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Gonzalez CM, Greene RE, Cooper LA, Lypson ML. Recommendations for Faculty Development in Addressing Implicit Bias in Clinical Encounters and Clinical Learning Environments. J Gen Intern Med 2024; 39:2326-2332. [PMID: 38831249 PMCID: PMC11347534 DOI: 10.1007/s11606-024-08832-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024]
Affiliation(s)
- Cristina M Gonzalez
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA.
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Richard E Greene
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
- Office of Diversity Affairs, NYU Grossman School of Medicine, New York, NY, USA
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine and Johns Hopkins Center for Health Equity, Baltimore, MD, USA
| | - Monica L Lypson
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Svetkey LP, Bennett GG, Reese B, Corsino L, Pinheiro SO, Fischer JE, Seidenstein J, Olsen MK, Brown T, Ezem N, Liu E, Majors A, Steinhauser KE, Sullivan BH, van Ryn M, Wilson SM, Yang H, Johnson KS. Design and pilot test of an implicit bias mitigation curriculum for clinicians. Front Med (Lausanne) 2024; 11:1316475. [PMID: 38903809 PMCID: PMC11187258 DOI: 10.3389/fmed.2024.1316475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction Clinician implicit racial bias (IB) may lead to lower quality care and adverse health outcomes for Black patients. Educational efforts to train clinicians to mitigate IB vary widely and have insufficient evidence of impact. We developed and pilot-tested an evidence-based clinician IB curriculum, "REACHing Equity." Methods To assess acceptability and feasibility, we conducted an uncontrolled one-arm pilot trial with post-intervention assessments. REACHing Equity is designed for clinicians to: (1) acquire knowledge about IB and its impact on healthcare, (2) increase awareness of one's own capacity for IB, and (3) develop skills to mitigate IB in the clinical encounter. We delivered REACHing Equity virtually in three facilitated, interactive sessions over 7-9 weeks. Participants were health care providers who completed baseline and end-of-study evaluation surveys. Results Of approximately 1,592 clinicians invited, 37 participated, of whom 29 self-identified as women and 24 as non-Hispanic White. Attendance averaged 90% per session; 78% attended all 3 sessions. Response rate for evaluation surveys was 67%. Most respondents agreed or strongly agreed that the curriculum objectives were met, and that REACHing Equity equipped them to mitigate the impact of implicit bias in clinical care. Participants consistently reported higher self-efficacy for mitigating IB after compared to before completing the curriculum. Conclusions Despite apparent barriers to clinician participation, we demonstrated feasibility and acceptability of the REACHing Equity intervention. Further research is needed to develop objective measures of uptake and clinician skill, test the impact of REACHing Equity on clinically relevant outcomes, and refine the curriculum for uptake and dissemination.ClinicalTrials.gov ID: NCT03415308.
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Affiliation(s)
- Laura P. Svetkey
- Department of Medicine, Duke University Medical School, Durham, NC, United States
| | - Gary G. Bennett
- Department of Psychology and Neuroscience, Duke University Medical School, Durham, NC, United States
| | - Benjamin Reese
- Department of Psychiatry and Behavioral Sciences, Duke University Medical School, Durham, NC, United States
| | - Leonor Corsino
- Departments of Medicine and Population Health Sciences, Duke University Medical School, Durham, NC, United States
| | - Sandro O. Pinheiro
- Department of Medicine, Duke University Medical School, Durham, NC, United States
| | - Jonathan E. Fischer
- Department of Family Medicine and Community Health, Duke University Medical School, Durham, NC, United States
| | - Judy Seidenstein
- Duke School of Medicine, Duke University Medical School, Durham, NC, United States
| | - Maren K. Olsen
- Department of Biostatistics & Bioinformatics, Duke University Medical School, Durham, NC, United States
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Veterans Affairs Health Care System, Durham, NC, United States
| | - Tyson Brown
- Department of Sociology, Duke University, Durham, NC, United States
| | - Natalie Ezem
- Duke School of Medicine, Duke University Medical School, Durham, NC, United States
- Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Evan Liu
- Duke School of Medicine, Duke University Medical School, Durham, NC, United States
- Tufts University School of Medicine, Somerville, MA, Untied States
| | - Alesha Majors
- Duke Clinical Research Institute, Durham, NC, United States
| | - Karen E. Steinhauser
- Department of Medicine, Duke University Medical School, Durham, NC, United States
- Departments of Medicine and Population Health Sciences, Duke University Medical School, Durham, NC, United States
| | - Brandy H. Sullivan
- Department of Anatomy and Physiology at Forsyth Technical Community College, Winston-Salem, NC, United States
| | | | - Sarah M. Wilson
- Department of Psychiatry and Behavioral Sciences, Duke University Medical School, Durham, NC, United States
| | - Hongqiu Yang
- Duke Clinical Research Institute, Durham, NC, United States
| | - Kimberly S. Johnson
- Department of Medicine, Duke University Medical School, Durham, NC, United States
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Thompson CM, Bishop MJ, Dillard TC, Maurice JM, Rollins DD, Pulido MD, Salas MJ, Mendelson EA, Yan J, Gerlikovski ER, Benevento SV, Zeinstra C, Kesavadas T. Healing Health Care Disparities: Development and Pilot Testing of a Virtual Reality Implicit Bias Training Module for Physicians in the Context of Black Maternal Health. HEALTH COMMUNICATION 2024:1-12. [PMID: 38711251 DOI: 10.1080/10410236.2024.2347000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Grounded in communication models of cultural competence, this study reports on the development and testing of the first module in a larger virtual reality (VR) implicit bias training for physicians to help them better: (a) recognize implicit bias and its effects on communication, patients, and patient care; (b) identify their own implicit biases and exercise strategies for managing them; and (c) learn and practice communicating with BIPOC patients in a culture-centered manner that demonstrates respect and builds trust. Led by communication faculty, a large, interdisciplinary team of researchers, clinicians, and engineers developed the first module tested herein focused on training goal (a). Within the module, participants observe five scenes between patient Marilyn Hayes (a Black woman) and Dr. Richard Flynn (her obstetrician, a White man) during a postpartum visit. The interaction contains examples of implicit bias, and participants are asked to both identify and consider how implicit bias impacts communication, the patient, and patient care. The team recruited 30 medical students and resident physicians to participate in a lab-based study that included a pretest, a training experience of the module using a head-mounted VR display, and a posttest. Following the training, participants reported improved attitudes toward implicit bias instruction, greater importance of determining patients' beliefs and perspectives for history-taking, treatment, and providing quality health care; and greater communication efficacy. Participants' agreement with the importance of assessing patients' perspectives, opinions, and psychosocial and cultural contexts did not significantly change. Implications for medical education about cultural competency and implicit bias are discussed.
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Affiliation(s)
- Charee M Thompson
- Department of Communication, University of Illinois Urbana-Champaign
| | - Mardia J Bishop
- Department of Communication, University of Illinois Urbana-Champaign
| | | | - Joseph M Maurice
- Department of Obstetrics & Gynecology, Creighton University School of Medicine
| | - Déjà D Rollins
- Department of Communication, University of Illinois Urbana-Champaign
| | - Manuel D Pulido
- Department of Communication Studies, California State University, Long Beach
| | - M J Salas
- School of Communication and Information, Rutgers University
| | - Emily A Mendelson
- Department of Communication, University of Illinois Urbana-Champaign
| | - Jia Yan
- Department of Communication, University of Illinois Urbana-Champaign
| | | | - Sarah V Benevento
- Department of Communication, University of Illinois Urbana-Champaign
| | | | - Thenkurussi Kesavadas
- Division of Research and Economic Development, University at Albany, The State University of New York
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Shen J, Clinton AJ, Penka J, Gregory ME, Sova L, Pfeil S, Patterson J, Maa T. Smartphone-Based Virtual and Augmented Reality Implicit Association Training (VARIAT) for Reducing Implicit Biases Toward Patients Among Health Care Providers: App Development and Pilot Testing. JMIR Serious Games 2024; 12:e51310. [PMID: 38488662 PMCID: PMC11004623 DOI: 10.2196/51310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/24/2023] [Accepted: 12/12/2023] [Indexed: 04/12/2024] Open
Abstract
Background Implicit bias is as prevalent among health care professionals as among the wider population and is significantly associated with lower health care quality. Objective The study goal was to develop and evaluate the preliminary efficacy of an innovative mobile app, VARIAT (Virtual and Augmented Reality Implicit Association Training), to reduce implicit biases among Medicaid providers. Methods An interdisciplinary team developed 2 interactive case-based training modules for Medicaid providers focused on implicit bias related to race and socioeconomic status (SES) and sexual orientation and gender identity (SOGI), respectively. The simulations combine experiential learning, facilitated debriefing, and game-based educational strategies. Medicaid providers (n=18) participated in this pilot study. Outcomes were measured on 3 domains: training reactions, affective knowledge, and skill-based knowledge related to implicit biases in race/SES or SOGI. Results Participants reported high relevance of training to their job for both the race/SES module (mean score 4.75, SD 0.45) and SOGI module (mean score 4.67, SD 0.50). Significant improvement in skill-based knowledge for minimizing health disparities for lesbian, gay, bisexual, transgender, and queer patients was found after training (Cohen d=0.72; 95% CI -1.38 to -0.04). Conclusions This study developed an innovative smartphone-based implicit bias training program for Medicaid providers and conducted a pilot evaluation on the user experience and preliminary efficacy. Preliminary evidence showed positive satisfaction and preliminary efficacy of the intervention.
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Affiliation(s)
- Jiabin Shen
- Department of Psychology, University of Massachusetts Lowell, Lowell, MA, United States
| | - Alex J Clinton
- Department of Psychology, University of Massachusetts Lowell, Lowell, MA, United States
| | | | - Megan E Gregory
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Lindsey Sova
- Center for Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, College of Medicine, Ohio State University, Columbus, OH, United States
| | - Sheryl Pfeil
- College of Medicine, Ohio State University, Columbus, OH, United States
| | - Jeremy Patterson
- Advanced Computing Center for Arts and Design, Ohio State University, Columbus, OH, United States
| | - Tensing Maa
- Center for Clinical Excellence, Nationwide Children’s Hospital, Columbus, OH, United States
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Binda DD, Kraus A, Gariépy-Assal L, Tang B, Wade CG, Olveczky DD, Molina RL. Anti-racism curricula in undergraduate medical education: A scoping review. MEDICAL TEACHER 2024:1-11. [PMID: 38431914 DOI: 10.1080/0142159x.2024.2322136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Medical educators have increasingly focused on the systemic effects of racism on health inequities in the United States (U.S.) and globally. There is a call for educators to teach students how to actively promote an anti-racist culture in healthcare. This scoping review assesses the existing undergraduate medical education (UME) literature of anti-racism curricula, implementation, and assessment. METHODS The Ovid, Embase, ERIC, Web of Science, and MedEdPORTAL databases were queried on 7 April 2023. Keywords included anti-racism, medical education, and assessment. Inclusion criteria consisted of any UME anti-racism publication. Non-English articles with no UME anti-racism curriculum were excluded. Two independent reviewers screened the abstracts, followed by full-text appraisal. Data was extracted using a predetermined framework based on Kirkpatrick's educational outcomes model, Miller's pyramid for assessing clinical competence, and Sotto-Santiago's theoretical framework for anti-racism curricula. Study characteristics and anti-racism curriculum components (instructional design, assessment, outcomes) were collected and synthesized. RESULTS In total, 1064 articles were screened. Of these, 20 met the inclusion criteria, with 90% (n = 18) published in the past five years. Learners ranged from first-year to fourth-year medical students. Study designs included pre- and post-test evaluations (n = 10; 50%), post-test evaluations only (n = 7; 35%), and qualitative assessments (n = 3; 15%). Educational interventions included lectures (n = 10, 50%), multimedia (n = 6, 30%), small-group case discussions (n = 15, 75%), large-group discussions (n = 5, 25%), and reflections (n = 5, 25%). Evaluation tools for these curricula included surveys (n = 18; 90%), focus groups (n = 4; 20%), and direct observations (n = 1; 5%). CONCLUSIONS Our scoping review highlights the growing attention to anti-racism in UME curricula. We identified a gap in published assessments of behavior change in applying knowledge and skills to anti-racist action in UME training. We also provide considerations for developing UME anti-racism curricula. These include explicitly naming and defining anti-racism as well as incorporating longitudinal learning opportunities and assessments.
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Affiliation(s)
- Dhanesh D Binda
- Master of Medical Sciences in Medical Education Program, Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Alexandria Kraus
- Master of Medical Sciences in Medical Education Program, Harvard Medical School, Boston, MA, USA
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Laurence Gariépy-Assal
- Master of Medical Sciences in Medical Education Program, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Université de Montreal, