60. [PMID: 34036850 DOI: 10.1080/10410236.2021.1932107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Physicians have an opportunity to provide accurate and timely information about sexual behavior to individuals in their care. However, many young people, and in particular college women, are reticent to talk to their physicians about sexual behavior. One explanation for this reticence may be the fact that physicians' implicit bias has the potential to denigrate communication between physicians and patients. However, little is known about how patients perceive physicians' implicit bias, or to what extent it shapes a patient's beliefs about communicating with their physician. Qualitative analysis of in-depth, semi-structured interviews was used to describe and explain the way women college students perceive issues concerning physicians' implicit bias. Results were interpreted through the lens of Communication Privacy Management theory and revealed that participants either avoided or limited communication with a physician as a result of anticipating implicit bias. Major themes included "untangling identity and the effects of physicians' implicit bias" and "seeking to understand physicians' cognition and emotion." These findings have the potential to improve communication interventions both for women college students and healthcare professionals by introducing evidence of patients' perceptions of implicit biases along the intersection of race, young age, sexuality, and female gender in physician-patient communication about sexual behavior.
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Roberts KJ, Omaits E. Evaluation of a Virtual Health Equity Training for Mid-Career Primary Healthcare Providers. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231219614. [PMID: 38116494 PMCID: PMC10729640 DOI: 10.1177/23821205231219614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 11/22/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Providing cultural competence training is recommended as a way to improve patient-centered care and reduce health disparities. Increasing awareness of implicit biases and understanding internal motivations for overcoming these biases can influence provider decisions and communications with patients. This study aims to provide a health equity and implicit bias training to healthcare providers and assess knowledge and attitude gains. METHODS Mid-career primary healthcare providers (n = 21) with at least 5 years of primary care experience participated in the training as a prerequisite for providing patient care in a telehealth primary care practice that overwhelmingly serves patients of color. RESULTS There was a significant increase in knowledge (p < .001) as well as attitudes (p < .001) in healthcare providers from pretest to posttest. Almost none (4.5%) of the providers were distracted during the training, which may be due to the interactive nature of the training that included group-based reflection discussions. CONCLUSION A virtual training for primary healthcare providers on health equity and implicit bias improved knowledge and equitable attitudes and had high satisfaction. Additional research is needed to determine if this type of training can influence providers' ability to actively address known disparities in care.
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Royce CS, Morgan HK, Baecher-Lind L, Cox S, Everett EN, Fleming A, Graziano SC, Sims SM, Morosky C, Sutton J, Sonn T. The time is now: addressing implicit bias in obstetrics and gynecology education. Am J Obstet Gynecol 2022; 228:369-381. [PMID: 36549568 DOI: 10.1016/j.ajog.2022.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/29/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Obstetrician-gynecologists can improve the learning environment and patient care by addressing implicit bias. Accumulating evidence demonstrates that racial and gender-based discrimination is woven into medical education, formal curricula, patient-provider-trainee interactions in the clinical workspace, and all aspects of learner assessment. Implicit bias negatively affects learners in every space. Strategies to address implicit bias at the individual, interpersonal, institutional, and structural level to improve the well-being of learners and patients are needed. The authors review an approach to addressing implicit bias in obstetrics and gynecology education, which includes: (1) curricular design using an educational framework of antiracism and social justice theories, (2) bias awareness and management pedagogy throughout the curriculum, (3) elimination of stereotypical patient descriptions from syllabi and examination questions, and (4) critical review of epidemiology and evidence-based medicine for underlying assumptions based on discriminatory practices or structural racism that unintentionally reinforce stereotypes and bias. The movement toward competency-based medical education and holistic evaluations may result in decreased bias in learner assessment. Educators may wish to monitor grades and narratives for bias as a form of continuous educational equity improvement. Given that practicing physicians may have little training in this area, faculty development efforts in bias awareness and mitigation strategies may have significant impact on learner well-being.
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Affiliation(s)
- Celeste S Royce
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA.
| | - Helen Kang Morgan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Laura Baecher-Lind
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA
| | - Susan Cox
- Department of Medical Education, The University of Texas at Tyler School of Medicine, Tyler, TX
| | - Elise N Everett
- Department of Obstetrics, Gynecology and Reproductive Sciences, Robert Larner College of Medicine, The University of Vermont, Burlington, VT
| | - Angela Fleming
- Department of Obstetrics and Gynecology, Michigan State University College of Osteopathic Medicine, East Lansing, MI
| | - Scott C Graziano
- Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Shireen Madani Sims
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL
| | - Christopher Morosky
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT
| | - Jill Sutton
- Department of Obstetrics and Gynecology, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Tammy Sonn
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO
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Lowe E, Kogan AC, Feldman CT, Ma SB, Lie DA. Preceptors' preparedness to teach about substance and opioid use disorder: a qualitative study. BMC MEDICAL EDUCATION 2022; 22:867. [PMID: 36517790 PMCID: PMC9749622 DOI: 10.1186/s12909-022-03922-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
STUDY AIM Little is known about preceptors' comfort and readiness to teach clinical students about the care of patients with substance and opioid use disorder (SUD/OUD). This study explores preceptors' views about caring for such patients, and their preparedness to teach about SUD/OUD management, to improve graduate competencies. METHODS Participants were recruited by convenience and snowball sampling. Semi-structured interviews were conducted with physician, physician assistant, and nurse practitioner preceptors who taught medical and physician assistant students. Interviews were conducted via Zoom® videoconferencing. Transcripts were generated and independently analyzed for themes by 4 experienced coders using constant comparison and a grounded theory approach. RESULTS Fifteen interviews were conducted to theme saturation. We identified 3 major themes and 10 subthemes supported by exemplar quotes. The major themes were: education about SUD/OUD in primary care (subthemes include need for longitudinal curriculum, redefining 'success' in treatment, and precepting challenges), treatment of SUD/OUD in primary care (need for systemic support and care continuity), and medication-assisted therapy (MAT) training as a tool for teaching (preceptors' own training, and need for clinical students to be trained). CONCLUSIONS Preceptors agreed that treatment of SUD/OUD belongs in primary care and students should learn about SUD/OUD from the start of their medical education. Data analysis enabled the construction of an emerging conceptual framework reflecting a diversity of experiences and opinions of preceptor comfort and preparedness to teach about SUD/OUD, associated with various barriers and motivators. This framework can guide future strategies to address facilitators and obstacles to advance and promote preceptor preparedness to teach students about the care and management of patients with SUD/OUD.
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Affiliation(s)
- Enya Lowe
- Division of Physician Assistant Studies, Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine of USC, University of Southern California, 1000 S. Fremont Avenue Bldg #635, Alhambra, CA 91803 USA
| | - Alexis Coulourides Kogan
- Family Medicine and Gerontology, Department of Family Medicine and Geriatrics, Keck School of Medicine of USC, University of Southern California, Alhambra, USA
| | - Corinne T. Feldman
- Division of Physician Assistant Studies, Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine of USC, University of Southern California, 1000 S. Fremont Avenue Bldg #635, Alhambra, CA 91803 USA
| | - Sae Byul Ma
- Division of Physician Assistant Studies, Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine of USC, University of Southern California, 1000 S. Fremont Avenue Bldg #635, Alhambra, CA 91803 USA
| | - Désirée A. Lie
- Division of Physician Assistant Studies, Primary Care Physician Assistant Program, Department of Family Medicine, Keck School of Medicine of USC, University of Southern California, 1000 S. Fremont Avenue Bldg #635, Alhambra, CA 91803 USA
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Mavis SC, Caruso CG, Dyess NF, Carr CB, Gerberi D, Dadiz R. Implicit Bias Training in Health Professions Education: A Scoping Review. MEDICAL SCIENCE EDUCATOR 2022; 32:1541-1552. [PMID: 36532396 PMCID: PMC9755456 DOI: 10.1007/s40670-022-01673-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 06/17/2023]
Abstract
There is a recurrent call for effective implicit bias (IB) education within health professions education (HPE). We aimed to explore the state of IB education within HPE for clinical learners and IB educators using the Arksey and O'Malley scoping review framework. Thirty publications variable in curricular design met inclusion criteria. No studies assessed learner outcomes at the level of Miller's "shows" or "does" nor reported program evaluation outcomes at the level of Kirkpatrick's "behavior" or "results." Rigorous, theory-guided studies assessing behavioral change, patient care delivery, and patient outcomes are needed to move the field of IB education forward within HPE. Supplementary Information The online version contains supplementary material available at 10.1007/s40670-022-01673-z.
