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Nour N, Onchonga D, Neville S, O'Donnell P, Abdalla ME. Integrating the social determinants of health into graduate medical education training: a scoping review. BMC MEDICAL EDUCATION 2024; 24:565. [PMID: 38783280 PMCID: PMC11119707 DOI: 10.1186/s12909-024-05394-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 04/04/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The social determinants of health (SDH) play a key role in the health of individuals, communities, and populations. Academic institutions and clinical licensing bodies increasingly recognize the need for healthcare professionals to understand the importance of considering the SDH to engage with patients and manage their care effectively. However, incorporating relevant skills, knowledge, and attitudes relating to the SDH into curricula must be more consistent. This scoping review explores the integration of the SDH into graduate medical education training programs. METHODS A systematic search was performed of PubMed, Ovid MEDLINE, ERIC, and Scopus databases for articles published between January 2010 and March 2023. A scoping review methodology was employed, and articles related to training in medical or surgical specialties for registrars and residents were included. Pilot programs, non-SDH-related programs, and studies published in languages other than English were excluded. RESULTS The initial search produced 829 articles after removing duplicates. The total number of articles included in the review was 24. Most articles were from developed countries such as the USA (22), one from Canada, and only one from a low- and middle-income country, Kenya. The most highly represented discipline was pediatrics. Five papers explored the inclusion of SDH in internal medicine training, with the remaining articles covering family medicine, obstetrics, gynecology, or a combination of disciplines. Longitudinal programs are the most effective and frequently employed educational method regarding SDH in graduate training. Most programs utilize combined teaching methods and rely on participant surveys to evaluate their curriculum. CONCLUSION Applying standardized educational and evaluation strategies for SDH training programs can pose a challenge due to the diversity of the techniques reported in the literature. Exploring the most effective educational strategy in delivering these concepts and evaluating the downstream impacts on patient care, particularly in surgical and non-clinical specialties and low- and middle-income countries, can be essential in integrating and creating a sustainable healthcare force.
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Affiliation(s)
- Nehal Nour
- Faculty of Education & Health Services, School of Medicine, University of Limerick, Garraun, Castletroy, Co., Limerick, V94 T9PX, Ireland.
| | - David Onchonga
- Faculty of Education & Health Services, School of Medicine, University of Limerick, Garraun, Castletroy, Co., Limerick, V94 T9PX, Ireland
| | - Siobhan Neville
- Faculty of Education & Health Services, School of Medicine, University of Limerick, Garraun, Castletroy, Co., Limerick, V94 T9PX, Ireland.
| | - Patrick O'Donnell
- Faculty of Education & Health Services, School of Medicine, University of Limerick, Garraun, Castletroy, Co., Limerick, V94 T9PX, Ireland
| | - Mohamed Elhassan Abdalla
- Faculty of Education & Health Services, School of Medicine, University of Limerick, Garraun, Castletroy, Co., Limerick, V94 T9PX, Ireland
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Picha KJ, Welch Bacon CE, Bay C, Lewis JH, Snyder Valier AR. Athletic Trainers' Familiarity, Comfort, Knowledge, and Recognition of Social Determinants of Health. J Athl Train 2024; 59:403-409. [PMID: 36827608 PMCID: PMC11064108 DOI: 10.4085/1062-6050-0337.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
CONTEXT Social determinants of health (SDOH)-education, transportation, housing, employment, health systems and services, economic status, and physical and social environments-influence patient outcomes; therefore, athletic trainers (ATs) need to understand and address these factors. However, little is known about how ATs perceive SDOH or how knowledgeable they are about social factors that contribute to patient health and well-being. OBJECTIVE To evaluate ATs' familiarity and comfort with SDOH and their perceived knowledge and recognition of SDOH. DESIGN Cross-sectional study. SETTING Online survey. PATIENTS OR OTHER PARTICIPANTS Our survey was distributed to 17 000 ATs; 1829 accessed it (access rate = 10.8%), and 1694 completed it (completion rate = 92.6%, AT experience = 15.2 ± 10.6 years, age = 36.6 ± 10.8 years). MAIN OUTCOME MEASURE(S) The survey included multipart questions that evaluated ATs' perceptions of their familiarity, comfort, and knowledge about SDOH. Data were summarized using descriptive statistics. RESULTS Few respondents (4.1%, 70/1691) reported being extremely familiar with SDOH. Most indicated being moderately familiar (45.0%, 761/1691), minimally familiar (34.7%, 587/1691), or not familiar at all (16.1%, 273/1691). For questions about comfort, few described being extremely comfortable (3.5%, 59/1691) with SDOH, and most reported being moderately comfortable (35.4%, 598/1691), minimally comfortable (41.1%, 695/1691), or not comfortable at all (18.6%, 314/1691). For questions about knowledge, few indicated being extremely knowledgeable (2.7%, 46/1686) about SDOH, and the majority described being moderately (36.8%, 622/1686), minimally (41.8%, 704/1686), or not knowledgeable at all (18.6%, 314/1686). Over half of ATs accurately categorized 8 of the 9 SDOH listed in the survey, and 22% endorsed more correct than incorrect items. CONCLUSIONS A majority of ATs perceived their familiarity, comfort, and knowledge about SDOH to be moderate to low, which may reflect the relatively recent emphasis on SDOH in athletic health care. Because SDOH can have a major effect on patient health and well-being, strategies should be developed for educating ATs about SDOH. Developing strategies to increase comfort with SDOH in patient care is critical to ensure that those factors that can be addressed at the patient level are identified and managed.
