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Tiako MJN, Aguilar G, Adeyemo O, Reynolds H, Campbell KH, Stanwood N, Galerneau F. Developing an interactive reproductive health equity session for pre-clerkship medical students. MEDICAL EDUCATION ONLINE 2024; 29:2364984. [PMID: 38903002 PMCID: PMC11195450 DOI: 10.1080/10872981.2024.2364984] [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: 09/02/2023] [Accepted: 06/03/2024] [Indexed: 06/22/2024]
Abstract
In the United States, sexual, reproductive, and perinatal health inequities are well documented and known to be caused by a history of systemic oppression along many axes, including but not limited to race, ethnicity, gender, socioeconomic position, sexual orientation, and disability. Medical schools are responsible for educating students on systems of oppression and their impact on health. Reproductive justice advocates, including lay persons, medical students, and teaching faculty, have urged for integrating the reproductive justice framework into medical education and clinical practice. In response to medical student advocacy, we developed introductory didactic sessions on social and reproductive justice for preclinical medical students. These were created in a team-based learning format and include pre-course primer materials on reproductive justice. During the sessions, students engaged with hypothetical clinical vignettes in small groups to identify oppressive structures that may have contributed to the health outcomes described and potential avenues for contextually relevant and level-appropriate advocacy. The sessions took place in November 2019 (in-person) and 2020 (virtually) and were well attended by students. We highlight our experience, student feedback, and next steps, including further integration of reproductive health equity into medical school curricula in concert with department-wide education for faculty, residents, nursing, and allied health professionals. This introduction to social and reproductive justice can be adapted and scaled across different medical school curricula, enhancing the training of a new generation of physicians to become critically aware of how oppressive structures create health inequities and able to mitigate their impact through their roles as clinicians, researchers, and advocates.
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Affiliation(s)
| | - Gabriela Aguilar
- Department of Obstetrics and Gynecology, NYU Langone Health, New York, NY, USA
| | - Oluwatosin Adeyemo
- Yale School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Section of Obstetrics and Midwifery, New Haven, CT, USA
| | | | - Katherine H. Campbell
- Yale School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal and Fetal Medicine, New Haven, CT, USA
| | - Nancy Stanwood
- Planned Parenthood of Southern New England, New Haven, CT, USA
| | - France Galerneau
- Yale School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal and Fetal Medicine, New Haven, CT, USA
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Ghosh AK, Azan A, Basu G, Bernstein J, Gillespie E, Gordon LB, Krishnamurthy S, LeFrancois D, Marcus EN, Tejani M, Townley T, Rimler E, Whelan H. Building Climate Change into Medical Education: A Society of General Internal Medicine Position Statement. J Gen Intern Med 2024; 39:2581-2589. [PMID: 38424345 PMCID: PMC11436550 DOI: 10.1007/s11606-024-08690-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
Building expertise in climate and planetary health among healthcare professionals cannot come with greater urgency as the threats from climate change become increasingly apparent. Current and future healthcare professionals-particularly internists-will increasingly need to understand the interconnectedness of natural systems and human health to better serve their patients longitudinally. Despite this, few national medical societies and accreditation bodies espouse frameworks for climate change and planetary health-related education at the undergraduate (UME), graduate (GME), and continuing (CME) medical education level. As a community of medical educators with an enduring interest in climate change and planetary health, the Society of General Internal Medicine (SGIM) recognizes the need to explicitly define structured educational opportunities and core competencies in both UME and GME as well as pathways for faculty development. In this position statement, we build from the related SGIM Climate and Health position statement, and review and synthesize existing position statements made by US-based medical societies and accreditation bodies that focus on climate change and planetary health-related medical education, identify gaps using Bloom's Hierarchy, and provide recommendations on behalf of SGIM regarding the development of climate and planetary health curricula development. Identified gaps include (1) limited systematic approach to climate and planetary health medical education at all levels; (2) minimal emphasis on learner-driven approaches; (3) limited focus on physician and learner well-being; and (4) limited role for health equity and climate justice. Recommendations include a call to relevant accreditation bodies to explicitly include climate change and planetary health as a competency, extend the structural competency framework to climate change and planetary health to build climate justice, proactively include learners in curricular development and teaching, and ensure resources and support to design and implement climate and planetary health-focused education that includes well-being and resiliency.
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Affiliation(s)
- Arnab K Ghosh
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 E 70th St, New York, NY, 10065, USA.
| | - Alexander Azan
- Division of General Internal Medicine, Department of Medicine, NYU Grossman School of Medicine, 550 1ST Ave, New York, NY, 10016, USA
| | - Gaurab Basu
- Department of Medicine, Cambridge Health Alliance, Harvard Medical School, 1493 Cambridge Street25 Shattuck Street, CambridgeBoston, MAMA, 0213902115, USA
| | - Joanna Bernstein
- Department of Medicine, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Elizabeth Gillespie
- School of Medicine, University of Colorado Anschutz Medical Campus, Leprino Building, 4th Floor, 12401 East 17th Avenue, Aurora, CO, 80045, USA
| | - Lesley B Gordon
- Department of Medicine, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA
| | - Sudarshan Krishnamurthy
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, 27101, USA
| | - Darlene LeFrancois
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center, 111 East 210th St, Bronx, NY, 10467, USA
| | - Erin N Marcus
- Division of General Internal Medicine, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - Mehul Tejani
- Division of General Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30332, USA
| | - Theresa Townley
- Division of General Internal Medicine, Creighton University School of Medicine Omaha, 7500 Mercy Road, Omaha, NE, 68124, USA
| | - Eva Rimler
- Division of General Interval Medicine, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Heather Whelan
- Division of Hospital Medicine, Department of Medicine, San Francisco VA Medical Center, University of California San Francisco, San Francisco, CA, 94121, USA
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Raskob K, Ramanan RA, Lezak M, Negrete JE, Binder E, Addington-White J, Laponis R, Griffiths EP. Advocating with Community: A Community-Engaged Advocacy Curriculum for Internal Medicine Residents. J Gen Intern Med 2024:10.1007/s11606-024-09049-2. [PMID: 39313667 DOI: 10.1007/s11606-024-09049-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 09/13/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND In 2022, the Accreditation Council for Graduate Medical Education updated its competencies for residents in all specialties to include health policy advocacy. A recent systematic review shows that while a growing number of residency curricula include policy advocacy, few programs join in policy advocacy efforts with community partners. AIM To create a community-engaged advocacy curriculum for residents that is part of a mutually beneficial partnership with community-based organizations (CBOs). SETTING A university-affiliated residency program and CBOs within a large US city. PARTICIPANTS Eighty internal medicine residents and local CBO clients and staff. PROGRAM DESCRIPTION The curriculum was delivered over 2 years and included advocacy skills sessions, service learning and reflection at the CBOs, and direct policy advocacy. PROGRAM EVALUATION Residents and CBO partners were surveyed to gather quantitative and qualitative data. Residents perceived that the program enhanced their confidence and skills in community engagement and policy advocacy. All CBO staff agreed that the partnership advanced the CBO's mission, residents' volunteering provided beneficial service, and residents had a meaningful impact on their advocacy efforts. DISCUSSION Our community-engaged advocacy curriculum successfully met its aims and has contributed to policy change. Future directions include building a statewide coalition of residents and CBOs.
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Affiliation(s)
- Kathleen Raskob
- Division of General Internal Medicine, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA.
| | - Radhika A Ramanan
- Division of General Internal Medicine, University of California San Francisco, San Francisco, USA
| | | | | | | | - Joan Addington-White
- Division of General Internal Medicine, University of California San Francisco, San Francisco, USA
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Ryan Laponis
- Division of General Internal Medicine, University of California San Francisco, San Francisco, USA
| | - Elizabeth P Griffiths
- Division of General Internal Medicine, University of California San Francisco, San Francisco, USA
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Sutkowi-Hemstreet A, Covington JK, Adams TN. Justice, Equity, Diversity, and Inclusion-Related Curricular Elements in Entry-Level Physical Therapist Education: A Delphi Study. JOURNAL, PHYSICAL THERAPY EDUCATION 2024:00001416-990000000-00129. [PMID: 39259596 DOI: 10.1097/jte.0000000000000361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 05/21/2024] [Indexed: 09/13/2024]
Abstract
INTRODUCTION The purpose of this Delphi study was to determine whether experts in justice, equity, diversity, and inclusion (JEDI) in the field of physical therapy could achieve consensus on the key JEDI-related curricular content topics to be included in entry-level physical therapist education. REVIEW OF LITERATURE Inequities exist at all levels of health care for historically underserved populations, including referrals, access, and quality of physical therapy services. The physical therapy field is facing challenges and opportunities in how to best prepare providers to address individual, community, and population health inequities. There is a lack of consensus in physical therapist education regarding essential curricular content related to justice, equity, diversity, inclusion, and antiracism. SUBJECTS Eighty-four experts in JEDI in the physical therapy profession were invited through email to participate in the Delphi process. METHODS A Delphi survey brought together 39 identified experts in justice, equity, diversity, and inclusion within the field of physical therapy to reach consensus on key JEDI-related curricular topics in physical therapist education. In the first-round survey, participants answered an open-ended question: "What JEDI-related curricular content should be included in entry-level physical therapist education?" The work team coded these free-text responses to populate an initial list of curricular elements. Over 2 subsequent rounds of surveys, the experts came to a consensus on which curricular elements should be addressed within physical therapist education. Nineteen experts completed all survey rounds. RESULTS In round I, coding of the expert group's responses generated 61 initial JEDI-related curricular elements. By round III, the group refined the list to 43 curricular elements; 41 of the 43 (95%) elements garnered 94% or higher consensus. The expert group deemed 30 of the elements "entry-level" content and 13 as more "advanced practice" topics. DISCUSSION AND CONCLUSIONS Experts had a strong consensus on key JEDI-related curricular elements that physical therapist education programs should include to best prepare providers to improve the health of society. Future scholarship will explore recommendations for how physical therapist education programs might prioritize and implement JEDI-related content.