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Affiliation(s)
- Stephanie C. Mavis
- Department of Pediatric and Adolescent Medicine, Division of Neonatal Medicine at Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Catherine G. Caruso
- Department of Pediatrics, Oregon Health and Science University, Portland, OR USA
| | - Nicolle F. Dyess
- Department of Pediatrics, Division of Neonatal Medicine at the University of Colorado, Aurora, CO USA
| | - Cara Beth Carr
- Department of Pediatrics, Division of Neonatology at University Hospitals Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH USA
| | - Dana Gerberi
- Mayo Clinic College of Medicine and Science, Rochester, MN USA
| | - Rita Dadiz
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY USA
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De D, Richardson J. Using cultural safety to enhance nursing care for children and young people. Nurs Child Young People 2022; 34:36-42. [PMID: 35781531 DOI: 10.7748/ncyp.2022.e1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 06/15/2023]
Abstract
People from minority groups frequently experience adversity in various aspects of their lives, including when accessing healthcare services. Culture has a significant role in all healthcare encounters between nurses, multidisciplinary teams, and children and young people and their families. This article defines culture and explains the importance of considering people's cultural values, beliefs and practices when providing care. It outlines the principles of cultural safety - an approach that incorporates ideas such as cultural awareness, sensitivity and competence - and describes how it can enhance the care of children and young people from a wide range of backgrounds.
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Affiliation(s)
- Diana De
- College of Biomedical and Life Sciences, Cardiff University, Cardiff, Wales
| | - Jim Richardson
- Children and Young Persons Nursing, Kingston University and St George's, University of London, London, England
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15
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Parsons A, Mojtahedi D. Can jurors be biased in their evaluation of third-party evidence within cases of rape? INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2022; 85:101837. [PMID: 36122514 DOI: 10.1016/j.ijlp.2022.101837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 08/24/2022] [Accepted: 09/07/2022] [Indexed: 06/15/2023]
Abstract
Prior research has indicated that beliefs in rape myths can influence juror decision making in cases involving sexual assault, however, the phenomenon has been typically examined in relation to victim and defendant believability, as well as final verdicts. The current study observed mock jurors' evaluations of third-party witness evidence in alleged rape cases to determine whether these judgements were influenced by inherent rape myths. Participants (N = 196) took part in a mock juror experiment that included evidence from an eyewitness that was either in support of the defence, prosecution, or neutral. We found that males and individuals holding strong beliefs in rape myths were more likely to find defendants 'not guilty'. Additionally, participants endorsing rape myths were also more likely to view eyewitness evidence favourably, but only when it was in support of the defence. Our findings suggest that personal biases can influence the level of credence jurors place on case evidence, potentially through a confirmation bias.
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Affiliation(s)
- Ashleigh Parsons
- Centre for Cognition and Neuroscience, University of Huddersfield, Department of Psychology, Huddersfield, UK
| | - Dara Mojtahedi
- Centre for Cognition and Neuroscience, University of Huddersfield, Department of Psychology, Huddersfield, UK.
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Gleicher ST, Chalmiers MA, Aiyanyor B, Jain R, Kotha N, Scott K, Song RS, Tram J, Vuong CL, Kesselheim J. Confronting implicit bias toward patients: a scoping review of post-graduate physician curricula. BMC MEDICAL EDUCATION 2022; 22:696. [PMID: 36175856 PMCID: PMC9520104 DOI: 10.1186/s12909-022-03720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Physicians' behavior may unknowingly be impacted by prejudice and thereby contribute to healthcare inequities. Despite increasingly robust data demonstrating physician implicit bias (The Office of Minority Health. Minority Population Profiles, 2021; COVID-19 Shines Light on Health Disparities, National Conference of State Legislatures 2021), the evidence behind how to change this with training programs remains unclear. This scoping review therefore reports on the implementation, outcomes, and characteristics of post-graduate physician implicit bias curricula. METHODS The authors conducted a literature review using scoping review methodology. They searched 7 databases in February and November 2020 for English-language academic and gray literature on implicit bias curricula for physicians at all levels of post-graduate training. Ten reviewers screened studies for eligibility independently, then extracted data from these studies and compiled it into a chart and analytical summary. RESULTS Of the 4,599 articles screened, this review identified 90 articles on implicit bias interventions for post-graduate physicians. Inductive data analysis revealed a spectrum of educational approaches, which were categorized int o 4 educational models called Competence, Skills-Based, Social Contact, and Critical Models. The most commonly reported strength was the interactive nature of the curricula (26%), and the most frequently identified challenges were related to time and resources available (53%). Half of the interventions discussed facilitator preparation, and the majority (62%) evaluated outcomes using pre and post self-assessments. CONCLUSIONS This review provides a comprehensive synthesis of the literature on physician implicit bias curricula. It is our goal that this supports medical educators in applying and improving aspects of these interventions in their own programs.
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Affiliation(s)
- S T Gleicher
- Neurology, University of Washington, Seattle, USA.
| | - M A Chalmiers
- School of Medicine, University of California San Diego, San Diego, USA
| | - B Aiyanyor
- Pediatric Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, USA
| | - R Jain
- Pediatric Hematology/Oncology, University of California San Francisco, San Francisco, USA
| | - N Kotha
- School of Medicine, University of California San Diego, San Diego, USA
| | - K Scott
- Neonatal Intensive Care, Children's Hospital of Philadelphia, Philadelphia, USA
| | | | - J Tram
- School of Medicine, University of California San Diego, San Diego, USA
| | - C L Vuong
- Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, USA
| | - J Kesselheim
- DFCI/BCH Cancer and Blood Disorders Center, Harvard Medical School, Boston, USA
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Gill AC, Zhou Y, Greely JT, Beasley AD, Purkiss J, Juneja M. Longitudinal outcomes one year following implicit bias training in medical students. MEDICAL TEACHER 2022; 44:744-751. [PMID: 35021935 DOI: 10.1080/0142159x.2021.2023120] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Training in implicit bias is broadly recognized as important in medical education and is mandated by some accrediting bodies. This study examined medical students' retention of concepts immediately following and one-year post participation in an implicit bias workshop. METHODS Study subjects were 272 third-year medical students who participated in workshops held between 2018-2020 that used the Implicit Associations Test (IAT) as a trigger for discussions in small groups. We developed a survey and administered it to students to capture their awareness of implicit bias pre-, post-, and one-year post-workshop attendance. Repeated Measures Analyses and independent-samples t-tests were used to examine for differences in responses on each of the seven survey items and a tabulated 7-item average of these seven items. RESULTS Six of seven survey items and the tabulated 7-item average examined by Repeated Measures Analyses showed statistically significant increases between the pre-, post-, and one-year post-surveys (ps range: 0.01-0.07), with a small to moderate effect sizes (ƞp2s range: 0.01-0.07). Pairwise comparisons among these three surveys' results indicated statistically significant improvements between the pre- and the post-workshop surveys (ps range: 0.01-0.03) but no statistically significant differences between the post- and the one-year post-workshop surveys (ps range: 0.57-0.99). A separate sample of 17 off-cycle students who took the one-year post- workshop survey two years after the workshop did not differ statistically on the level of awareness of bias compared to those taking the same survey one year later, as examined by the two-group independent t-tests for the seven one-year post-workshop survey items (ps range: 0.56-0.99). CONCLUSIONS The findings support one-year retention of knowledge and attitudes gained from an implicit bias workshop and suggest similar retention at two years. Future educational interventions that train learners to recognize and manage implicit and explicit behaviors in clinical practice are needed.
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Affiliation(s)
- Anne C Gill
- Department of Pediatrics, and Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Yuanyuan Zhou
- Senior Data Analyst in the Division of Evaluation, Assessment and Education Research, and Instructor in the Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jocelyn T Greely
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Anitra D Beasley
- Department of Obstetrics & Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Joel Purkiss
- Assessment and Educational Research, and Assistant Professor, Department of Education, Innovation, and Technology, Baylor College of Medicine, Houston, TX, USA
| | - Malvika Juneja
- Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
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Hsu PT, Chen JJ, Ho YF. The effects of narrative pedagogy on increasing nursing students' willingness to practice older people care: A mixed-methods research. Nurse Educ Pract 2022; 62:103356. [DOI: 10.1016/j.nepr.2022.103356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/29/2022] [Accepted: 04/23/2022] [Indexed: 11/30/2022]
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Javier D, Solis LG, Paul MF, Thompson EL, Maynard G, Latif Z, Stinson K, Ahmed T, Vishwanatha JK. Implementation of an unconscious bias course for the National Research Mentoring Network. BMC MEDICAL EDUCATION 2022; 22:391. [PMID: 35597975 PMCID: PMC9124381 DOI: 10.1186/s12909-022-03466-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 05/16/2022] [Indexed: 05/07/2023]
Abstract
PURPOSE Increased awareness and mitigation of one's unconscious bias is a critical strategy in diversifying the Science, Technology, Engineering, Mathematics, and Medicine (STEMM) disciplines and workforce. Greater management of unconscious bias can enhance diverse recruitment, persistence, retention, and engagement of trainees. The purpose of this study was to describe the implementation of an asynchronous course on unconscious bias for people in STEMM. Specifically, we explored who engaged with the course and reflections from participation. METHOD A five-part, asynchronous Unconscious Bias Course was developed and was hosted on a national mentoring platform starting in July 2020. To examine course engagement, we assessed the demographics of course participants and completion. Participant responses to reflection questions after each module were also synthesized using qualitative methods. RESULTS Overall, 977 people registered for the course and 42% completed all modules. In the reflection responses, participants reflected on their unconscious biases in their lived experiences and how it relates to actions, judgements, external factors, stereotypes, and un-intentionality. Participants also reflected on microaggressions, their impact on the recipients and others, and the relationship between microaggressions and unconscious bias. Participants reported four key strategies used by allies against unconscious bias: immediately acting (83%), reflection (46%), improving the organizational culture (30%), and individual-level ally-ship (44%). Strategies for self-awareness included: reflection, pausing/breathing, and self-observation. CONCLUSION The assessment of the Unconscious Bias Course implementation revealed the course reached a wide cross-section of people in STEMM and demonstrated that participants were able to reflect on the underpinnings of the course. This course, and its suite of offerings, support a nationwide effort to mitigate bias and prepare individuals to be culturally competent in a diverse society in order to foster a STEMM environment that caters to individuals' success and diversification of these fields.
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Affiliation(s)
- Damaris Javier
- Institute for Health Disparities, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
| | - Linda Grace Solis
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, USA
| | - Mirabelle Fernandes Paul
- Western University of Health Sciences, United States and College of Osteopathic Medicine of the Pacific-Northwest, Lebanon, Oregon , USA
| | - Erika L Thompson
- Institute for Health Disparities, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, USA
| | - Grace Maynard
- Institute for Health Disparities, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Zainab Latif
- Vanderbilt University Medical Center, Nashville, USA
| | - Katie Stinson
- Institute for Health Disparities, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Toufeeq Ahmed
- Vanderbilt University Medical Center, Nashville, USA
| | - Jamboor K Vishwanatha
- Institute for Health Disparities, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
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Turnock A, Langley K, Jones CR. Understanding Stigma in Autism: A Narrative Review and Theoretical Model. AUTISM IN ADULTHOOD 2022; 4:76-91. [PMID: 36605561 PMCID: PMC8992913 DOI: 10.1089/aut.2021.0005] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The experience of stigma by autistic people is relatively understudied, despite contributing to a range of poor outcomes and having an overarching impact on well-being. The current review of the literature synthesizes research to determine what is currently known and presents a theoretical model of autism stigma. Autism stigma is primarily influenced by a public and professional understanding of autism in combination with interpretation of visible autistic traits. Moderating factors include the quality and quantity of contact with autistic people, cultural factors, sex and gender, individual differences, and diagnostic disclosure. Stigma can reduce well-being as well as increase the presence of camouflaging behaviors, which mask autistic traits. Caregivers of autistic people can experience stigma by association, that is, affiliate stigma, which can impact their own well-being. A variety of interventions and approaches to reduce stigma are discussed, including "autism friendly" spaces, positive media representation, educational and psychosocial training for the public and professionals, as well as cultural and systemic shifts that foster inclusivity and recognize neurodiversity.
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Affiliation(s)
- Alice Turnock
- School of Medicine, Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Kate Langley
- Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Catherine R.G. Jones
- Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom
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Desired student characteristics for hand therapy clinical placements: A mixed method study. J Hand Ther 2022; 36:221-227. [PMID: 35034805 DOI: 10.1016/j.jht.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Mixed method design. INTRODUCTION Conceptualizing the desired characteristics of a student for a clinical site is vital information during the matching process. PURPOSE OF THE STUDY The objective of this study was to identify the specific student characteristics preferred by the hand therapy clinician educator. METHODS A questionnaire was emailed to members of the American Society of Hand Therapists. A semi structured interview was developed to investigate the topic further. Data was collected and analyzed to determine descriptive statistics and themes regarding the preferred student characteristics. RESULTS The most common themes found regarding desired student characteristics by hand therapists were students that possess strong interpersonal skills, a willingness to self-study and learn independently, and students that exhibit professional behaviors. DISCUSSION If students are successfully matched to clinical placements, this may encourage sites to take students in the future and also reduce the need for the clinical educator or university to address problems that arise during the experience. CONCLUSION Hand therapy clinical educators desire students with strong interpersonal skills, a willingness to self-study and learn independently, demonstrate professionalism and clinical reasoning skills, who possess a sincere interest in hand therapy and demonstrate cultural competence when interacting with patients from different backgrounds and social environments. Finally, hand therapy clinical educators want students to be honest about what they know and what they don't know regarding hand therapy.
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Zhou Y, Purkiss J, Juneja M, Greely J, Beasley A, Gill A. Dataset: Knowledge and attitude retention following an implicit bias classroom workshop. F1000Res 2022; 11:25. [PMID: 35265323 PMCID: PMC8874035 DOI: 10.12688/f1000research.74442.1] [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] [Accepted: 12/21/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Baylor College of Medicine provides a classroom-based implicit bias workshop to all third-year medical students to increase students' awareness of their unconscious bias and develop strategies for reducing health care disparities. The workshop meets our immediate goals and objectives. However, we are unsure if the benefit would be long-term or diminish over time. Methods: To examine the concept retention from the implicit bias classroom workshop, we administered a self-developed seven-item seven-point Likert-scale survey to our medical students at pre-, post-, and one-year post-workshop attendance. Results: The data set was comprised of survey results from two cohorts of our third and fourth-year medical students from 2018 to 2020 and included 289 completed records at three measurement points. The data included: Student Identifiers, Sex, Race/Ethnicity, Student Enrollment Type, Cohort, and three repeated measures results for each of the seven items, which were documented in wide format. The data may be of interest to those who wish to examine how factors including elapsed time, race, and sex may associate with attitudes and understandings of implicit bias following related training, and those interested in analytical methods on longitudinal research in general.
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Affiliation(s)
- Yuanyuan Zhou
- Division of Evaluation, Assessment, and Education Research, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, 77030, USA
- Department of Education, Innovation, and Technology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, 77030, USA
| | - Joel Purkiss
- Division of Evaluation, Assessment, and Education Research, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, 77030, USA
- Department of Education, Innovation, and Technology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, 77030, USA
| | - Malvika Juneja
- Department of Family and Community Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, 77030, USA
| | - Jocelyn Greely
- Department of Obstetrics & Gynecology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, 77030, USA
| | - Anitra Beasley
- Department of Obstetrics & Gynecology, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, 77030, USA
| | - Anne Gill
- Department of Pediatrics, Baylor College of Medicine, One Baylor Plaza, Houston, Texas, 77030, USA
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Dhanani LY, Harris EL, Mirto J, Franz B. Barriers to Working with Patients Who Misuse Opioids and Physician Burnout: Implications for Medical Education. Subst Use Misuse 2022; 57:1177-1184. [PMID: 35473470 DOI: 10.1080/10826084.2022.2069264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Physicians are on the front lines of the U.S. opioid epidemic, providing care in multiple treatment settings. Very little is known, however, about whether this experience has contributed to physician burnout. This information is critical for guiding efforts to expand the relatively low level of training on opioid misuse currently available in medical education. METHODS We surveyed 408 board-certified physicians practicing in Ohio about their experiences working with patients who misuse opioids. We also collected quantitative measures of physicians' burnout and their level of contact with this patient population. We coded and analyzed open-ended responses and calculated a partial correlation between contact and burnout, controlling for relevant factors. RESULTS Physicians experienced three primary barriers when working with patients who misuse opioids: inadequate knowledge and training, limited external resources and partnerships in their communities, and an incomplete context for understanding problematic patient behaviors. 70% of physicians experienced negative emotions when working with this patient population and 19% mentioned experiencing burnout specifically. Contact with patients who misuse opioids was significantly and positively associated with burnout scores. CONCLUSIONS Our findings underscore the need for medical educators to take a proactive approach to equipping physicians with the knowledge, skills, and resources needed to effectively work with patients who misuse opioids.
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Affiliation(s)
| | - Emily L Harris
- OMS-III, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
| | - Jordan Mirto
- OMS-III, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
| | - Berkeley Franz
- Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
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Prasad-Reddy L, Fina P, Kerner D, Daisy-Bell B. The Impact of Implicit Biases in Pharmacy Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2022; 86:8518. [PMID: 35074855 PMCID: PMC8787172 DOI: 10.5688/ajpe8518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/23/2021] [Indexed: 06/14/2023]
Affiliation(s)
| | - Paul Fina
- Chicago State University, College of Pharmacy, Chicago, Illinois
| | - Daniel Kerner
- Chicago State University, College of Pharmacy, Chicago, Illinois
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Gonzalez CM, Lypson ML, Sukhera J. Twelve tips for teaching implicit bias recognition and management. MEDICAL TEACHER 2021; 43:1368-1373. [PMID: 33556288 PMCID: PMC8349376 DOI: 10.1080/0142159x.2021.1879378] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Implicit biases describe mental associations that affect our actions in an unconscious manner. We can hold certain implicit biases regarding members of certain social groups. Such biases can perpetuate health disparities by widening inequity and decreasing trust in both healthcare and medical education. Despite the widespread discourse about bias in medical education, teaching and learning about the topic should be informed by empirical research and best practice. In this paper, the authors provide a series of twelve tips for teaching implicit bias recognition and management in medical education. Each tip provides a specific and practical strategy that is theoretically and empirically developed through research and evaluation. Ultimately, these twelve tips can assist educators to incorporate implicit bias instruction across the continuum of medical education to improve inequity and advance justice.
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Affiliation(s)
- Cristina M Gonzalez
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Monica L Lypson
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington D.C, USA
- Medicine and Learning health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Javeed Sukhera
- Departments of Psychiatry/Paediatrics and Scientist, Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry Western University Canada, London, Canada
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Developing Cultural Awareness Curricular Competencies for Humanitarian Non-Governmental Organization Staff. Prehosp Disaster Med 2021; 36:669-675. [PMID: 34593079 DOI: 10.1017/s1049023x21000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cultural awareness is an important part of organizational success when interacting with multiple cultures. Research has shown a dearth of standardized cultural awareness training programs for non-governmental humanitarian organization staff. PURPOSE This study aims to develop an expert-consensus set of cultural awareness competencies as the basis for development of humanitarian staff cultural awareness trainings. METHODS A modified Delphi process was selected. The first round of surveys collected a list of cultural awareness competencies from experts in the fields of non-governmental organization (NGO) operations and cultural awareness education and research. This collated list of competencies was then used as the basis of a survey obtaining ratings by the group on a five-point Likert scale. Competencies which achieved an average rating of 4.0 or higher were considered to be "important" for inclusion in future training programs. RESULTS A total of 67.9% of contacted experts agreed to participate, with 84.2% of those completing all rounds of the survey. This group developed a list of ten competencies, including: Cultural Awareness/Sensitivity and Intercultural Communication; Cultural Intelligence; Unconscious Bias/Diversity Awareness; a Universal Declaration of Ethical Principles; Gender and Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual Identities (LGBTQ+) Issues and Safety; Analytical and Critical Thinking Skills; Negotiation; Program Mission; Power Dynamics; and Empathy. CONCLUSIONS This study defined a set of ten expert-consensus cultural awareness competencies which can be a basis for future NGO staff training. Future work can both use these competencies to create educational programs and further define and expand the set of competencies based on analyses of their implementation.
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Pidgeon H, McKinney D, Tan-Creevy J, Shah M, Ansari S, Gottlieb M. Thinking Beyond the Emergency Department: Addressing Homelessness in Residency Education. Ann Emerg Med 2021; 79:397-403. [PMID: 34607743 DOI: 10.1016/j.annemergmed.2021.07.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Harrison Pidgeon
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL.
| | - Dennis McKinney
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Jeny Tan-Creevy
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Meeta Shah
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Sobia Ansari
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
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Chohan N, Arzoky Z, Khan N. Twelve tips for incorporating migrant and ethnic minorities in the medical curriculum and healthcare. MEDICAL TEACHER 2021; 43:1122-1126. [PMID: 33136470 DOI: 10.1080/0142159x.2020.1841129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Migrant and ethnic communities face several challenges within healthcare systems as patients, physicians and medical students. For health inequalities to be addressed, changes need to be made within our healthcare systems, starting from how the medical curriculum is taught to prospective clinicians. In this article, we present twelve ways to challenge the difficulties migrant and ethnic minorities face in healthcare by incorporating patient, physician and medical student factors into the medical school curriculum and healthcare, in a hope to change outcomes for our widely diverse population of patients and colleagues.
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Gulati S, Shrimpton C. A long and winding road: non-traditional routes into medical leadership. BMJ LEADER 2021; 6:168-170. [DOI: 10.1136/leader-2021-000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/07/2021] [Indexed: 11/03/2022]
Abstract
IntroductionClinicians enter the medical profession through a variety of routes. This paper explores how non-traditional routes into the medical profession can follow through into subsequent medical leadership practice, influencing issues of confidence, self-image and assumptions about leadership as a concept.MethodThe first-person reflections of a doctor who entered the profession and the National Health Service from the German system and with a non-standard background are considered. We then discuss how those involved in leadership education can use diversity as a developmental tool. The article starts and ends with personal reflections and observations from a Consultant Opthalmologist, interposed with insights from the pedagogy of leadership development by a University academic.ConclusionsWe conclude that medical leadership development can be enriched through recognising the value that non-traditional routes in clinical leadership can bring, and that educators can use the leverage of difference and diversity to create positive loops of development activity.
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Vora S, Dahlen B, Adler M, Kessler DO, Jones VF, Kimble S, Calhoun A. Recommendations and Guidelines for the Use of Simulation to Address Structural Racism and Implicit Bias. Simul Healthc 2021; 16:275-284. [PMID: 34398114 DOI: 10.1097/sih.0000000000000591] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
SUMMARY STATEMENT Simulation-based education is a particularly germane strategy for addressing the difficult topic of racism and implicit bias due to its immersive nature and the paradigm of structured debriefing. Researchers have proposed actionable frameworks for implicit bias education, particularly outlining the need to shift from recognition to transformation, with the goal of changing discriminatory behaviors and policies. As simulation educators tasked with training health care professionals, we have an opportunity to meet this need for transformation. Simulation can shift behaviors, but missteps in design and implementation when used to address implicit bias can also lead to negative outcomes. The focus of this article is to provide recommendations to consider when designing simulation-based education to specifically address racism and implicit bias.
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Affiliation(s)
- Samreen Vora
- From the Simulation Program (S.V.), Children's Minnesota, Minneapolis, MN; Center for Professional Development and Practice (B.D.), Children's Minnesota, Minneapolis, MN; Department of Pediatrics and Medical Education (M.A.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Emergency Medicine (D.K.), Columbia University Vagelos College of Physicians and Surgeons, New York City, NY; Department of Pediatrics (V.F.J.), University of Louisville, Louisville, KY; Division of Education and Training (S.K.), The University of Texas MD Anderson Cancer Center, Houston, TX; and Department of Pediatricsa (A.C.), University of Louisville, Norton Children's Hospital, Louisville, KY
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Papanagnou D, Klein MR, Zhang XC, Cameron KA, Doty A, McCarthy DM, Rising KL, Salzman DH. Developing standardized patient-based cases for communication training: lessons learned from training residents to communicate diagnostic uncertainty. Adv Simul (Lond) 2021; 6:26. [PMID: 34294153 PMCID: PMC8296470 DOI: 10.1186/s41077-021-00176-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/18/2021] [Indexed: 12/01/2022] Open
Abstract
Health professions education has benefitted from standardized patient (SP) programs to develop and refine communication and interpersonal skills in trainees. Effective case design is essential to ensure an SP encounter successfully meets learning objectives that are focused on communication skills. Creative, well-designed case scenarios offer learners the opportunity to engage in complex patient encounters, while challenging them to address the personal and emotional contexts in which their patients are situated. Therefore, prior to considering the practical execution of the patient encounter, educators will first need a clear and structured strategy for writing, organizing, and developing cases. The authors reflect on lessons learned in developing standardized patient-based cases to train learners to communicate to patients during times of diagnostic uncertainty, and provide suggestions to develop a set of simulation cases that are both standardized and diverse. Key steps and workflow processes that can assist educators with case design are introduced. The authors review the need to increase awareness of and mitigate existing norms and implicit biases, while maximizing variation in patient diversity. Opportunities to leverage the breadth of emotional dispositions of the SP and the affective domain of a clinical encounter are also discussed as a means to guide future case development and maximize the value of a case for its respective learning outcomes.
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Affiliation(s)
- Dimitrios Papanagnou
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut Street, College Building, Suite 100, Room 101, Philadelphia, PA, 19107, USA.
| | - Matthew R Klein
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Xiao Chi Zhang
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut Street, College Building, Suite 100, Room 101, Philadelphia, PA, 19107, USA
| | - Kenzie A Cameron
- Division of General Internal Medicine and Geriatrics/Department of Medicine and Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amanda Doty
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Danielle M McCarthy
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristin L Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut Street, College Building, Suite 100, Room 101, Philadelphia, PA, 19107, USA
| | - David H Salzman
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Gonzalez CM, Walker SA, Rodriguez N, Noah YS, Marantz PR. Implicit Bias Recognition and Management in Interpersonal Encounters and the Learning Environment: A Skills-Based Curriculum for Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11168. [PMID: 34277934 PMCID: PMC8275619 DOI: 10.15766/mep_2374-8265.11168] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 05/05/2021] [Indexed: 05/21/2023]
Abstract
Introduction Students desire instruction in skill development to address both their own implicit biases and bias perceived in the learning environment. Curricula to date achieve strategy identification through reflection and discussion but do not provide opportunity for personally relevant skill development and practice in implicit bias recognition and management. To address this gap, we developed and evaluated a skills-based elective in implicit bias recognition and management focused on learners' own interpersonal interactions, including patient encounters, and perceived bias in the learning environment. Method Fifteen first-year medical students completed the nine-session elective over three annual offerings. Each session lasted 1.5 hours. Curriculum development was informed by published frameworks and transformative learning theory. Direct observation of student performances in role-plays and other active learning exercises constituted the formative assessment. Program evaluation focused on the impact of instruction through pre- and posttests, along with analysis of notes taken by the investigative team, including notes on formative assessments. Results Students engaged with all aspects of instruction, including role-plays. Pretest/posttest results demonstrated increased self-reported knowledge and comfort in addressing perceived bias. Formative assessment demonstrated students' skill development in safely and respectfully addressing perceived bias in the learning environment without endangering their relationships with supervisors. Discussion Skills developed-addressing bias in interpersonal encounters and perceived bias in clinical and teaching encounters-are relevant to learners throughout their careers. This course is relevant to medical students and trainees at various experience levels and could serve as a template for novel, skills-based curricula across health professions.
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Affiliation(s)
- Cristina M. Gonzalez
- Professor, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center
| | - Sydney A. Walker
- Medical Student, Oregon Health & Science University School of Medicine
| | - Natalia Rodriguez
- Medical Student, Perelman School of Medicine at the University of Pennsylvania
| | | | - Paul R. Marantz
- Associate Dean for Clinical Research Education and Professor, Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine
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Sra MS. Learnings from the pandemic: A medical student's perspective. THE NATIONAL MEDICAL JOURNAL OF INDIA 2021; 34:249. [PMID: 35112533 DOI: 10.25259/nmji_441_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Manraj Singh Sra
- All India Institute of Medical Sciences, New Delhi, India Correspondence to 525, Model Town, Phase-1, Bathinda 151001, Punjab, India
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Lagunes-Cordoba E, Davalos A, Fresan-Orellana A, Jarrett M, Gonzalez-Olvera J, Thornicroft G, Henderson C. Mental Health Service Users' Perceptions of Stigma, From the General Population and From Mental Health Professionals in Mexico: A Qualitative Study. Community Ment Health J 2021; 57:985-993. [PMID: 32892303 PMCID: PMC8131298 DOI: 10.1007/s10597-020-00706-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 08/26/2020] [Indexed: 11/28/2022]
Abstract
Negative attitudes towards people with mental health disorders have been widely studied and identified in the general population, and even within health care professionals. Moreover, studies focused on service users have also identified mental health professionals, including psychiatrists, as a source of stigma. However, in Mexico and Latin America few studies have been conducted addressing this issue. To explore mental health service users' perceptions of stigma by members of the general population and by psychiatrists in Mexico, service users at a psychiatric hospital in Mexico were invited to participate in either focus groups or individual interviews, which were audio recorded, transcribed and analysed using thematic analysis. A total of 47 service users participated in this study. The results suggested that participants were not only aware of the possible consequences of mental health related stigma, but they have also experienced stigmatisation for having a mental illness. Participants also considered psychiatrists can hold negative attitudes towards people with mental illness, something that can represent a barrier for them to have optimal quality of care. Therefore, participants agreed that these attitudes should be addressed to improve the care they received from these professionals. This study suggests that, like members of the general population, psychiatrists are also considered as a source of stigma by people with mental illness in Mexico. These findings not only add to previous work conducted in Mexico and other countries, they also confirm the importance of addressing negative attitudes in this group of health professionals.
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Affiliation(s)
- Emmeline Lagunes-Cordoba
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Alan Davalos
- Instituto Nacional de Psiquiatría "Ramón de La Fuente Muñíz", Mexico City, Mexico
| | - Ana Fresan-Orellana
- Instituto Nacional de Psiquiatría "Ramón de La Fuente Muñíz", Mexico City, Mexico
| | | | | | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Claire Henderson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.,Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Gonzalez CM, Nava S, List J, Liguori A, Marantz PR. How Assumptions and Preferences Can Affect Patient Care: An Introduction to Implicit Bias for First-Year Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11162. [PMID: 34263027 PMCID: PMC8236500 DOI: 10.15766/mep_2374-8265.11162] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 04/04/2021] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Instruction in implicit bias is becoming prevalent across the spectrum of medical training. Little education exists for preclinical students, and guidance for faculty to facilitate such education is minimal. To address these gaps, we designed and delivered a single session for incoming first-year medical students and developed a facilitator training program. METHODS One faculty member delivered a 1-hour, multimedia, interactive lecture to all first-year medical students. Students subsequently met in small groups with trained facilitators. Activities included reflection, guided debriefing, and strategy identification to become aware of when they might be making an assumption causing them to jump to a conclusion about someone. The program evaluation consisted of aggregated student strategies and facilitator feedback during postsession debriefs, both analyzed through thematic analysis. RESULTS We delivered instruction to 1,098 students. Student strategies resulted in three themes: (1) humility, (2) reflection, and (3) partnering. The postsession debriefs uncovered opportunities to enhance the session. Lessons learned included presenting material to an entire class at once, allowing students to engage in dynamic discussion in the small groups, eliminating anonymous polling in the small groups, and highlighting management of implicit bias as essential to professional development. DISCUSSION Our instructional design enabled first-year medical students to identify at least one strategy to use when implicit biases are activated. The large-group session was deliverable by one faculty member, and volunteers successfully facilitated small-group sessions after only one training session, making this model a feasible innovation to reach an entire medical school class at the same time.