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Affiliation(s)
- Kelsey J Picha
- Departments of Interdisciplinary Health Sciences, A.T. Still University, Mesa
- Departments of Athletic Training, A.T. Still University, A.T. Still University, Mesa
| | - Cailee E Welch Bacon
- Departments of Athletic Training, A.T. Still University, A.T. Still University, Mesa
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa
| | - Curt Bay
- Departments of Interdisciplinary Health Sciences, A.T. Still University, Mesa
| | - Joy H Lewis
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa
| | - Alison R Snyder Valier
- Departments of Athletic Training, A.T. Still University, A.T. Still University, Mesa
- Departments of Research Support, A.T. Still University, Mesa
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa
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Smith KR, Shah NK, Adamczyk AL, Weinstein LC, Kelly EL. Harm reduction in undergraduate and graduate medical education: a systematic scoping review. BMC MEDICAL EDUCATION 2023; 23:986. [PMID: 38129846 PMCID: PMC10734177 DOI: 10.1186/s12909-023-04931-9] [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: 08/15/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Substance use increasingly contributes to early morbidity and mortality, which necessitates greater preparation of the healthcare workforce to mitigate its harm. The purpose of this systematic scoping review is to: 1) review published curricula on harm reduction for substance use implemented by undergraduate (UME) and graduate medical education (GME) in the United States and Canada, 2) develop a framework to describe a comprehensive approach to harm reduction medical education, and 3) propose additional content topics for future consideration. METHODS PubMed, Scopus, ERIC: Education Resources Information Center (Ovid), and MedEdPORTAL were searched. Studies included any English language curricula about harm reduction within UME or GME in the United States or Canada from 1993 until Nov 22, 2021. Two authors independently reviewed and screened records for data extraction. Data were analyzed on trainee population, curricula objectives, format, content, and evaluation. RESULTS Twenty-three articles describing 19 distinct educational programs across the United States were included in the final sample, most of which created their own curricula (n = 17). Data on educational content were categorized by content and approach. Most programs (85%) focused on introductory substance use knowledge and skills without an understanding of harm reduction principles. Based on our synthesis of the educational content in these curricula, we iteratively developed a Harm Reduction Educational Spectrum (HRES) framework to describe curricula and identified 17 discrete content topics grouped into 6 themes based on their reliance on harm reduction principles. CONCLUSIONS Harm reduction is under-represented in published medical curricula. Because the drug supply market changes rapidly, the content of medical curricula may be quickly outmoded thus curricula that include foundational knowledge of harm reduction principles may be more enduring. Students should be grounded in harm reduction principles to develop the advanced skills necessary to reduce the physical harm associated with drugs while still simultaneously recognizing the possibility of patients' ongoing substance use. We present the Harm Reduction Educational Spectrum as a new framework to guide future healthcare workforce development and to ultimately provide the highest-quality care for patients who use drugs.
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Affiliation(s)
- Kelsey R Smith
- University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
- Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut St, Curtis Building, Philadelphia, PA, 19107, USA.