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Affiliation(s)
- Allyson Sutkowi-Hemstreet
- Allyson Sutkowi-Hemstreet is the teaching specialist in the Department of Rehabilitation Medicine at the University of Minnesota, Division of PT, MMC 388, 420 Delaware St SE, Minneapolis, MN 55455 ( ). Please address all correspondence to Allyson Sutkowi-Hemstreet
- J. Kyle Covington is the director of educational innovation; director of post-professional education; and associate professor in the Doctor of Physical Therapy Division, Department of Orthopaedic Surgery at the Duke University School of Medicine
- Tiffany N. Adams is the director of diversity, equity, and inclusion and assistant professor in the Doctor of Physical Therapy Division, Department of Orthopaedic Surgery at the Duke University School of Medicine
| | - J Kyle Covington
- Allyson Sutkowi-Hemstreet is the teaching specialist in the Department of Rehabilitation Medicine at the University of Minnesota, Division of PT, MMC 388, 420 Delaware St SE, Minneapolis, MN 55455 ( ). Please address all correspondence to Allyson Sutkowi-Hemstreet
- J. Kyle Covington is the director of educational innovation; director of post-professional education; and associate professor in the Doctor of Physical Therapy Division, Department of Orthopaedic Surgery at the Duke University School of Medicine
- Tiffany N. Adams is the director of diversity, equity, and inclusion and assistant professor in the Doctor of Physical Therapy Division, Department of Orthopaedic Surgery at the Duke University School of Medicine
| | - Tiffany N Adams
- Allyson Sutkowi-Hemstreet is the teaching specialist in the Department of Rehabilitation Medicine at the University of Minnesota, Division of PT, MMC 388, 420 Delaware St SE, Minneapolis, MN 55455 ( ). Please address all correspondence to Allyson Sutkowi-Hemstreet
- J. Kyle Covington is the director of educational innovation; director of post-professional education; and associate professor in the Doctor of Physical Therapy Division, Department of Orthopaedic Surgery at the Duke University School of Medicine
- Tiffany N. Adams is the director of diversity, equity, and inclusion and assistant professor in the Doctor of Physical Therapy Division, Department of Orthopaedic Surgery at the Duke University School of Medicine
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Bell KA, Adams T. A Culture Shift for Excellence in Physical Therapy: Promoting Equity Through the Structural Determinants of Health. Phys Ther 2024; 104:pzae098. [PMID: 39023224 DOI: 10.1093/ptj/pzae098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 05/04/2024] [Accepted: 07/17/2024] [Indexed: 07/20/2024]
Abstract
The purpose of this perspective is to discuss the imperative for curricular change that focuses on the utilization of structural competency to promote excellence in physical therapist professional education, transform society, and achieve health equity. Pedagogy centered around biomedical and social determinants of health (SDOH) models are limited in that they lack self-reflexivity, encode social identities like race and gender as risk factors for poor health, fail to examine structural causes of health inequity, conflate SDOH and the structural forces that shape their unequal distribution, and overlook instances of injustice. Promoting health equity will require structural competency, an approach that considers drivers of health beyond the individual and their conditions of daily living (ie, SDOH). Utilizing this approach in physical therapist professional education will help learners understand the evolving needs of society in a deeper, more holistic way: one that considers structural determinants of health as the primary drivers of health equity and inequity. IMPACT This paper provides a perspective on how physical therapist professional education can promote health equity for all by embracing an equity-focused, structurally competent pedagogy/approach.
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Affiliation(s)
- Karla A Bell
- Jefferson College of Rehabilitation Sciences & Jefferson College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Tiffany Adams
- Division of Physical Therapy, Department of Orthopaedic Surgery, Duke University School of Medicine, Duke University, Durham, North Carolina, USA
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Kim JJ, Winburn AP, Moore MK. Structural vulnerability approaches to forensic anthropology: Beyond evolutionary theory. Forensic Sci Int Synerg 2024; 9:100552. [PMID: 39285896 PMCID: PMC11402529 DOI: 10.1016/j.fsisyn.2024.100552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
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Yang LH, Eger MA, Link BG. The Human Cost of Politicizing Immigration: Migration Stigma, US Politics, and Health. JAMA 2024; 332:619-620. [PMID: 38949836 DOI: 10.1001/jama.2024.11126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
This Viewpoint discusses stigma and health consequences associated with migration in the context of the US election and identifies ways to develop structural competencies for physicians and future research.
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Affiliation(s)
- Lawrence H Yang
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York
- Mailman School of Public Health, Columbia University, New York, New York
| | - Maureen A Eger
- Department of Sociology, Umeå University, Umeå, Sweden
- Center for Right-Wing Studies, University of California, Berkeley
| | - Bruce G Link
- Department of Sociology and School of Public Policy, University of California, Riverside
- Mailman School of Public Health, Columbia University, New York, New York
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Ramsdell AK, Hupert N, Abramson E, Safdieh JE, Katz S. Bringing a Structural Competency Framework to the (Simulated) Bedside: The Premature Discharge Objective Structured Clinical Exam. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:857-862. [PMID: 38728682 DOI: 10.1097/acm.0000000000005756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
PROBLEM Structural competency is increasingly valued as a framework to address health equity within undergraduate medical education. As of academic year 2023-2024, the Liaison Committee on Medical Education (LCME) requires that medical schools have content regarding basic principles of structurally competent health care. Despite encouraging data about the effectiveness of structural competency curricula, most occur within the walls of a classroom and do not enter the authentic or simulated clinical space. APPROACH From 2022 to 2023, an objective structured clinical exam (OSCE) focused on premature discharge, previously known as discharge against medical advice, was integrated into the required fourth-year Health Policy course at Weill Cornell Medical College, which uses the framework of structural competency. After a simulated clinical encounter, students completed a reflection assignment and participated in group debriefing to reflect on how policy coursework affected their simulated clinical experience. Students completed an evaluation about their OSCE experience, and OSCE checklist performance was analyzed. OUTCOMES Of 82 students who participated in the curriculum, 68 completed a curricular evaluation, and 62 consented to have their OSCE performance evaluated for research. Mean overall OSCE checklist performance evaluating students' patient-centered communication skills, harm reduction skills, and discharge planning and counseling was 14.3/16 (89.6%; standard deviation, 9.8%). Students reported it was valuable to focus on structural factors affecting care within the simulated clinical encounter by using the structural competency framework. NEXT STEPS To the authors' knowledge, this is the first OSCE for medical students designed to deepen their understanding of structural competency by embedding the experience into an existing course using the framework. Future work should explore how this curriculum affects students' attitudes toward structurally vulnerable patients. With structural competency as an LCME requirement, the use of OSCEs may give educators a means to teach and assess fundamental concepts.
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Bauer L, Wienke A, Führer A. Compassionate Othering: the construction of refugee patients in medical students' narratives - a qualitative study using story completion. BMC MEDICAL EDUCATION 2024; 24:703. [PMID: 38937730 PMCID: PMC11212417 DOI: 10.1186/s12909-024-05684-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 06/20/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Refugees remain a marginalized population and are exposed to a variety of discriminatory processes, among them Othering which categorizes people as belonging or not-belonging according to certain ascribed characteristics. We explored how the narrative construction of refugee patients by medical students constitutes a form of Othering. METHODS Using story completion, 124 5th year medical students at the Martin- Luther- University Halle-Wittenberg in October 2019 wrote a fictional story in response to a story stem situated in a medical practice. In a comparative approach, one patient presenting with abdominal pain lacks further characterization (version A) and the other is a refugee (version B). The stories were coded using qualitative content analysis by Mayring with a focus on content and narrative strategies (plot structure and perspective). RESULTS We identified four themes: characters, medical condition, access to care and provision of substandard care. The stories were predominantly framed with a medical or an interaction-based plot structure and written from a process-oriented perspective. The themes in version B, supported by their use of narrative strategies, were largely contextualized within the patients' history of migration. An empathic depiction of patient B and the students' compassion for the patients facing substandard care were key motifs as well. CONCLUSION The perception of the version B patients predominantly as refugees establishes their construction as an Other. The students' compassion acts as a representation of societal inequalities and remains an inept response without the tools to counter underlying discriminatory structures. Based on a discourse of deservingness, compassion alone therefore perpetuates Othering and highlights the need for structural competency training in medical school.
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Affiliation(s)
- Lena Bauer
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany.
| | - Andreas Wienke
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Amand Führer
- Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
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Burra TA, Soong C, Wong BM. Taking action on inequities: a structural paradigm for quality and safety. BMJ Qual Saf 2024; 33:351-353. [PMID: 38688709 DOI: 10.1136/bmjqs-2023-017027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2024] [Indexed: 05/02/2024]
Affiliation(s)
- Tara A Burra
- Department of Psychiatry, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Christine Soong
- General Internal Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Brian M Wong
- Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Williams JC, Crisp Z, Crow B, Alexandar-Bloch A, Galvin K, Qayyum Z, Aysola J, Cheng SM. Core Competencies of an Anti-racist Physician: Elective Course for Undergraduate Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2024; 20:11395. [PMID: 38957536 PMCID: PMC11219086 DOI: 10.15766/mep_2374-8265.11395] [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: 01/26/2023] [Accepted: 01/09/2024] [Indexed: 07/04/2024]
Abstract
Introduction Medical schools seeking to correct and reform curricula towards anti-racist perspectives need to address anti-Black forms of racism specifically and teach students critical upstander skills to interrupt manifestations of racism. We developed a course to teach preclinical medical students basic anti-racism competencies including recognition and awareness of anti-Black racism in medicine and upstander skills to advocate for patients and colleagues. Methods In 2021 and 2022, we designed, implemented, and evaluated an elective course for second-year medical students (N = 149) to introduce competencies of anti-racism focusing on upstander skills for addressing anti-Blackness. We designed three patient cases and one student-centered case to illustrate manifestations of anti-Black racism in medicine and used these cases to stimulate small-group discussions and guide students toward recognizing and understanding ways of responding to racism. We designed pre- and postassessments to evaluate the effectiveness of the course and utilized anonymous feedback surveys. Results Participants showed significant improvement in pre- to postassessment scores in both years of the course. The anonymous feedback survey showed that 97% of students rated the course at least somewhat effective, and the qualitative responses revealed five core themes: course timing, case complexity, learner differentiation, direct instruction, and access to resources. Discussion This course reinforces upstander competencies necessary for advancing anti-racism in medicine. It addresses a gap in medical education by reckoning with the entrenched nature of anti-Black racism in the culture of medicine and seeks to empower undergraduate medical students to advocate for Black-identifying patients and colleagues.
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Affiliation(s)
- J. Corey Williams
- Assistant Professor, Department of Psychiatry, MedStar Georgetown University Hospital
| | - Zharia Crisp
- Second-Year Medical Student, University of Chicago Pritzker School of Medicine
| | - Brendan Crow
- Third-Year Resident Physician, Mountain Area Health Education Center (MAHEC) Family Medicine Residency
| | - Aaron Alexandar-Bloch
- Assistant Professor, Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania
| | - Katie Galvin
- Assistant Director of Longitudinal Curricular Coordination, Georgetown University School of Medicine
| | - Zheala Qayyum
- Assistant Professor of Psychiatry, Harvard Medical School
| | - Jaya Aysola
- Associate Professor of Medicine, Associate Professor of Pediatrics, and Executive Director, Penn Medicine Center for Health Equity Advancement
| | - Susan M. Cheng
- Associate Professor, Department of Family Medicine, and Senior Associate Dean for Diversity, Equity, Inclusion & Belonging, Georgetown University School of Medicine
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Basu G, Stojicic P, Goldman A, Shaffer J, McCormick D. Health Professionals Organizing for Climate Action: A Novel Community Organizing Fellowship. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:408-413. [PMID: 38228058 PMCID: PMC10980566 DOI: 10.1097/acm.0000000000005637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
PROBLEM Climate change is a public health and health equity crisis. Health professionals are well positioned to advance solutions but may lack the training and self-efficacy needed to achieve them. APPROACH The Center for Health Equity Education and Advocacy at Cambridge Health Alliance, a Harvard Medical School Teaching Hospital, developed a novel, longitudinal fellowship that taught health professionals about health and health equity effects of climate change, as well as community organizing practices that may help them mitigate these effects. The fellowship cohort included 40 fellows organized into 12 teams and was conducted from January to June 2022. Each team developed a project to address climate change and received coaching from an experienced community organizer coach. Effects of the fellowship on participants' knowledge, skills, and attitudes were evaluated using pre- and postfellowship surveys. OUTCOMES Surveys were analyzed for 38 of 40 (95%) participants who consented to the evaluation and completed both surveys. Surveys used a 7-point Likert scale for item responses. McNemar's test for paired data was used to assess changes in the proportion of respondents who agreed ("somewhat agree"/"agree"/"strongly agree") with statements in pre- vs postfellowship surveys. Statistically significant improvements were found for 11 of the 17 items assessing knowledge, skills, and attitudes. Participants' views of the fellowship and its effects were assessed through additional items in the postfellowship survey. Most respondents agreed that the fellowship increased their knowledge of the connections between climate change and health equity (32/38, 84.2%) and prepared them to effectively participate in a community organizing campaign (37/38, 94.7%). Each of the 12 groups developed climate health projects by the fellowship's end. NEXT STEPS This novel fellowship was well received and effective in teaching community organizing to health professionals concerned about climate change. Future studies are needed to assess longer-term effects of the fellowship.
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Hallowell R, Saluja S, Lewis L, Novak DA, Valentine W, Batch E, Clayton Johnson MA, Bluthenthal RN, Cousineau MR, Ben-Ari R. Advocacy for Health Justice: An Innovative Pilot Course for MD and Master of Public Policy Students. TEACHING AND LEARNING IN MEDICINE 2024; 36:198-210. [PMID: 36519450 DOI: 10.1080/10401334.2022.2155169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 11/15/2022] [Indexed: 06/17/2023]
Abstract
Problem: U.S. medical schools are searching for ways to address issues of health justice in undergraduate medical education. Physicians have not typically received training in how to be effective advocates for systemic change and individuals in policy fields are not usually equipped to understand the complex issues of health science and their intersection with the health system and society. To address this gap, medical school faculty partnered with school of public policy faculty on a collaborative learning model that engaged MD and Master of Public Policy students together to strengthen their collective knowledge of the healthcare landscape, and to build skills to work for health justice. Intervention: We hypothesized that pairing medical students with public policy students to learn about the intersections of health justice and advocacy could enhance the efficacy of each group and provide a new model of collaboration between medical and policy professionals. The students collaborated on a health justice advocacy project through which they provided consultation to an established community organization. Context: The 8-week course took place in the spring of 2021 in Los Angeles, California. Due to Covid-19 the course was taught online and included asynchronous learning modules and live Zoom sessions. The project also served as a pilot for the post-clerkship phase of a new longitudinal health justice curriculum for MD students that launched in August 2021. Impact: Analysis of student work products, course evaluations, partner interviews, and student focus groups showed that students valued learning through their interdisciplinary collaborative work which gave them new perspectives on health justice issues. The community partners indicated that the students consultative work products were useful for their initiatives, and that they found working with MD and MPP students to be a valuable way to think about how to build stronger and more inclusive coalitions to advocate for health justice. This project has the potential for national impact as it aligns with the Association of American Medical Colleges' renewed focus on the responsibility of academic medicine to partner with communities for health justice. The project also contributed to the national conversation on how to align health systems science education with the aims of health justice through our participation in the American Medical Association Accelerating Change in Medical Education Consortium. Lessons Learned: Leveraging faculty relationships with community partners was crucial for developing meaningful projects for students. Cultivating and expanding community partner networks is necessary to sustain and scale up this type of intervention. Centering the needs of communities and supporting their on-going work for health justice is essential for becoming an effective advocate. Learning communities that bring interdisciplinary students, healthcare providers, policy professionals, and community partners together to learn from one another can create key opportunities for ameliorating health inequities.
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Affiliation(s)
- Ronan Hallowell
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sonali Saluja
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - LaVonna Lewis
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
| | - Daniel A Novak
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Eric Batch
- American Heart Association, Los Angeles, California, USA
| | | | - Ricky N Bluthenthal
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael R Cousineau
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ron Ben-Ari
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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14
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Oppenlander KE, Raleigh MF. Implementation of Formal Curriculum on Health Care Disparities in Military Family Medicine Residency. Fam Med 2024; 56:190-194. [PMID: 38467036 PMCID: PMC11136623 DOI: 10.22454/fammed.2024.683797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND AND OBJECTIVES The Accreditation Council for Graduate Medical Education (ACGME) requires education on health care disparities (HCD), but research assessing formal curricula is limited. To improve knowledge and confidence in HCD, the family medicine residency program at Darnall Army Medical Center implemented a formal HCD curriculum. METHODS During the 2021-2022 academic year, starting July 2021, a formal HCD curriculum was implemented for family medicine residents and faculty. Ten lectures on HCDs and implicit bias were given over the course of the year. Residents and faculty were asked to incorporate HCD into their regular continuing medical education lectures. ACGME survey data as well as a pre- and postcurriculum survey were used to assess HCD knowledge and confidence. Descriptive statistics and a paired-sample t tests were calculated to compare pre- to postcurriculum changes. RESULTS The percentage of residents who reported that they had received HCD education increased from 72% on the 2021 ACGME survey to 100% in 2022 (N=18). We found a significant (P<.05) improvement in knowledge and confidence across 11 of 12 questions on the pre- and postcurriculum survey. CONCLUSIONS A formal curriculum in a military family medicine residency setting was effective for improving self-reported HCD knowledge and confidence.
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Affiliation(s)
| | - Meghan F. Raleigh
- Family Medicine Residency Program, Carl R Darnall Army Medical CenterFort Cavazos, TX
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15
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Henry TL, Rollin FG, Olakunle OE. How to Create a Diversity, Equity, and Inclusion Curriculum: More Than Checking a Box. Ann Fam Med 2024; 22:154-160. [PMID: 38527815 PMCID: PMC11237195 DOI: 10.1370/afm.3078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/30/2023] [Accepted: 10/16/2023] [Indexed: 03/27/2024] Open
Abstract
We are beginning to accept and address the role that medicine as an institution played in legitimizing scientific racism and creating structural barriers to health equity. There is a call for greater emphasis in medical education on explaining our role in perpetuating health inequities and educating learners on how bias and racism lead to poor health outcomes for historically marginalized communities. Diversity, equity, and inclusion (DEI; also referred to as EDI) and antiracism are key parts of patient care and medical education as they empower health professionals to be advocates for their patients, leading to better health care outcomes and more culturally and socially humble health care professionals. The Liaison Committee on Medical Education has set forth standards to include structural competency and other equity principles in the medical curriculum, but medical schools are still struggling with how to specifically do so. Here, we highlight a stepwise approach to systematically developing and implementing medical educational curriculum content with a DEI and antiracism lens. This article serves as a blueprint to prepare institution leadership, medical faculty, staff, and learners in how to effectively begin or scale up their current DEI and antiracism curricular efforts.
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Affiliation(s)
- Tracey L Henry
- Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Francois G Rollin
- Department of Medicine, Division of General Internal Medicine, Emory University School of Medicine, Atlanta, Georgia
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16
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Dickson CA, Ergun-Longmire B, Greydanus DE, Eke R, Giedeman B, Nickson NM, Hoang LN, Adabanya U, Payares DVP, Chahin S, McCrary J, White K, Moon JH, Haitova N, Deleon J, Apple RW. Health equity in pediatrics: Current concepts for the care of children in the 21st century (Dis Mon). Dis Mon 2024; 70:101631. [PMID: 37739834 DOI: 10.1016/j.disamonth.2023.101631] [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: 09/24/2023]
Abstract
This is an analysis of important aspects of health equity in caring for children and adolescents written by a multidisciplinary team from different medical centers. In this discussion for clinicians, we look at definitions of pediatric health equity and the enormous impact of social determinants of health in this area. Factors involved with pediatric healthcare disparities that are considered include race, ethnicity, gender, age, poverty, socioeconomic status, LGBT status, living in rural communities, housing instability, food insecurity, access to transportation, availability of healthcare professionals, the status of education, and employment as well as immigration. Additional issues involved with health equity in pediatrics that are reviewed will include the impact of the COVID-19 pandemic, behavioral health concepts, and the negative health effects of climate change. Recommendations that are presented include reflection of one's own attitudes on as well as an understanding of these topics, consideration of the role of various healthcare providers (i.e., community health workers, peer health navigators, others), the impact of behavioral health integration, and the need for well-conceived curricula as well as multi-faceted training programs in pediatric health equity at the undergraduate and postgraduate medical education levels. Furthermore, ongoing research in pediatric health equity is needed to scrutinize current concepts and stimulate the development of ideas with an ever-greater positive influence on the health of our beloved children. Clinicians caring for children can serve as champions for the optimal health of children and their families; in addition, these healthcare professionals are uniquely positioned in their daily work to understand the drivers of health inequities and to be advocates for optimal health equity in the 21st century for all children and adolescents.
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Affiliation(s)
- Cheryl A Dickson
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Berrin Ergun-Longmire
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Donald E Greydanus
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
| | - Ransome Eke
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Bethany Giedeman
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Nikoli M Nickson
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Linh-Nhu Hoang
- Department of Psychology, Western Michigan University, Kalamazoo, MI, United States
| | - Uzochukwu Adabanya
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Daniela V Pinto Payares
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Summer Chahin
- Department of Psychology, C.S. Mott Children's Hospital/Michigan Medicine, Ann Arbor, MI, United States
| | - Jerica McCrary
- Center for Rural Health and Health Disparities, Mercer University School of Medicine, Columbus, GA, United States
| | - Katie White
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Jin Hyung Moon
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Nizoramo Haitova
- Department of Educational Leadership, Research and Technology, Western Michigan University, Kalamazoo, MI, United States
| | - Jocelyn Deleon
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Roger W Apple
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
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17
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Iwai Y, Holdren S, Browne AR, Lenze NR, Lopez FG, Randolph AM, Weil AB. By Medical Students, for Medical Students: A Narrative Medicine Antiracism Program. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241261238. [PMID: 38882027 PMCID: PMC11179471 DOI: 10.1177/23821205241261238] [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: 01/11/2024] [Accepted: 05/17/2024] [Indexed: 06/18/2024]
Abstract
Objectives Medical schools have sought to incorporate concepts of race and racism in their curricula to facilitate students' abilities to grapple with healthcare disparities in the United States; however, these efforts frequently fail to address implicit bias or equip students with cultural humility, reflective capacity, and interpersonal skills required to navigate racialized systems in healthcare. The purpose of this study was to develop and evaluate an antiracism narrative medicine (NM) program designed by and for preclinical medical students. Method Preclinical medical students at a single center were eligible to participate from June-July 2021. Program evaluation included a postprogram qualitative interview and electronic survey. The semistructured interview included questions about program experience, lessons learned, and perspectives on antiracism curricula in medical education. Interviews were qualitatively analyzed using open and axial coding. Survey data were analyzed with descriptive statistics. Results A total of 30 students registered. All (100%) respondents reported "somewhat true" or "very true" in the postprogram survey when asked about their ability to reflect on their own racial identity, racial identity of others, and influence of their racial identity on their future role as a healthcare worker through the program. Qualitative analysis revealed 3 themes: (1) curricular engagement; (2) racism and antiracism in medicine; and (3) group experience. Subthemes included: meaningful theoretical content; multimodal works and unique perspectives; race, identity, and intersectionality; deeper diversity, equity, and inclusion engagement; reconstructive visions; future oriented work; close reading and writing build confidence in discomfort; community and support system; and authentic space among peer learners. Conclusion This virtual, peer-facilitated antiracism NM program provided an engaging and challenging experience for participants. Postprogram interviews revealed the program deepened students' understanding of racism, promoted self-reflection and community building, and propagated reconstructive visions for continuing antiracism work.
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Affiliation(s)
- Yoshiko Iwai
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Sarah Holdren
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Alyssa R Browne
- Department of Sociology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Nicholas R Lenze
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Felix Gabriel Lopez
- Department of Psychology, The New School for Social Research, New York, NY, USA
| | - Antonia M Randolph
- Department of American Studies, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Amy B Weil
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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18
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Jeffrey S, Ashton L, Ferfolja T, Armour M. Transgender and gender diverse people with endometriosis: A perspective on affirming gynaecological care. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241251974. [PMID: 38742674 PMCID: PMC11095187 DOI: 10.1177/17455057241251974] [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: 11/30/2023] [Revised: 03/29/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024]
Abstract
Transgender and gender diverse people presumed female at birth experience gynaecological conditions, such as chronic pelvic pain at elevated rates, estimated to impact between 51% and 72% of this population, compared to rates of up to 26.6% in cisgender women. The negative impact of these conditions is likely amplified due to limited access to safe and affirming healthcare. Despite this high prevalence rate, there is limited research investigating the prevalence, presentation or management options for trans and gender diverse people with endometriosis. Cisgender women with endometriosis report barriers to accessing care, with lengthy times to diagnosis and limited treatment options available. However, barriers for trans and gender diverse individuals are enhanced by physician bias and lack of education in gender-affirming care. This is reflected in stories of discrimination and denial of basic healthcare. A healthcare environment built on the presumption that gynaecological patients are women, others trans and gender diverse patients, which can result in avoidance of needed medical care. A lack of knowledge of gender-affirming care alongside healthcare provider bias highlights a need for gender-affirming care and bias reduction training in undergraduate healthcare provider curricula. Research to date assessing current curriculum in Australia and Aotearoa (New Zealand) shows limited inclusion of lesbian, gay, bisexual, trans, queer, intersex, asexual and other related identities content as a whole with gender-affirming care being among the least-frequently addressed topics. This review will detail barriers to accessing gender-affirming healthcare specific to gynaecology, interweaving the experiences of a non-binary individual seeking access to gender-affirming endometriosis care.
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Affiliation(s)
- Sam Jeffrey
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | | | - Tania Ferfolja
- School of Education, Western Sydney University, Penrith, NSW, Australia
| | - Mike Armour
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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Spinelli H, Martinovich V. From the factory model to the classroom-workshop: Learning from practice in the fields of health and education. Glob Public Health 2024; 19:2290677. [PMID: 38084759 DOI: 10.1080/17441692.2023.2290677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023]
Abstract
In this article, we engage in a dialogue about structural competencies based on the proposal of the classroom-workshop, aimed at educational and work environments in the fields of health and education. Our starting point is the notion that practical experiences do not merely represent a collection of specialised technical knowledge, as they are part of the complexity of the social game. Drawing from the theoretical frameworks of Pierce, Gadamer, Freire, and others, the proposal of the classroom-workshop recovers the power of collective praxis. Learning from and with others becomes central in the social game in order to collectively appropriate knowledge by making the autonomy of learning as horizontal as possible. By centering the relational world of learning and working, the classroom-workshop recovers the circular structure of understanding that enables a reflective appropriation of the territory - understood as the social space where life takes place - while de-instrumentalizing the reading of theoretical traditions and resignifiying the practice of writing. It establishes connections, links, and anchors that enable a dialogue between theory and practice, so often dissociated and fragmented.
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Affiliation(s)
- Hugo Spinelli
- Instituto de Salud Colectiva, Universidad Nacional de Lanús, :Buenos Aires, Argentina
| | - Viviana Martinovich
- Instituto de Salud Colectiva, Universidad Nacional de Lanús, :Buenos Aires, Argentina
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20
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Piñones-Rivera C, Holmes S, Morse M, Ferrall J, Nambiar K, Martínez-Hernáez Á. Structural competency in global perspective. Glob Public Health 2024; 19:2326631. [PMID: 38468161 DOI: 10.1080/17441692.2024.2326631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
This special issue aims to help fill two critical gaps in the growing literature as well as in practice. First, to bring together scholars and practitioners from around the world who develop, practice, review, and question structural competency with the aim of promoting a dialogue with related approaches, such as Latin American Social Medicine, Collective Health, and others, which have been key in diverse geographical and social settings. Second, to contribute to expanding structural competency beyond clinical medicine to include other health-related areas such as social work, global health, public health practice, epidemiological research, health policy, community organisation and beyond. This conceptual expansion is currently taking place in structural competency, and we hope that this volume will help to raise awareness and reinforce what is already happening. In sum, this collection of articles puts structural competency more rigorously and actively in conversation with different geographic, political, social, and professional contexts worldwide. We hope this conversation sparks further development in scholarly, political and community movements for social and health justice.
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Affiliation(s)
| | - Seth Holmes
- Environmental Science Policy Management and Medical Anthropology, University of California, Berkeley, CA, USA
- Department of Social Anthropology, University of Barcelona, Barcelona, Spain
- ICREA Catalan Institution for Research and Advanced Study, Barcelona, Spain
| | | | - Joel Ferrall
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kavya Nambiar
- UC Berkeley-UCSF Joint Medical Program, Berkeley, CA, USA
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21
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Lynn TM, D’urzo KA, Vaughan-Ogunlusi O, Wiesendanger K, Colbert-Kaip S, Capcara A, Chen S, Sreenan S, Brennan MP. The impact of a student-led anti-racism programme on medical students' perceptions and awareness of racial bias in medicine and confidence to advocate against racism. MEDICAL EDUCATION ONLINE 2023; 28:2176802. [PMID: 36787247 PMCID: PMC9930825 DOI: 10.1080/10872981.2023.2176802] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/30/2022] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Systemic racism impacts personal and community health; however, education regarding its role in perpetuating healthcare inequity remains limited in medical curricula. This study implemented and evaluated the impact of a student-led anti-racism programme on medical students' perceptions of racial bias in medicine, awareness of, and confidence to advocate against racism in medicine. METHOD A total of 543 early stage medical students were invited to participate in the programme. Participants were assigned readings and videos exploring racial injustice in medicine and attended a virtual small-group discussion facilitated by faculty and students. Online surveys were used to collect pre- and post-programme data using Likert scales for response items. Open-ended questions were independently reviewed by three authors using reflexive thematic analysis. RESULTS Sixty-three early-stage medical students enrolled in the programme, of which 42 completed the pre-programme survey. There was a 76% (n = 32) response rate for the post-programme survey. The majority of students (60%, n = 25) had no previous education about racism in medicine. From pre- to post-programme, there was a significant change in students' perceived definition of race from genetic, biological, geographical, and cultural factors to socio-political factors (P < 0.0001). Significant increases in almost all factors assessing student awareness of racism and confidence to advocate against racism were observed. Student-identified barriers to discussing racism included lack of education and lived experience, fear of starting conflict and offending others. All survey respondents would recommend this programme to peers and 69% (n = 32) engaged in further topical self-directed education. CONCLUSION This simple and reproducible programme improved awareness and confidence to advocate against racism in medicine and resulted in a change in opinion regarding race-based medical practice. These findings are in line with best practice towards addressing racial bias in medicine, decolonizing medical curricula and strengthening anti-racism teaching of future physicians.
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Affiliation(s)
- Thérése M. Lynn
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Katrina A. D’urzo
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Kathryn Wiesendanger
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Sarah Colbert-Kaip
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Austin Capcara
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Sarah Chen
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Seamus Sreenan
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Endocrinology, Connolly Hospital, Dublin, Ireland
| | - Marian P. Brennan
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- School of Pharmacy and Biomedical Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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22
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Caiola C, Nelson TB, Black KZ, Calogero C, Guard K, Haberstroh A, Corral I. Structural competency in pre-health and health professional learning: A scoping review. J Interprof Care 2023; 37:922-931. [PMID: 36264080 PMCID: PMC10188213 DOI: 10.1080/13561820.2022.2124238] [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: 04/18/2022] [Revised: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 10/24/2022]
Abstract
Structural competency training provides guidance to healthcare providers on recognizing and addressing structural factors leading to health inequities. To inform the evidence-based progression of structural competency curriculum development, this study was designed to map the current state of the literature on structural competency training with pre-health students, healthcare professional students, and/or healthcare professionals. We performed a scoping review and identified peer-reviewed, primary research articles assessing structural competency training interventions. The category of learners, timing of the structural competency training, types of teaching and learning activities used, instruments used to measure training outcomes, and evaluation criteria were examined. Eleven (n = 11) articles met inclusion criteria, addressing all training levels, and largely focused on medical education. Active learning strategies and researcher-developed instruments to measure training outcomes were most used. Evaluation criteria largely focused on trainees' affective reactions, utility assessments, and direct measure of the trainee learning. We suggest designing interprofessional structural competency education with an emphasis on active learning strategies and standardized training curricula. Evaluation instruments integrated at different points in the health professional learning trajectory are important for evidence-based progression in curriculum development focused on achieving structural competency.
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Affiliation(s)
- Courtney Caiola
- Department of Nursing Science, College of Nursing, East Carolina University, Greenville, NC, USA
| | - Taylor B Nelson
- School of Nursing, the University of North Carolina, Chapel Hill NC, USA
| | - Kristin Z Black
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Christie Calogero
- Bachelor of Science in Nursing Student, College of Nursing, East Carolina University, Greenville, NC, USA
| | - Kaitlin Guard
- Department of Nursing Science, College of Nursing, East Carolina University, Greenville, NC, USA
| | | | - Irma Corral
- Department of Psychiatry and Behavioral Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA
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23
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Anaya YBM. The Power of Policy. Fam Med 2023; 55:644-645. [PMID: 38019681 PMCID: PMC10741710 DOI: 10.22454/fammed.2023.800098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Affiliation(s)
- Yohualli Balderas-Medina Anaya
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Abstract
A growing body of literature has engaged with mass incarceration as a public health problem. This article reviews some of that literature, illustrating why and how bioethicists can and should engage with the problem of mass incarceration as a remediable cause of health inequities. "Mass incarceration" refers to a phenomenon that emerged in the United States fifty years ago: imprisoning a vastly larger proportion of the population than peer countries do, with a greatly disproportionate number of incarcerated people being members of marginalized racial and ethnic groups. Bioethicists have long engaged with questions of health justice for incarcerated people, including consent issues for those participating in research and access to health care. This article provides an overview of the individual and public health impacts of mass incarceration. The article argues that mass incarceration is a bioethics issue that should be addressed in medical education, identifies opportunities for bioethicists to guide hospitals' interactions with law enforcement officials, and calls on bioethicists to be in conversation with medical and nursing students and health care professionals about these groups' advocacy efforts concerning structural racism, police violence, and mass incarceration.
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Narruhn RA, Espina CR. "I've Never Been to a Doctor": Health Care Access for the Marshallese in Washington State. ANS Adv Nurs Sci 2023; 46:424-440. [PMID: 36094285 DOI: 10.1097/ans.0000000000000456] [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: 11/26/2022]
Abstract
The Ri Majel (Marshallese) migrants of Washington State have endured health inequities and unique laws dictating their access to health care once they arrive to the United States. These health inequities can be seen to be a result of historical trauma and militarization of their islands. The research question was an inquiry regarding access to health care for the Ri Majel in Washington State. We first provide detailed historical data in the background to contextualize our research inquiry. We interviewed 12 people and using manifest content analysis found 2 main themes regarding the health of the Ri Majel: (1) health care access and inequity and (2) historical trauma and embodiment. Health care access was impeded by (1) ongoing effects of radiation, (2) repeated denial of services, (3) lack of health care and insurance, (4) lack of language interpretation during health care visits, and (5) poverty. Historical trauma and embodiment were evidenced by these findings: (1) illness and early mortality; (2) provider lack of knowledge and understanding of the Ri Majel; (3) structural discrimination; (4) feelings of sadness and despair; (5) shyness and humility; and (6) a sense of "cannot/will not" and fatalism. Our findings demonstrate the need to examine structural factors when assessing health inequities and a need to understand and mitigate the effects of historical trauma enacted by structural racism, violence, and colonialism. Strategies to mitigate the embodiment of historical trauma require further investigation.
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Affiliation(s)
- Robin A Narruhn
- College of Nursing, Seattle University, Seattle, Washington (Dr Narruhn); and RN-to-BSN Program, Department of Health & Community Studies, Western Washington University, Bellingham (Dr Espina)
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Holmes SM. Learning Language, Un/Learning Empathy in Medical School. Cult Med Psychiatry 2023:10.1007/s11013-023-09830-8. [PMID: 37725219 DOI: 10.1007/s11013-023-09830-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 09/21/2023]
Abstract
This article considers the ways in which empathy for patients and related solidarity with communities may be trained out of medical students during medical school. The article focuses especially on the pre-clinical years of medical school, those that begin with orientation and initiation events such as the White Coat Ceremony. The ethnographic data for the article come from field notes and recordings from my own medical training as well as hundreds of hours of observant participation and interviews with medical students over the past several years. Exploring the framework of language socialization, I argue that learning the verbal, textual and bodily language of medical practice contributes to the increasing experience of separation between physicians and patients. Further considering the ethnographic data, I argue that we also learn a form of empathy limited to performance that short circuits clinical care and the possibility for solidarity for health equity. The article concludes with implications for medical education and the medical social sciences and humanities.
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Affiliation(s)
- Seth M Holmes
- University of California, Berkeley, 50 University Hall, MC 7360, Berkeley, CA, 94720, USA.
- University of Barcelona, Barcelona, Spain.
- ICREA Catalan Institution for Research and Advanced Study, Barcelona, Spain.
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Mihaly L, Scherzer T, McGuinness C, Stephan L. Shifting the Paradigm: Antiracist Education for Advanced Practice Nursing Providers. Health Equity 2023; 7:603-611. [PMID: 37731778 PMCID: PMC10507936 DOI: 10.1089/heq.2023.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction Racism in the United States adversely impacts health outcomes. Achieving health equity will require an explicitly antiracist approach to the education of health care providers (HCPs). This article examines a required course that focuses on teaching advanced practice nursing students about the structural foundations of racism. This approach shifts significantly away from teaching race-based medicine (which assumes a biological basis for disparities) and the social determinants of health (which often blames individuals for disparities). Methods A mixed methods evaluation was conducted to understand the change in learners' understanding of (1) structural racism and (2) the role that HCPs can play in addressing structural racism. Anonymous surveys asked the following: (1) What are three examples of structural racism in the context of health care? and (2) What is the HCP's role in addressing structural racism? Results Statistically significant increases were observed. The percentage of students who could provide at least one example of structural racism increased from 41% to 70%. Significant increases were also found in students' abilities to identify structural and institutional antiracist interventions. Discussion This project yields important data that can inform educational efforts focused on structural racism. The results strongly suggest that the course resulted in a change in student understanding of racism in health care and strategies to address it. Health Equity Implications The development of a required course for advanced practice nurses focused on structural racism, including attention to social and institutional interventions, can significantly shift HCP understanding and is one strategy to move us toward health equity.
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Affiliation(s)
- Lisa Mihaly
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, California, USA
- Division of Adolescent and Young Adult Medicine, Nursing Faculty, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Teresa Scherzer
- Office of the Dean, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Cara McGuinness
- Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts, USA
| | - Linda Stephan
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, California, USA
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Macias-Konstantopoulos WL, Collins KA, Diaz R, Duber HC, Edwards CD, Hsu AP, Ranney ML, Riviello RJ, Wettstein ZS, Sachs CJ. Race, Healthcare, and Health Disparities: A Critical Review and Recommendations for Advancing Health Equity. West J Emerg Med 2023; 24:906-918. [PMID: 37788031 PMCID: PMC10527840 DOI: 10.5811/westjem.58408] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 04/17/2023] [Accepted: 05/24/2023] [Indexed: 10/04/2023] Open
Abstract
An overwhelming body of evidence points to an inextricable link between race and health disparities in the United States. Although race is best understood as a social construct, its role in health outcomes has historically been attributed to increasingly debunked theories of underlying biological and genetic differences across races. Recently, growing calls for health equity and social justice have raised awareness of the impact of implicit bias and structural racism on social determinants of health, healthcare quality, and ultimately, health outcomes. This more nuanced recognition of the role of race in health disparities has, in turn, facilitated introspective racial disparities research, root cause analyses, and changes in practice within the medical community. Examining the complex interplay between race, social determinants of health, and health outcomes allows systems of health to create mechanisms for checks and balances that mitigate unfair and avoidable health inequalities. As one of the specialties most intertwined with social medicine, emergency medicine (EM) is ideally positioned to address racism in medicine, develop health equity metrics, monitor disparities in clinical performance data, identify research gaps, implement processes and policies to eliminate racial health inequities, and promote anti-racist ideals as advocates for structural change. In this critical review our aim was to (a) provide a synopsis of racial disparities across a broad scope of clinical pathology interests addressed in emergency departments-communicable diseases, non-communicable conditions, and injuries-and (b) through a race-conscious analysis, develop EM practice recommendations for advancing a culture of equity with the potential for measurable impact on healthcare quality and health outcomes.
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Affiliation(s)
- Wendy L Macias-Konstantopoulos
- Center for Social Justice and Health Equity, Department of Emergency Medicine, Boston, Massachusetts
- Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | | | - Rosemarie Diaz
- University of California-Los Angeles, Department of Emergency Medicine, Los Angeles, California
| | - Herbert C Duber
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
- Washington State Department of Health, Tumwater, Washington
| | - Courtney D Edwards
- Samford University, Moffett & Sanders School of Nursing, Birmingham, Alabama
| | - Antony P Hsu
- Trinity Health Ann Arbor Hospital, Department of Emergency Medicine, Ypsilanti, Michigan
| | - Megan L Ranney
- Yale University, Yale School of Public Health, New Haven, Connecticut
| | - Ralph J Riviello
- University of Texas Health San Antonio, Department of Emergency Medicine, San Antonio, Texas
| | - Zachary S Wettstein
- University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington
| | - Carolyn J Sachs
- Ronald Reagan-UCLA Medical Center and David Geffen School of Medicine at University of California-Los Angeles, Department of Emergency Medicine, Los Angeles, California
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Agrawal N, Lucier J, Ogawa R, Arons A. Advocacy Curricula in Graduate Medical Education: an Updated Systematic Review from 2017 to 2022. J Gen Intern Med 2023; 38:2792-2807. [PMID: 37340255 PMCID: PMC10507002 DOI: 10.1007/s11606-023-08244-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/15/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Advocacy is an integral component of a physician's professional responsibilities, yet efforts to teach advocacy skills in a systematic and comprehensive manner have been inconsistent and challenging. There is currently no consensus on the tools and content that should be included in advocacy curricula for graduate medical trainees. OBJECTIVE To conduct a systematic review of recently published GME advocacy curricula and delineate foundational concepts and topics in advocacy education that are pertinent to trainees across specialties and career paths. METHODS We conducted an updated systematic review based off Howell et al. (J Gen Intern Med 34(11):2592-2601, 2019) to identify articles published between September 2017 and March 2022 that described GME advocacy curricula developed in the USA and Canada. Searches of grey literature were used to find citations potentially missed by the search strategy. Articles were independently reviewed by two authors to identify those meeting our inclusion and exclusion criteria; a third author resolved discrepancies. Three reviewers used a web-based interface to extract curricular details from the final selection of articles. Two reviewers conducted a detailed analysis of recurring themes in curricular design and implementation. RESULTS Of 867 articles reviewed, 26 articles, describing 31 unique curricula, met inclusion and exclusion criteria. The majority (84%) represented Internal Medicine, Family Medicine, Pediatrics, and Psychiatry programs. The most common learning methods included experiential learning, didactics, and project-based work. Most covered community partnerships (58%) and legislative advocacy (58%) as advocacy tools and social determinants of health (58%) as an educational topic. Evaluation results were inconsistently reported. Analysis of recurring themes showed that advocacy curricula benefit from an overarching culture supportive of advocacy education and should ideally be learner-centric, educator-friendly, and action-oriented. DISCUSSION Combining core features of advocacy curricula identified in prior publications with our findings, we propose an integrative framework to guide design and implementation of advocacy curricula for GME trainees. Additional research is needed to build expert consensus and ultimately develop model curricula for disseminated use.
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Affiliation(s)
- Nupur Agrawal
- Division of Internal Medicine and Pediatrics, Department of Internal Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA USA
| | - Jessica Lucier
- Palliative Care Program, Division of General Internal Medicine & Health Services Research, Department of Internal Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA USA
| | - Rikke Ogawa
- UCI Libraries, University of California Irvine, Irvine, CA USA
| | - Abigail Arons
- Division of General Internal Medicine, Department of Internal Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA USA
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Osmanlliu E, Kalwani NM, Parameswaran V, Qureshi L, Dash R, Scheinker D, Rodriguez F. Sociodemographic disparities in the use of cardiovascular ambulatory care and telemedicine during the COVID-19 pandemic. Am Heart J 2023; 263:169-176. [PMID: 37369269 PMCID: PMC10290766 DOI: 10.1016/j.ahj.2023.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND The COVID-19 pandemic accelerated adoption of telemedicine in cardiology clinics. Early in the pandemic, there were sociodemographic disparities in telemedicine use. It is unknown if these disparities persisted and whether they were associated with changes in the population of patients accessing care. METHODS We examined all adult cardiology visits at an academic and an affiliated community practice in Northern California from March 2019 to February 2020 (pre-COVID) and March 2020 to February 2021 (COVID). We compared patient sociodemographic characteristics between these periods. We used logistic regression to assess the association of patient/visit characteristics with visit modality (in-person vs telemedicine and video- vs phone-based telemedicine) during the COVID period. RESULTS There were 54,948 pre-COVID and 58,940 COVID visits. Telemedicine use increased from <1% to 70.7% of visits (49.7% video, 21.0% phone) during the COVID period. Patient sociodemographic characteristics were similar during both periods. In adjusted analyses, visits for patients from some sociodemographic groups were less likely to be delivered by telemedicine, and when delivered by telemedicine, were less likely to be delivered by video versus phone. The observed disparities in the use of video-based telemedicine were greatest for patients aged ≥80 years (vs age <60, OR 0.24, 95% CI 0.21, 0.28), Black patients (vs non-Hispanic White, OR 0.64, 95% CI 0.56, 0.74), patients with limited English proficiency (vs English proficient, OR 0.52, 95% CI 0.46-0.59), and those on Medicaid (vs privately insured, OR 0.47, 95% CI 0.41-0.54). CONCLUSIONS During the first year of the pandemic, the sociodemographic characteristics of patients receiving cardiovascular care remained stable, but the modality of care diverged across groups. There were differences in the use of telemedicine vs in-person care and most notably in the use of video- vs phone-based telemedicine. Future studies should examine barriers and outcomes in digital healthcare access across diverse patient groups.
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Affiliation(s)
- Esli Osmanlliu
- McGill University Health Centre Research Institute, McGill University, Montréal, CA
| | - Neil M Kalwani
- VA Palo Alto Health Care System, Palo Alto, CA; Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA.
| | - Vijaya Parameswaran
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Lubna Qureshi
- Digital Health Care Integration, Stanford Health Care, Stanford, CA
| | - Rajesh Dash
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - David Scheinker
- Department of Management Science and Engineering, Stanford University, Stanford, CA; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
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Tarleton C, Tong W, McNeill E, Owda A, Barron B, Cunningham H. Preparing Medical Students for Anti-racism at the Bedside: Teaching Skills to Mitigate Racism and Bias in Clinical Encounters. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11333. [PMID: 37576358 PMCID: PMC10412739 DOI: 10.15766/mep_2374-8265.11333] [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: 08/28/2022] [Accepted: 04/30/2023] [Indexed: 08/15/2023]
Abstract
Introduction Systemic racism perpetuates health disparities and negatively impacts health care delivery and patient outcomes. Racism and bias can affect every aspect of clinical care, including history-taking, physical examination, laboratory interpretation, note-writing, oral presentation, and decision-making. Medical students must learn racism- and bias-mitigation skills early in their professional development to provide high-quality, equitable care. Methods In November 2021, senior medical students and faculty with expertise in promoting health equity and justice in medicine designed and cotaught a Zoom-based, 75-minute, interactive session for second-year medical students. Participants prepared by reading assigned articles. Breakout rooms were used to facilitate small-group discussions. Session topics included use of a structural vulnerability assessment tool, examples of how bias can impact the physical exam, demonstration of how language can transmit bias, and skill practice using neutral instead of stigmatizing language. Results Forty second-year medical students participated in the session. Thirty-one students (78%) completed Likert-type surveys evaluating reaction and learning. Results showed improvements in students' perceptions of their abilities to assess for structural factors that influence health, recognize ways bias can impact clinical encounters, and apply skills to minimize bias in clinical care and decision-making. Discussion Providing opportunities for health care learners to think critically about how bias impacts patients and communities and equipping them with tools to begin dismantling exclusionary, racist practices in medicine are achievable and crucial to actualizing a just and equitable health system. This educational session can be adapted for training across health care professions and the educational continuum.
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Affiliation(s)
- Catherine Tarleton
- First-Year Resident, Department of Obstetrics, Gynecology and Women's Health, University of Hawai'i at Mānoa John A. Burns School of Medicine
| | - Wendy Tong
- First-Year Resident, Department of Medicine, McGaw Medical Center of Northwestern University
| | - Emily McNeill
- First-Year Resident, Department of Neurology, University of California, San Francisco Weill Institute for Neurosciences
| | - Ahmed Owda
- First-Year Resident, Department of Ophthalmology, University of Michigan Medical School
| | - Beth Barron
- Associate Professor, Department of Medicine, Columbia University Irving Medical Center
- Co-last author
| | - Hetty Cunningham
- Associate Professor, Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, and Morgan Stanley Children's Hospital at New York Presbyterian
- Co-last author
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Wispelwey B, Tanous O, Asi Y, Hammoudeh W, Mills D. Because its power remains naturalized: introducing the settler colonial determinants of health. Front Public Health 2023; 11:1137428. [PMID: 37533522 PMCID: PMC10393129 DOI: 10.3389/fpubh.2023.1137428] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/23/2023] [Indexed: 08/04/2023] Open
Abstract
Indigenous people suffer earlier death and more frequent and severe disease than their settler counterparts, a remarkably persistent reality over time, across settler colonized geographies, and despite their ongoing resistance to elimination. Although these health inequities are well-known, they have been impervious to comprehensive and convincing explication, let alone remediation. Settler colonial studies, a fast-growing multidisciplinary and interdisciplinary field, is a promising candidate to rectify this impasse. Settler colonialism's relationship to health inequity is at once obvious and incompletely described, a paradox arising from epistemic coloniality and perceived analytic challenges that we address here in three parts. First, in considering settler colonialism an enduring structure rather than a past event, and by wedding this fundamental insight to the ascendant structural paradigm for understanding health inequities, a picture emerges in which this system of power serves as a foundational and ongoing configuration determining social and political mechanisms that impose on human health. Second, because modern racialization has served to solidify and maintain the hierarchies of colonial relations, settler colonialism adds explanatory power to racism's health impacts and potential amelioration by historicizing this process for differentially racialized groups. Finally, advances in structural racism methodologies and the work of a few visionary scholars have already begun to elucidate the possibilities for a body of literature linking settler colonialism and health, illuminating future research opportunities and pathways toward the decolonization required for health equity.
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Affiliation(s)
- Bram Wispelwey
- Department of Global Health and Population, School of Public Health, Harvard University, Boston, MA, United States
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
- François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University, Boston, MA, United States
| | - Osama Tanous
- François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University, Boston, MA, United States
| | - Yara Asi
- François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University, Boston, MA, United States
- School of Global Health Management and Informatics, College of Community Innovation and Education, University of Central Florida, Orlando, FL, United States
| | - Weeam Hammoudeh
- François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University, Boston, MA, United States
- Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | - David Mills
- François-Xavier Bagnoud Center for Health and Human Rights, School of Public Health, Harvard University, Boston, MA, United States
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
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Fahie VP, Chen L, Lemaire GS, Ahmed HS. Development and Implementation of an Academic and Professional Nursing Organization Partnership to Enhance Leadership Skills and Knowledge About HIV-Related Nursing Care Among Diverse, Prelicensure, Clinical Nurse Leader Scholars. J Assoc Nurses AIDS Care 2023; 34:398-406. [PMID: 37141161 DOI: 10.1097/jnc.0000000000000414] [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: 05/05/2023]
Abstract
ABSTRACT Historically, racial discrimination, few role models, and a general lack of support both in academic and professional contexts has hindered the education and career advancement of minority nursing students. The American Association of Colleges of Nursing (AACN), in its G uiding Principles for Academic-Practice Partnerships , describes the creation of an academic-professional nursing organization partnership to address barriers to the success of nursing students from underrepresented groups. In keeping with the AACN's guiding principles, the University of Maryland School of Nursing and the Association of Nurses in AIDS Care (ANAC) developed a partnership to deliver a multifaceted program for prelicensure, second-degree, Master of Science in Nursing, Clinical Nurse Leader Scholars which prepares them to address the health care needs of people living with HIV/AIDS and bolsters student leadership knowledge and skills. The objective of this article is to describe the program components, outcomes, and lessons learned from this academic-professional nursing organization partnership. The approach described may be useful for future partnerships designed to enhance leadership experiences and skills for minority nursing students and will hopefully be used to advocate for their success.
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Affiliation(s)
- Vanessa P Fahie
- Vanessa P. Fahie, PhD, RN, is an Assistant Professor and the Project Director, University of Maryland School of Nursing, Baltimore, Maryland, USA. Lynn Chen, PhD, is an Assistant Professor and Evaluator, School of Nursing, University of Maryland School of Nursing, Baltimore, Maryland, USA. Gail Schoen Lemaire, PhD, PMHCNS, BC, CNL, CNE, is an Associate Professor, former Associate Dean, Master of Science in Nursing Program and former CNL Option Director, University of Maryland School of Nursing, Baltimore, Maryland, USA. Hina S. Ahmed, MHA, program Manager and the Liaison to the project, Association for Nurses in AIDS Care, Washington, District of Columbia, USA
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Gborkorquellie TT, Ward MC, Falusi OO, Barber AN, Smith TK. Diversity, Equity, Inclusion, and Justice in Medical Education: A Faculty Development Perspective. Pediatr Ann 2023; 52:e266-e272. [PMID: 37427969 DOI: 10.3928/19382359-20230516-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
As many residency programs expand teaching to address the knowledge, skills, and attitudes that residents need to dismantle structural racism and other systemic inequities, many faculty are not prepared to teach these topics. However, there is limited literature on which to base faculty development in this area. The aim of this article is to review how diversity, equity, inclusion, and justice education is integrated in pediatric faculty development efforts. This review will include published and gray literature on curricula and programs in medical education for faculty learners and will address common barriers and challenges faced by faculty members. [Pediatr Ann. 2023;52(7):e266-e272.].
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Binagwaho A, Mathewos K. The Right to Health: Looking beyond Health Facilities. Health Hum Rights 2023; 25:133-135. [PMID: 37266319 PMCID: PMC9973503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Affiliation(s)
- Agnes Binagwaho
- Retired vice chancellor of the University of Global Health Equity, Rwanda, and a senior lecturer in global health and social medicine at Harvard Medical School, Boston, United States
| | - Kedest Mathewos
- Research associate at the University of Global Health Equity, Kigali, Rwanda
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Downey MM, Thompson-Lastad A. From Apathy to Structural Competency and the Right to Health: An Institutional Ethnography of a Maternal and Child Wellness Center. Health Hum Rights 2023; 25:23-38. [PMID: 37266317 PMCID: PMC9973510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Given the persistence of health inequities in the United States, scholars and health professionals alike have turned to the social determinants of health (SDH) framework to understand the overlapping factors that produce and shape these inequities. However, there is scant empirical literature on how frontline health and social service workers perceive and apply the SDH framework, or related movements such as the right to health, in their daily practice. Our study seeks to bridge this gap by applying constructs from the sociological imagination and structural competency (an emerging paradigm in health professions' education) to understand the perspectives and experiences of social work case managers, community health workers, legal advocates, and mental health counselors at a maternal and child health center in a large US city. This frontline workforce displayed strong sociological imagination, elements of structural competency, and engagement with the principles of the right to health. Workers shared reflections on the SDH framework in ways that signaled promising opportunities for frontline workers to link with the global movement for the right to health. We offer a novel approach to understanding the relationships between frontline worker perspectives on and experiences with the SDH, sociological imagination, structural competency, and the right to health.
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Affiliation(s)
- Margaret Mary Downey
- Member of the Structural Competency Working Group and an assistant professor at Tulane University’s School of Social Work, New Orleans, United States
| | - Ariana Thompson-Lastad
- Member of the Structural Competency Working Group’s leadership team, an assistant professor at the University of California San Francisco School of Medicine, and core faculty at the Osher Center for Integrative Medicine, San Francisco, United States
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Murray TA. Health Equity and Sociopolitical Movements. J Nurs Educ 2023; 62:323-324. [PMID: 37279978 DOI: 10.3928/01484834-20230511-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Teri A Murray
- Professor, Dean Emerita, Chief Diversity, and Inclusion Officer, Trudy Busch Valentine School of Nursing, Saint Louis University, Associate Editor, Journal of Nursing Education
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Percy S, Sahi S, Bua E, Shamasunder S, Lipnick M, Law T. Living the work: the HEAL Initiative as a model for perioperative health workforce transformation and health equity work. Can J Anaesth 2023; 70:968-971. [PMID: 37217737 PMCID: PMC10202527 DOI: 10.1007/s12630-023-02451-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 05/24/2023] Open
Affiliation(s)
- Samuel Percy
- Division of Pediatric Anesthesiology, Children's Hospital Colorado, Aurora, CO, USA.
| | - Saad Sahi
- Center for Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, CA, USA
| | - Emmanuel Bua
- Department of Surgery, Busitema University, Mbale, Tororo, Uganda
| | - Sriram Shamasunder
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Michael Lipnick
- Center for Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, CA, USA
| | - Tyler Law
- Center for Health Equity in Surgery and Anesthesia, University of California San Francisco, San Francisco, CA, USA
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Ordonez E, Bradby C, Carey J, Gupta S, Hiller KM, Miller D, Pierce A, Wiesendanger K, Moffett S. Beyond diversity and inclusion: Developing a research agenda for anti-racism in emergency medicine education. AEM EDUCATION AND TRAINING 2023; 7:S68-S77. [PMID: 37383834 PMCID: PMC10294218 DOI: 10.1002/aet2.10876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 06/30/2023]
Abstract
Background Addressing racism in emergency medicine education is vital for providing optimal training and assessment of physicians in the specialty, developing physicians with the skills necessary to advocate for their patients, and recruiting and retaining a diverse group of physicians. To form a prioritized research agenda, the Society of Academic Emergency Medicine (SAEM) conducted a consensus conference at the annual meeting in May 2022 on addressing racism in emergency medicine, which included a subgroup on education. Methods The education workgroup worked on summarizing the current literature on addressing racism in emergency medicine education, identifying critical knowledge gaps, and creating a consensus-driven research agenda for addressing racism in emergency medicine education. We used a nominal group technique and modified Delphi to develop priority questions for research. We then distributed a pre-conference survey to conference registrants to rate priority areas for research. During the consensus conference, group leaders provided an overview and background describing the rationale for the preliminary research question list. Attendees were then involved in discussions to help modify and develop research questions. Results Nineteen questions were initially selected by the education workgroup as potential areas for research. The education workgroup's next round of consensus building resulted in a consensus of ten questions to be included in the pre-conference survey. No questions in the pre-conference survey reached consensus. After robust discussion and voting by workgroup members and attendees at the consensus conference, six questions were determined to be priority research areas. Conclusions We believe recognizing and addressing racism in emergency medicine education is imperative. Critical gaps in curriculum design, assessment, bias training, allyship, and the learning environment negatively impact training programs. These gaps must be prioritized for research as they can have adverse effects on recruitment, the ability to promote a safe learning environment, patient care, and patient outcomes.
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Affiliation(s)
- Edgardo Ordonez
- Henry JN Taub Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | - Cassandra Bradby
- Department of Emergency MedicineThe Brody School of Medicine at East Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Jennifer Carey
- Department of Emergency MedicineUMass Chan Medical SchoolWorcesterMassachusettsUSA
| | - Sanjey Gupta
- Department of Emergency MedicineZucker School of Medicine at Hofstra/NorthwellBayshoreNew YorkUSA
| | - Katherine M. Hiller
- Department of Emergency MedicineIndiana University School of MedicineBloomingtonIndianaUSA
| | - Danielle Miller
- Department of Emergency MedicineUniversity of Colorado School of MedicineDenverColoradoUSA
| | - Ava Pierce
- Division of Emergency MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Kathryn Wiesendanger
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Shannon Moffett
- Department of Emergency MedicineRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
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Emani S, Rodriguez JA, Bates DW. Racism and Electronic Health Records (EHRs): Perspectives for research and practice. J Am Med Inform Assoc 2023; 30:995-999. [PMID: 36869772 PMCID: PMC10114075 DOI: 10.1093/jamia/ocad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/17/2023] [Accepted: 02/19/2023] [Indexed: 03/05/2023] Open
Abstract
Informatics researchers and practitioners have started exploring racism related to the implementation and use of electronic health records (EHRs). While this work has begun to expose structural racism which is a fundamental driver of racial and ethnic disparities, there is a lack of inclusion of concepts of racism in this work. This perspective provides a classification of racism at 3 levels-individual, organizational, and structural-and offers recommendations for future research, practice, and policy. Our recommendations include the need to capture and use structural measures of social determinants of health to address structural racism, intersectionality as a theoretical framework for research, structural competency training, research on the role of prejudice and stereotyping in stigmatizing documentation in EHRs, and actions to increase the diversity of private sector informatics workforce and participation of minority scholars in specialty groups. Informaticians have an ethical and moral obligation to address racism, and private and public sector organizations have a transformative role in addressing equity and racism associated with EHR implementation and use.
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Affiliation(s)
- Srinivas Emani
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jorge A Rodriguez
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Perkins S, Nishimura H, Olatunde PF, Kalbarczyk A. Educational approaches to teach students to address colonialism in global health: a scoping review. BMJ Glob Health 2023; 8:e011610. [PMID: 37055173 PMCID: PMC10106004 DOI: 10.1136/bmjgh-2022-011610] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/18/2023] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION The enduring legacy of colonisation on global health education, research and practice is receiving increased attention and has led to calls for the 'decolonisation of global health'. There is little evidence on effective educational approaches to teach students to critically examine and dismantle structures that perpetuate colonial legacies and neocolonialist control that influence in global health. METHODS We conducted a scoping review of the published literature to provide a synthesis of guidelines for, and evaluations of educational approaches focused on anticolonial education in global health. We searched five databases using terms generated to capture three concepts, 'global health', 'education' and 'colonialism'. Pairs of study team members conducted each step of the review, following Preferred Reporting Items for Systematic reviews and Meta-Analyse guidelines; any conflicts were resolved by a third reviewer. RESULTS This search retrieved 1153 unique references; 28 articles were included in the final analysis. The articles centred North American students; their training, their evaluations of educational experiences, their individual awareness and their experiential learning. Few references discussed pedagogical approaches or education theory in guidelines and descriptions of educational approaches. There was limited emphasis on alternative ways of knowing, prioritisation of partners' experiences, and affecting systemic change. CONCLUSION Explicit incorporation of anticolonial curricula in global health education, informed by antioppressive pedagogy and meaningful collaboration with Indigenous and low-income and middle-income country partners, is needed in both classroom and global health learning experiences.
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Affiliation(s)
- Sylvie Perkins
- Center for Indigenous Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Holly Nishimura
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Praise F Olatunde
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anna Kalbarczyk
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Falusi O, Chun-Seeley L, de la Torre D, Dooley DG, Baiyewu M, Gborkorquellie TT, Merrill CT, Davis E, Ward MC. Teaching the Teachers: Development and Evaluation of a Racial Health Equity Curriculum for Faculty. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11305. [PMID: 36999061 PMCID: PMC10043344 DOI: 10.15766/mep_2374-8265.11305] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/05/2022] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Faculty are increasingly expected to teach about the impact of racism on health and to model the principles of health equity. However, they often feel ill-equipped to do so, and there is limited literature on faculty development on these topics. We developed a curriculum for faculty education on racism and actions to advance racial health equity. METHODS The curriculum design was based on a literature review and needs assessments. Implementation consisted of four live virtual 1-hour sessions incorporating interactive didactics, cases, reflection, goal setting, and discussion offered to a multidisciplinary group of pediatric faculty at a children's hospital. Topics included the history of racism, racism in health care, interacting with trainees and colleagues, and racial equity in policy. Evaluation consisted of pre- and postsurveys at the beginning and end of the curriculum and a survey after each session. RESULTS A mean of 78 faculty members attended each session (range: 66-94). Participants reported high satisfaction and increased knowledge at the end of each session. Qualitative themes included self-reflection on personal biases, application of health equity frameworks and tools, becoming disruptors of racism, and the importance of systemic change and policy. DISCUSSION This curriculum is an effective method for increasing faculty knowledge and comfort. The materials can be adapted for various audiences.
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Affiliation(s)
- Olanrewaju Falusi
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences; Associate Program Director, Pediatric Residency Program, Children's National Hospital; Medical Director of Advocacy Education, Child Health Advocacy Institute, Children's National Hospital
| | - Lin Chun-Seeley
- Program Lead, Advocacy Education and Community Affairs, Pediatric Resident Health Equity Education, Child Health Advocacy Institute, Children's National Hospital
| | - Desiree de la Torre
- Director, Community Affairs and Population Health Improvement, Child Health Advocacy Institute, Children's National Hospital
| | - Danielle G. Dooley
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences; Medical Director of Community Affairs, Child Health Advocacy Institute, Children's National Hospital
| | - Melissa Baiyewu
- Program Manager, Health Promotion and Disease Prevention Programs, Child Health Advocacy Institute, Children's National Hospital
| | - Theiline T. Gborkorquellie
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences; Assistant Director of Health Equity Education, Pediatric Residency Program, Children's National Hospital; Affiliate Faculty, Child Health Advocacy Institute, Children's National Hospital
| | - Chaya T. Merrill
- Assistant Professor, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences; Director, Child Health Data Lab, Child Health Advocacy Institute, Children's National Hospital
| | - Elizabeth Davis
- Manager, Government Affairs, Child Health Advocacy Institute, Children's National Hospital
| | - Maranda C. Ward
- Assistant Professor and Director of Equity, Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences
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Brown EA, Kinder H, Stang G, Shumpert W. Using adult learning characteristics and the humanities to teach undergraduate healthcare students about social determinants of health. HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS 2023; 10:114. [PMID: 36969313 PMCID: PMC10024284 DOI: 10.1057/s41599-023-01599-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
Authors used an andragogy framework to help undergraduate allied health students better understand social determinants of health (SDOH) using a photo essay assignment. The study examined students' perceptions of SDOH in various communities, description of health outcomes associated with their chosen SDOH, and lessons learned and suggestions to improve the assignment for future cohorts. Data were extracted from photo essays from 2019-2021 and entered in Microsoft Excel and Word for data analysis after course completion. Conventional qualitative content analysis was used to analyze student evaluation data from open-ended questions. Data were extracted from 53 student essays from 2019 to 2021. Most photo essays described communities in South Carolina (n = 42, 79.2%), urban areas (n = 37, 69.8%), or intermediary SDOH (75.5%). Several themes emerged concerning lessons learned (awareness and empathy are key to addressing SDOH), health equity (collaboration is necessary to provide resources, especially for underserved populations), and constructive feedback for the instructor (more time to discuss SDOH and assignment with peers and instructor). Faculty must work with students to think about more upstream factors like policy and cultural and societal values. Collecting evaluation data, specifically lessons learned and constructive feedback for faculty, can help faculty continuously improve course topics and assignments. Following a transparency framework can support student success and help faculty become effective leaders in the classroom while teaching subjects like SDOH and social justice.
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Affiliation(s)
- Elizabeth A. Brown
- Old Dominion University, Norfolk, VA USA
- Medical University of South Carolina (MUSC), Charleston, SC USA
| | - Hannah Kinder
- Medical University of South Carolina (MUSC), Charleston, SC USA
| | - Garrett Stang
- Medical University of South Carolina (MUSC), Charleston, SC USA
| | - Wendy Shumpert
- Medical University of South Carolina (MUSC), Charleston, SC USA
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Martínez-Hernáez Á, Bekele D. Structural competency in epidemiological research: What's feasible, what's tricky, and the benefits of a 'structural turn'. Glob Public Health 2023:1-14. [PMID: 36609203 DOI: 10.1080/17441692.2023.2164903] [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: 01/09/2023]
Abstract
Structural competency is an emerging paradigm for both the training of health professionals and the creation of a common language addressing structural processes that determine health disparities. However, its application to the field of epidemiological design and research is absent. Based on our previous proposal of a tool for Structural and Intercultural Competency in Epidemiological Studies, the SICES guidelines, in this article we analyse the possibilities and challenges of a 'structural turn' in epidemiology. In terms of possibilities, we recognise the value of paradigms from multiple parts of the world, such as social and sociocultural epidemiology, critical epidemiology and collective health, in facilitating a structural turn in epidemiological studies. In this framework, structural competency would provide a new angle by focusing not only on what to research (e.g. inequalities), but with what skills and attitudes (e.g. cultural and epistemic humility). The challenges lie in the inclusion of reflexivity and a comprehensive view in the context of a positivist epidemiology oriented towards obtaining evidence from a biomedical, but not social, perspective.