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Affiliation(s)
- Cristina M. Gonzalez
- Professor, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine
| | - Stephanie Nava
- Research Assistant, Department of Medicine, Albert Einstein College of Medicine
| | - Julie List
- Principal Associate, Department of Family and Social Medicine, Albert Einstein College of Medicine
| | - Alyssa Liguori
- Research Assistant, Department of Medicine, Albert Einstein College of Medicine
| | - Paul R. Marantz
- Professor, Department of Epidemiology and Population Health, Albert Einstein College of Medicine; Professor, Department of Medicine, Albert Einstein College of Medicine; Associate Dean for Clinical Research Education, Albert Einstein College of Medicine
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Rodriguez N, Kintzer E, List J, Lypson M, Grochowalski JH, Marantz PR, Gonzalez CM. Implicit Bias Recognition and Management: Tailored Instruction for Faculty. J Natl Med Assoc 2021; 113:566-575. [PMID: 34140145 DOI: 10.1016/j.jnma.2021.05.003] [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: 02/08/2021] [Revised: 04/18/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implicit bias instruction is becoming more prevalent across the continuum of medical education. Little guidance exists for faculty on recognizing and debriefing about implicit bias during routine clinical encounters. OBJECTIVE To assess the impact and feasibility of single seminars on implicit bias and the approach to its management in clinical settings. METHODS Between September 2016 and November 2017, the authors delivered five departmental/divisional grand rounds across three different academic medical centers in New York, USA. Instruction provided background information on implicit bias, highlighted its relevance to clinical care, and discussed proposed interventions. To evaluate the impact of instruction participants completed a twelve-item retrospective pre-intervention/post-intervention survey. Questions related to comfort and confidence in recognizing and managing implicit bias, debriefing with learners, and role-modeling behaviors. Participants identified strategies for recognizing and managing potentially biased events through free text prompts. Authors qualitatively analyzed participants' identified strategies. RESULTS We received 116 completed surveys from 203 participants (57% response rate). Participants self-reported confidence and comfort increased for all questions. Qualitative analysis resulted in three themes: looking inward, looking outward, and taking action at individual and institutional levels. CONCLUSION After a single session, respondents reported increased confidence and comfort with the topic. They identified strategies relevant to their professional contexts which can inform future skills-based interventions. For healthcare organizations responding to calls for implicit bias training, this approach has great promise. It is feasible and can reach a wide audience through usual grand rounds programming, serving as an effective early step in such training.
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Affiliation(s)
- Natalia Rodriguez
- Perelman School of Medicine, University of Pennsylvania, United States
| | - Emily Kintzer
- Department of Obstetrics and Gynecology, Montefiore Medical Center, United States
| | - Julie List
- Department of Family and Social Medicine, Albert Einstein College of Medicine, United States
| | - Monica Lypson
- F. Edward Hébert School of Medicine, George Washington University School of Medicine and Health Sciences, University of Michigan Medical School, Uniformed Services University of the Health Sciences, United States
| | | | - Paul R Marantz
- Department of Epidemiology & Population Health, Department of Medicine, Albert Einstein College of Medicine, United States
| | - Cristina M Gonzalez
- Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, United States.
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Gonzalez CM, Noah YS, Correa N, Archer-Dyer H, Weingarten-Arams J, Sukhera J. Qualitative analysis of medical student reflections on the implicit association test. MEDICAL EDUCATION 2021; 55:741-748. [PMID: 33544914 PMCID: PMC8119345 DOI: 10.1111/medu.14468] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Health professions educators use the Implicit Association Test (IAT) to raise awareness of implicit bias in learners, often engendering strong emotional reactions. Once an emotional reaction ensues, the gap between learner reaction and strategy identification remains relatively underexplored. To better understand how learners may identify bias mitigation strategies, the authors explored perspectives of medical students during the clinical portion of their training to the experience of taking the IAT, and the resulting feedback. METHODS Medical students in Bronx, NY, USA, participated in one 90-minute session on implicit bias. The focus of analysis for this study is the post-session narrative assignment inviting them to take the race-based IAT and describe both their reaction to and the implications of their IAT results on their future work as physicians. The authors analysed 180 randomly selected de-identified essays completed from 2013 to 2019 using an approach informed by constructivist grounded theory methodology. RESULTS Medical students with clinical experience respond to the IAT through a continuum that includes their reactions to the IAT, acceptance of bias along with a struggle for strategy identification, and identification of a range of strategies to mitigate the impact of bias on clinical care. Results from the IAT invoked deep emotional reactions in students, and facilitated a questioning of previous assumptions, leading to paradigm shifts. An unexpected contrast to these deep and meaningful reflections was that students rarely chose to identify a strategy, and those that did provided strategies that were less nuanced. CONCLUSION Despite accepting implicit bias in themselves and desiring to provide unbiased care, students struggled to identify bias mitigation strategies, a crucial prerequisite to skill development. Educators should endeavour to expand instruction to bridge the chasm between students' acceptance of bias and skill development in management of bias to improve the outcomes of their clinical encounters.
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Affiliation(s)
- Cristina M Gonzalez
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Yuliana S Noah
- Department of Pediatrics, Jacobi Medical Center, Bronx, NY, USA
| | - Nereida Correa
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine and Jacobi Medical Center, Bronx, NY, USA
| | - Heather Archer-Dyer
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Javeed Sukhera
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Stewart JH, Butler PD, Tseng JF, Kennard AC, Mellinger JD, Buyske J. Acknowledgment, Reflection, and Action: The American Board of Surgery Leans into Antiracism. Ann Surg 2021; 273:619-622. [PMID: 33351484 DOI: 10.1097/sla.0000000000004684] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- John H Stewart
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Paris D Butler
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Jennifer F Tseng
- Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
| | | | - John D Mellinger
- Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Jo Buyske
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- American Board of Surgery, Philadelphia, Pennsylvania
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Samanta D, Singh R, Gedela S, Scott Perry M, Arya R. Underutilization of epilepsy surgery: Part II: Strategies to overcome barriers. Epilepsy Behav 2021; 117:107853. [PMID: 33678576 PMCID: PMC8035223 DOI: 10.1016/j.yebeh.2021.107853] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 12/12/2022]
Abstract
Interventions focused on utilization of epilepsy surgery can be divided into groups: those that improve patients' access to surgical evaluation and those that facilitate completion of the surgical evaluation and treatment. Educational intervention, technological innovation, and effective coordination and communication can significantly improve patients' access to surgery. Patient and public facing, individualized (analog and/or digital) communication can raise awareness and acceptance of epilepsy surgery. Educational interventions aimed at providers may mitigate knowledge gaps using practical and concise consensus statements and guidelines, while specific training can improve awareness around implicit bias. Innovative technology, such as clinical decision-making toolkits within the electronic medical record (EMR), machine learning techniques, online decision-support tools, nomograms, and scoring algorithms can facilitate timely identification of appropriate candidates for epilepsy surgery with individualized guidance regarding referral appropriateness, postoperative seizure freedom rate, and risks of complication after surgery. There are specific strategies applicable for epilepsy centers' success: building a multidisciplinary setup, maintaining/tracking volume and complexity of cases, collaborating with other centers, improving surgical outcome with reduced complications, utilizing advanced diagnostics tools, and considering minimally invasive surgical techniques. Established centers may use other strategies, such as multi-stage procedures for multifocal epilepsy, advanced functional mapping with tailored surgery for epilepsy involving the eloquent cortex, and generation of fresh hypotheses in cases of surgical failure. Finally, improved access to epilepsy surgery can be accomplished with policy changes (e.g., anti-discrimination policy, exemption in transportation cost, telehealth reimbursement policy, patient-centered epilepsy care models, pay-per-performance models, affordability and access to insurance, and increased funding for research). Every intervention should receive regular evaluation and feedback-driven modification to ensure appropriate utilization of epilepsy surgery.