| | - Nina K Shah
- Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St, #100, Philadelphia, PA, 19107, USA
| | - Abby L Adamczyk
- Scott Memorial Library, Thomas Jefferson University, 1020 Walnut St, Philadelphia, PA, 19107, USA
| | - Lara C Weinstein
- Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut St, Curtis Building, Philadelphia, PA, 19107, USA
| | - Erin L Kelly
- Department of Family and Community Medicine, Thomas Jefferson University, 1015 Walnut St, Curtis Building, Philadelphia, PA, 19107, USA
- Center for Social Medicine and Humanities, University of California Los Angeles, B7-435, Semel Institute, Los Angeles, CA, 90095-1759, USA
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Nadir N, Winfield A, Bentley S, Hock SM, Backster A, Bradby C, Rotoli J, Jones N, Falk M. Simulation for diversity, equity and inclusion in emergency medicine residency training: A qualitative study. AEM EDUCATION AND TRAINING 2023; 7:S78-S87. [PMID: 37383838 PMCID: PMC10294220 DOI: 10.1002/aet2.10870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 10/14/2022] [Accepted: 11/13/2022] [Indexed: 06/30/2023]
Abstract
Background The last few years have seen an increased focus on diversity, equity, and inclusion (DEI) initiatives across organizations. Simulation has been used in varying degrees for teaching about DEI topics with emergency medicine; however, there are no established best practices or guidelines on this subject. To further examine the use of simulation for DEI teachings, the DEISIM work group was created as a collaboration between the Society of Academic Emergency Medicine (SAEM) Simulation Academy and the Academy for Diversity and Inclusion in Emergency Medicine (ADIEM). This study represents their findings. Method This qualitative study was conducted using a three-pronged approach. Initial literature search was conducted followed by a call for submission of simulation curricula. These were then followed by five focus groups. Focus groups were recorded, transcribed by a professional transcription service, and then subjected to thematic analysis. Results Data were analyzed and organized into four broad categories including Learners, Facilitators, Organizational/Leadership, and Technical Issues. Challenges within each of these were identified, as were potential solutions. Select pertinent findings included focused faculty development, a carefully planned approach that utilized DEI content experts and the use of simulation for workplace microaggressions or discriminations. Conclusions There appears to be a clear role for simulation in DEI teachings. Such curricula, however, should be undertaken with careful planning and input from appropriate and representative parties. More research is needed on optimizing and standardizing simulation-based DEI curricula.
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Affiliation(s)
- Nur‐Ain Nadir
- Department of Emergency MedicineKaiser Permanente Central ValleyModestoCaliforniaUSA
- Department of Clinical ScienceKaiser Permanente Bernard Tyson School of MedicinePasadenaCaliforniaUSA
| | | | - Suzanne Bentley
- Emergency Medicine and Medical EducationIcahn School of Medicine at Mount SinaiNew York CityNew YorkUSA
- Emergency MedicineElmhurst Hospital CenterElmhurstNew YorkUSA
| | - Sara M. Hock
- Emergency MedicineRush University Medical CenterChicagoIllinoisUSA
| | | | - Cassandra Bradby
- Emergency MedicineEast Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Jason Rotoli
- Emergency MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Nathaniel Jones
- The Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | - Michael Falk
- Pediatric Emergency MedicineChildren's National Medical CenterWashingtonDistrict of ColumbiaUSA
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Liu A, Patel J, Gold JI, Baker NA, Rossi Foulkes R. The Role of Internal Medicine-Pediatric Programs and Transition Champions in Graduate Medical Trainee Health Care Transition Development. J Adolesc Health 2023:S1054-139X(23)00147-7. [PMID: 37140521 PMCID: PMC10363201 DOI: 10.1016/j.jadohealth.2023.02.037] [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: 11/14/2022] [Revised: 01/31/2023] [Accepted: 02/26/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Transition to adult health care for adolescents and young adults (AYAs), especially those with chronic conditions, is a critical time. Medical trainees lack competency in providing transition care, but little is known about the factors contributing to the development of health care transition (HCT) knowledge, attitudes, and practice. This study examines how Internal Medicine-Pediatrics (Med-Peds) programs and institutional HCT champions influence trainee HCT knowledge, attitudes, and practices. STUDY DESIGN A 78-item electronic survey regarding the knowledge, attitudes, and practices of caring for AYA patients was sent to trainees from 11 graduate medical institutions. RESULTS A total of 149 responses were analyzed, including 83 from institutions with Med-Peds programs and 63 from institutions without Med-Peds programs. Trainees with an institutional Med-Peds Program were more likely to identify an institutional HCT champion (odds ratio, 10.67; 95% confidence interval, 2.40-47.44; p = .002). The mean HCT knowledge scores and use of a routine, standardized HCT tools were higher in trainees with an institutional HCT champion. Trainees without an institutional Med-Peds program experienced more barriers to HCT education. Trainees with institutional HCT champions or Med-Peds programs reported greater comfort in providing transition education and using validated, standardized transition tools. DISCUSSION The presence of a Med-Peds residency program was associated with a greater likelihood of a visible institutional HCT champion. Both factors were associated with increased HCT knowledge, positive attitudes, and HCT practices. Both clinical champions and adoption of Med-Peds program curricula will enhance HCT training within graduate medical education.
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Affiliation(s)
- Allison Liu
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois.
| | - Jay Patel
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Jessica I Gold
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nabil Abou Baker
- The Department of Medicine, University of Chicago, Chicago Illinois
| | - Rita Rossi Foulkes
- Departments of Medicine and Pediatrics, Cedars-Sinai Health Systems, Los Angeles, California
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