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Affiliation(s)
| | - Deborah Bekele
- Medical Anthropology Research Centre, Universitat Rovira i Virgili, Tarragona, Spain
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Dixon J, Mendenhall E, Bosire EN, Limbani F, Ferrand RA, Chandler CIR. Making morbidity multiple: History, legacies, and possibilities for global health. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231164973. [PMID: 37008536 PMCID: PMC10052471 DOI: 10.1177/26335565231164973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/04/2023] [Indexed: 06/19/2023]
Abstract
Multimorbidity has been framed as a pressing global health challenge that exposes the limits of systems organised around single diseases. This article seeks to expand and strengthen current thinking around multimorbidity by analysing its construction within the field of global health. We suggest that the significance of multimorbidity lies not only in challenging divisions between disease categories but also in what it reveals about the culture and history of transnational biomedicine. Drawing on social research from sub-Saharan Africa to ground our arguments, we begin by describing the historical processes through which morbidity was made divisible in biomedicine and how the single disease became integral not only to disease control but to the extension of biopolitical power. Multimorbidity, we observe, is hoped to challenge single disease approaches but is assembled from the same problematic, historically-loaded categories that it exposes as breaking down. Next, we highlight the consequences of such classificatory legacies in everyday lives and suggest why frameworks and interventions to integrate care have tended to have limited traction in practice. Finally, we argue that efforts to align priorities and disciplines around a standardised biomedical definition of multimorbidity risks retracing the same steps. We call for transdisciplinary work across the field of global health around a more holistic, reflexive understanding of multimorbidity that foregrounds the culture and history of translocated biomedicine, the intractability of single disease thinking, and its often-adverse consequences in local worlds. We outline key domains within the architecture of global health where transformation is needed, including care delivery, medical training, the organisation of knowledge and expertise, global governance, and financing.
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Affiliation(s)
- Justin Dixon
- The Health Research Unit Zimbabwe (THRU ZIM), Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily Mendenhall
- Edmund A. Walsh School of Foreign Service, Georgetown University, Washington, DC, United States
- Faculty of Health Sciences, SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Edna N Bosire
- Faculty of Health Sciences, SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Felix Limbani
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Rashida A Ferrand
- The Health Research Unit Zimbabwe (THRU ZIM), Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Clare I R Chandler
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Kalkonde Y, Malik C, Kaur M, Pando U, Paikra G, Jain Y. Why are so many indigenous Pando people dying? Using observations from Chhattisgarh, India, to conduct structural assessment and identify solutions. Glob Public Health 2023; 18:2175014. [PMID: 36789520 DOI: 10.1080/17441692.2023.2175014] [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: 02/16/2023]
Abstract
Health challenges of communities are often assessed using biomedical or individual risk-based frameworks which are often inadequate for understanding their full extent. We use observations from the global South to demonstrate the usefulness of structural assessment to evaluate a public health problem and spur action. Following newspaper reports of excessive deaths in the marginalised indigenous or Adivasi community of the Pando people in Northern Chhattisgarh in central India, we were asked by the state government's public health authorities to identify root causes of these deaths. In this rapidly evolving situation, we used a combination of public health, social medicine, and structural vulnerability frameworks to conduct biomedical investigation, social inquiry, and structural assessment. After biomedical investigations, we identified scrub typhus, a neglected tropical disease, as the most likely cause for some of the deaths which was unrecognised by the treating physicians. In the social inquiry, the community members identified the lack of Adivasi status certificates, education, and jobs as the three major social factors leading to these deaths. During the structural assessment of these deaths, we inductively identified the following ten structures- political, administrative, legal, economic, social, cultural, material, technical, biological, and environmental. We recommended improving the diagnosis and treatment of scrub typhus, making the hospitals more friendly for Adivasi people, and tracking the health status of the Adivasi communities as some of the measures. We suggest that a combination of biomedical, social,and structural assessments can be used to comprehensively evaluate a complex public health problem to spur action..
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Affiliation(s)
| | - Chetanya Malik
- Sangwari - People's Association for Equity and Health, Ambikapur, India
| | - Manveen Kaur
- Sangwari - People's Association for Equity and Health, Ambikapur, India
| | - Uday Pando
- Chhattisgarh State, Special Backward Tribal Group Welfare Association, Ambikapur, India
| | - Gangaram Paikra
- Chaupal - Rural Development, Education and Research Organization, Ambikapur, India
| | - Yogesh Jain
- Sangwari - People's Association for Equity and Health, Ambikapur, India
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Anderson K, Calvin Pérez ME, Covarrubias Kindermann S, Jiles Castillo S, Paley J. Contributions from popular education in health to structural competency training: An experience from Chile. Glob Public Health 2023; 18:2236705. [PMID: 37519155 DOI: 10.1080/17441692.2023.2236705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 07/10/2023] [Indexed: 08/01/2023]
Abstract
Structural competency is used to train health professionals on how social, political, and economic dynamics create conditions that negatively impact a population's health. In the Global South, this approach has historical roots in social movements, popular education, social medicine, and human rights. In 1982, during a time of extreme poverty, inequality, and violence under the Chilean military dictatorship, Educación Popular en Salud (EPES), developed a programme for training community health promoters to address common illnesses and analyse the underlying causes of poor health. In 2010, EPES began using the same model to train international and Chilean health professionals. The approach advanced four competencies. Evaluations show that training contributes to transforming health professionals' mindsets and leads them to question their practices. However, educating practitioners does not change the underlying structures that generate poor health. This article examines the intersection between EPES' competencies and the structural competency framework, highlighting two major contributions of EPES to structural competency: a methodology that narrows the gap between a theoretical analysis of social determinants of health and implementing action plans; and organic long-term links with social movements that strengthen collective action in poor neighbourhoods to advance social justice.
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Affiliation(s)
- Karen Anderson
- Director EPES' International Training Program and member of the educational team, EPES Foundation, Santiago, Chile
| | - María Eugenia Calvin Pérez
- Director of Planning and Evaluation and member of the educational team, EPES Foundation, Santiago, Chile
| | | | - Susana Jiles Castillo
- Director of Project Management and member of the educational team, EPES Foundation, Santiago, Chile
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Bendixsen CG, Ramos AK, Holmes SM. Structural Competency and Agricultural Health and Safety: An Opportunity to Foster Equity within Agriculture. J Agromedicine 2023; 28:45-52. [PMID: 36420522 PMCID: PMC11034733 DOI: 10.1080/1059924x.2022.2148148] [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] [Indexed: 11/27/2022]
Abstract
The future of agricultural work in the United States (U.S.) must account for at least two important trends: 1) the persistence of the industry being riddled with high rates of injury and illness and 2) the growing proportion of hired farmworkers compared to family farmworkers working in these dangerous environments. These workers confront structural disadvantages that impede social justice and prosperity. Social structures like policies, economic systems, institutions, and social hierarchies create health disparities, often along the lines of social categories. The result is an already dangerous industry with vulnerable workers facing unjust risks, especially those that are undocumented. Agricultural health and safety professionals and other stakeholders should engage structural competency curricula in order to increase awareness of impact of structures and be better positioned to improve farmworker health and wellbeing. Similar work has been successful in the training healthcare professionals, e.g. the Structural Competency Working Group (SCWG). New strategies are needed to improve farmworker wellbeing and retain an adequate agricultural workforce. A greater understanding of the social and structural concerns that farmworkers face is an important step towards occupational and social justice. It is also clear that it will require collaboration and community-based efforts creating a larger team of people using similar concepts related to the structural influences on whether health and wellbeing are distributed equitably. This work is being moved forward in healthcare, social work, worker organizations, and community-based initiatives. Agricultural health and safety professionals have a vital contribution to make if they join the ranks.
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Affiliation(s)
- Casper G. Bendixsen
- National Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Athena K. Ramos
- Central States Agricultural Safety and Health Center, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Seth M. Holmes
- Division of Society and Environment, University of California Berkeley, Berkeley, California, USA
- Deprtment of Anthropology, University of Barcelona, Barcelona, Spain
- Catalan Institute for Research and Advanced Study, Barcelona, Spain
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Mizumoto J, Mitsuyama T, Kondo S, Izumiya M, Horita S, Eto M. Defining the observable processes of patient care related to social determinants of health. MEDICAL EDUCATION 2023; 57:57-65. [PMID: 35953461 DOI: 10.1111/medu.14915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION An understanding of social determinants of health (SDH) and patients' social circumstances is recommended to deliver contextualised care. However, the processes of patient care related to SDH in clinical settings have not been described in detail. Observable practice activities (OPAs) are a collection of learning objectives and activities that must be observed in daily practice and can be used to describe the precise processes for professionals to follow in specific situations (process OPA.) METHODS: We used a modified Delphi technique to generate expert consensus about the process OPA for patient care related to SDH in primary care settings. To reflect the opinions of various stakeholders, the expert panel comprised clinical professionals (physicians, nurses, public health nurses, social workers, pharmacists and medical clerks), residents, medical students, researchers (medical education, health care, sociology of marginalised people), support members for marginalised people and patients. The Delphi rounds were conducted online. In Round 1, a list of potentially important steps in the processes of care was distributed to panellists. The list was modified, and one new step was added. In Round 2, all steps were acknowledged with few modifications. RESULTS Of 63 experts recruited, 61 participated, and all participants completed the Delphi rounds. A total of 14 observable steps were identified, which were divided into four components: communication, practice, maintenance and advocacy. The importance of ongoing patient-physician relationships and collaboration with professionals and stakeholders was emphasised for the whole process of care. DISCUSSION This study presents the consensus of a variety of experts on the process OPA for patient care related to SDHs. Further research is warranted to investigate how this Communication-Practice-Maintenance-Advocacy framework could affect medical education, quality of patient care, and patient outcomes.
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Affiliation(s)
- Junki Mizumoto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshichika Mitsuyama
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Kondo
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masashi Izumiya
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shoko Horita
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masato Eto
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Szoko N, Ragunanthan B, Radovic A, Garrison JL, Torres O. Antiracist Curriculum Implementation for Pediatric Residents. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231162986. [PMID: 37123077 PMCID: PMC10134181 DOI: 10.1177/23821205231162986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Objectives Racism has been recognized as a public health crisis, with calls for greater focus on antiracism in medical training. We sought to evaluate a longitudinal antiracist curriculum among pediatric residents. Methods In 2020-2021, we delivered seven educational sessions to pediatric trainees in a single residency program. We administered pre-/post-surveys to assess changes in awareness of structural racism, knowledge of health inequities, antiracist clinical skills, and individual/institutional advocacy behaviors. Awareness was measured with 27 Likert-type items spanning five conceptual domains (schools, healthcare, justice system, employment, and housing/transportation). We evaluated knowledge with 18 true/false or multiple-choice questions. Participants indicated comfort with clinical skills using 13 Likert-type items drawn from national toolkits and policy statements. Individual/institutional advocacy behaviors were measured with 14 items from the Antiracism Behavioral Inventory. McNemar or paired Wilcoxon signed-rank tests compared measures before and after implementation. Results Out of 121 residents, 79 (65%) completed pre-surveys, 47 (39%) completed post-surveys, and 37 (31%) were eligible for matching across responses. 78% of respondents were female and 68% identified as White. We found significant increases in awareness across several conceptual domains (schools: p = 0.03; healthcare: p = 0.004; employment: p = 0.003; housing/transportation: p = 0.02). Mean knowledge score increased after implementation (p = 0.03). Self-reported clinical skills improved significantly (p < 0.001). Individual advocacy behaviors increased (p < 0.001); there were no changes in institutional advocacy. Conclusion We demonstrate improvements in several educational constructs with a novel antiracist curriculum. Efforts to scale and sustain this work are ongoing, and additional teaching and evaluation methodologies may be incorporated in the future.
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Affiliation(s)
- Nicholas Szoko
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- Nicholas Szoko, Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, 120 Lytton Avenue, Second Floor, Pittsburgh PA, 15213, USA.
| | | | - Ana Radovic
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica L. Garrison
- Division of Pediatric Hospital Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Orquidia Torres
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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