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Affiliation(s)
- Debopam Samanta
- Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
| | - Rani Singh
- Department of Pediatrics, Atrium Health/Levine Children's Hospital, United States
| | - Satyanarayana Gedela
- Department of Pediatrics, Emory University College of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, United States
| | - M Scott Perry
- Cook Children's Medical Center, Fort Worth, TX, United States
| | - Ravindra Arya
- Division of Neurology, Comprehensive Epilepsy Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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Gopal DP, Chetty U, O'Donnell P, Gajria C, Blackadder-Weinstein J. Implicit bias in healthcare: clinical practice, research and decision making. Future Healthc J 2021; 8:40-48. [PMID: 33791459 DOI: 10.7861/fhj.2020-0233] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Bias is the evaluation of something or someone that can be positive or negative, and implicit or unconscious bias is when the person is unaware of their evaluation. This is particularly relevant to policymaking during the coronavirus pandemic and racial inequality highlighted during the support for the Black Lives Matter movement. A literature review was performed to define bias, identify the impact of bias on clinical practice and research as well as clinical decision making (cognitive bias). Bias training could bridge the gap from the lack of awareness of bias to the ability to recognise bias in others and within ourselves. However, there are no effective debiasing strategies. Awareness of implicit bias must not deflect from wider socio-economic, political and structural barriers as well ignore explicit bias such as prejudice.
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Affiliation(s)
- Dipesh P Gopal
- Barts and The London School of Medicine and Dentistry, London, UK
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Tjia J, Pugnaire M, Calista J, Esparza N, Valdman O, Garcia M, Yazdani M, Hale J, Terrien J, Eisdorfer E, Zolezzi-Wyndham V, Chiriboga G, Rappaport L, Puerto G, Dykhouse E, Potts S, Sifuentes AF, Stanhope S, Allison J, Duodo V, Sabin J. COmmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP): A study protocol. Medicine (Baltimore) 2021; 100:e23680. [PMID: 33592827 PMCID: PMC7870252 DOI: 10.1097/md.0000000000023680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Healthcare professionals have negative implicit biases toward minority and poor patients. Few communication skills interventions target implicit bias as a factor contributing to disparities in health outcomes. We report the protocol from the COmmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP), a trial evaluating a novel educational and training intervention targeting graduate medical and nursing trainees that is designed to mitigate the effects of implicit bias in clinical encounters. The CONSULT-BP intervention combines knowledge acquisition, bias awareness, and practice of bias mitigating skills in simulation-based communication encounters with racially/ethnically diverse standardized patients. The trial evaluates the effect of this 3-part program on patient BP outcomes, self-reported patient medication adherence, patient-reported quality of provider communication, and trainee bias awareness. METHODS We are conducting a cluster randomized trial of the intervention among cohorts of internal medicine (IM), family medicine (FM), and nurse practitioner (NP) trainees at a single academic medical center. We are enrolling entire specialty cohorts of IM, FM, and NP trainees over a 3-year period, with each academic year constituting an intervention cycle. There are 3 cycles of implementation corresponding to 3 sequential academic years. Within each academic year, we randomize training times to 1 of 5 start dates using a stepped wedge design. The stepped wedge design compares outcomes within training clusters before and after the intervention, as well as across exposed and unexposed clusters. Primary outcome of blood pressure control is measured at the patient-level for patients clustered within trainees. Eligible patients for outcomes analysis are: English-speaking; non-White racial/ethnic minority; Medicaid recipient (regardless of race/ethnicity); hypertension; not have pregnancy, dementia, schizophrenia, bipolar illness, or other serious comorbidities that would interfere with hypertension self-control; not enrolled in hospice. Secondary outcomes include trainee bias awareness. A unique feature of this trial is the engagement of academic and community stakeholders to design, pilot test and implement a training program addressing healthcare. DISCUSSION Equipping clinicians with skills to mitigate implicit bias in clinical encounters is crucial to addressing persistent disparities in healthcare outcomes. Our novel, integrated approach may improve patient outcomes. TRIAL REGISTRATION NCT03375918. PROTOCOL VERSION 1.0 (November 10, 2020).
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Affiliation(s)
| | | | | | | | | | | | | | - Janet Hale
- University of Massachusetts Medical School
| | | | | | | | | | | | | | | | | | | | | | | | | | - Janice Sabin
- University of Washington, Seattle, Washington, USA
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Vandermause R, Fish AF, Bender A, Kuensting L, Murphy N, Lavin R. The "seeing place": Teaching nurse practitioners about cultural difference through dramatization. NURSE EDUCATION TODAY 2021; 97:104689. [PMID: 33302185 DOI: 10.1016/j.nedt.2020.104689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/11/2020] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The use of dramatization in health professional education is one method to teach students about implicit bias and cultural difference, yet it has not been widely studied among graduate students of nursing. OBJECTIVES The purpose of this article is to present a qualitative analysis of data regarding doctoral nursing students' responses to a new dramatic exercise as part of a funded project to facilitate cultural learning in a diversity-enhanced nursing curriculum. DESIGN We employed a cross-sectional posttest design with qualitative data collection and hermeneutic analysis. Setting and. PARTICIPANTS Subjects were students from two cohorts in a Doctor of Nursing Practice program at a large metropolitan university in the Midwestern United States (n = 136). METHODS Following a dramatic exercise facilitated by a local theatre group, students debriefed and provided feedback via paper-based surveys collected by their instructor. The research team reviewed and analyzed student feedback with an eye toward new learning or insights around cultural difference. RESULTS Students rated the dramatic exercise highly. Their written feedback provided for a deeper exploration of how they internalized messages about cultural difference. These experiences were thematized in the following way: (a) Awareness is facilitated through integrating nonverbal (kinesthetic) and verbal encounters, (b) Hesitancy to participate in unfamiliar activities creates tension, and (c) Safety is a foundational aspect of learning sensitive issues. CONCLUSION Dramatization of culturally sensitive scenarios for advanced practice nurses can lead to new understanding. Educators who understand the need for thoughtful introduction of dramatization experiences can better prepare nurses for interaction in cross-cultural clinical environments.
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Affiliation(s)
| | - Anne F Fish
- College of Nursing, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Annah Bender
- College of Nursing, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Laura Kuensting
- College of Nursing, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Natalie Murphy
- College of Nursing, University of Missouri-St. Louis, St. Louis, MO, USA
| | - Roberta Lavin
- College of Nursing, University of Missouri-St. Louis, St. Louis, MO, USA
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Corsino L, Railey K, Brooks K, Ostrovsky D, Pinheiro SO, McGhan-Johnson A, Padilla BI. The Impact of Racial Bias in Patient Care and Medical Education: Let's Focus on the Educator. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11183. [PMID: 34557589 PMCID: PMC8410857 DOI: 10.15766/mep_2374-8265.11183] [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: 07/30/2020] [Accepted: 06/20/2021] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Racial bias in health care is well documented. Research shows the presence of racial bias among health care providers. There is a paucity of workshops focused on racial bias effects in health professions educators. METHOD Two to three workshops were delivered to a diverse group of clinical educators from three programs at a major academic institution. Each workshop included a brief multimedia presentation followed by a facilitated group discussion. Participants completed the online Implicit Association Test (IAT), a baseline demographic questionnaire, and a brief post-then-pre questionnaire. RESULTS Twenty-four faculty participated in the study (six physicians, eight nurse practitioners, 10 physician assistants). Nineteen (90%) were women, 18 (86%) were White, nine (43%) had more than 10 years of experience as educators, and seven (35%) had previously participated in a biases program. Seventeen completed the IAT. Sixteen educators agreed or strongly agreed that bias has a significant impact on patients' outcomes at the end of the workshop compared to 17 before the workshop. Seventeen educators agreed or strongly agreed that recognizing their own racial bias would positively alter their teaching practice after the workshop compared to 15 before the workshop. DISCUSSION This series of workshops was created to fill a gap regarding the impact of racial bias on patient outcomes, health disparities, and health professions education. The impact of racial bias in health professions education and the long-term impact of awareness and knowledge of racial bias in education are areas needing further evaluation.
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Affiliation(s)
- Leonor Corsino
- Associate Professor of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Department of Medicine, Duke University School of Medicine
- Corresponding author:
| | - Kenyon Railey
- Assistant Professor, Department of Family Medicine & Community Health, Duke University School of Medicine
| | - Katherine Brooks
- Assistant Clinical Professor of Medicine, Division of Hospital Medicine, University of California, San Francisco, School of Medicine
| | - Daniel Ostrovsky
- Associate Professor, Departments of Medicine and Pediatrics, Duke University School of Medicine
| | - Sandro O. Pinheiro
- Professor of Medicine, Division of Geriatrics, Department of Medicine, Duke University School of Medicine
| | - Alyson McGhan-Johnson
- Assistant Professor, Division of Gastroenterology, Department of Medicine, Duke University School of Medicine
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Gonzalez CM, Walker SA, Rodriguez N, Karp E, Marantz PR. It Can Be Done! A Skills-Based Elective in Implicit Bias Recognition and Management for Preclinical Medical Students. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:S150-S155. [PMID: 32889927 PMCID: PMC7686093 DOI: 10.1097/acm.0000000000003697] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
PURPOSE Students perceive bias in learning environments. Curricula targeting implicit bias recognition and management increase student awareness and achieve strategy identification, but fall short of actual skill development to address bias. In light of this gap, the authors developed and evaluated a skills-based elective to recognize and manage implicit bias in the learning environment. METHOD Nine 1.5-hour sessions were delivered to 15 first-year medical students from 2017 to 2019. An evidence-based conceptual framework and transformative learning theory informed the instructional design; it incorporated active learning exercises. Skills assessment occurred through direct observation of student performances in role-play exercises. Using thematic analysis, the authors conducted a program evaluation based on focus groups with students and data from notes taken by the investigative team. RESULTS Students engaged with all aspects of instruction, including role-plays. Authors identified 3 themes from the program evaluation: (1) Student engagement can be enhanced, (2) Instruction is empowering, and (3) It (addressing bias in one's own and witnessed encounters) can be done! Analysis additionally highlighted opportunities for improvement and lessons learned. CONCLUSIONS This innovative course achieved skill development and practice for medical students in implicit bias recognition and management as it pertains to 3 facets of clinical care present at every stage of a health professional's career. These include interpersonal encounters, advocating for patients when bias is perceived in witnessed encounters with peers and supervisors, and addressing comments made by others within the learning environment. Outcomes could inform novel, skills-based curricula across the spectrum of health professions training and practice.
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Affiliation(s)
- Cristina M Gonzalez
- C.M. Gonzalez is professor of medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Sydney A Walker
- S.A. Walker is a medical student, Oregon Health and Sciences University School of Medicine, Portland, Oregon
| | - Natalia Rodriguez
- N. Rodriguez is a medical student, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elisa Karp
- E. Karp is a resident at Jacobi Medical Center, Bronx, New York
| | - Paul R Marantz
- P.R. Marantz is associate dean, Clinical Research Education, and professor, Department of Medicine and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
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Just in TIME: Trauma-Informed Medical Education. J Racial Ethn Health Disparities 2020; 7:1046-1052. [PMID: 33006111 PMCID: PMC7528708 DOI: 10.1007/s40615-020-00881-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 12/22/2022]
Abstract
Numerous organizations implement a trauma-informed approach. This model assists institutions in providing care and education that delivers support to members who have undergone traumatic experiences, and many institutions apply the principles as a universal precaution. Student and trainee experiences in medical education reveal a hidden curriculum that may deliver conflicting messages about the values of an institution, in which equity is promoted, but biased and discriminatory practices are commonplace. Implicit racial bias has been identified in the patient-provider interaction and may also extend its impact on the learner experience. Bias and discrimination inflict trauma on its targets via emotional injury. Applying the principles of the trauma-informed approach, we advocate for trauma-informed medical education (TIME). TIME fosters awareness that students and trainees can experience trauma from a biased system and culture and advocates for the establishment of policies and practices that support learners to prevent further re-traumatization. TIME will serve as a means to deliver just and equitable education.
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Johnson R, Scott J, Randolph SD. COVID-19 and Black America: The intersection of health equity and the NP workforce. Nurse Pract 2020; 45:11-14. [PMID: 32956193 DOI: 10.1097/01.npr.0000696932.97210.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Brand G, Osborne A, Wise S, Isaac C, Etherton-Beer C. Using MRI art, poetry, photography and patient narratives to bridge clinical and human experiences of stroke recovery. MEDICAL HUMANITIES 2020; 46:243-249. [PMID: 31171636 DOI: 10.1136/medhum-2018-011623] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 06/09/2023]
Abstract
Integrating co-produced humanities-based pedagogy into patient and workforce education is of growing interest. The aim of our Depth of Field: Exploring Stroke Recovery project grew from a strong commitment to use patients' lived experiences as a voice to educate new stroke patients and the health professional staff who will care for them. The aim of the initial Quality Improvement project at a West Australian Stroke Rehabilitation Unit (SRU) was to co-produce a reflective learning resource with stroke patients and their families to help navigate the stroke recovery journey. A series of artefacts (documentary-style photographs, audio-narrated vignettes, MRI images and poetry) were collected from four stroke patients and their families at differing stages of recovery over 12 months as they recounted the honest and raw reality of what life is really like following a stroke. These artefacts were used in a pilot qualitative project to explore new stroke patients, their families and SRU health professional staff perceptions towards the artefacts in order to inform the final educational resource. These findings enhance our understandings of how we can use art and patient (healthcare consumers) voice to widen the lens of stroke recovery and provides a valuable template to co-produce peer-to-peer and health professions education reflective learning resources to promote more human- centred approaches to care.
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Affiliation(s)
- Gabrielle Brand
- Division of Health Professions Education, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- School of Nursing & Midwifery; Monash Centre for Scholarship in Health Education, Monash University, Melbourne, Victoria, Australia
| | - Ashlee Osborne
- Division of Health Professions Education, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Steve Wise
- Medical Illustration Department, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Collette Isaac
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Christopher Etherton-Beer
- Medical School, Faculty of Health & Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Royal Perth Bentley Group, Royal Perth Hospital, Perth, Western Australia, Australia
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Rodriguez J, Kanungo C, Macias A. Appraising the Community of Practice at a Hospital Library System Using a Critical Librarianship Lens. Med Ref Serv Q 2020; 39:269-279. [PMID: 34000219 DOI: 10.1080/02763869.2020.1769423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The Kaiser Permanente health sciences librarians created inter-regional policies to standardize and guide the work of all librarians across regions. In response to the larger organization's emphasis on promoting diversity and equity in healthcare and the workplace, the library policies have evolved over time to include aspects of critical librarianship in the information services that the Kaiser Permanente librarians provide to their organization. The article describes how the inter-regional group of hospital librarians provide information services through a critical librarianship lens and provides examples of how other health sciences librarians can incorporate these principles to expand their services.
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Affiliation(s)
| | | | - Ana Macias
- Kaiser Permanente, Sacramento, California, USA
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Parsons S. Addressing Racial Biases in Medicine: A Review of the Literature, Critique, and Recommendations. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 50:371-386. [DOI: 10.1177/0020731420940961] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This article reviews the literature on racism in medicine in the United States and reflects on the persistent barriers to diminishing racial biases in the U.S. health care system. Espoused strategies for decreasing racial disparities and reducing racial biases among physicians are critiqued, and recommendations are offered. Those recommendations include increasing the number of minority students in medical school, using Xavier University in New Orleans, Louisiana, as the model for medical school preparation; revamping the teaching of cultural competence; ensuring the quality of non-clinical staff; and reducing the risk of burnout among medical providers.
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Affiliation(s)
- Sharon Parsons
- School of Doctoral Studies, Grand Canyon University, West Palm Beach, Florida, USA
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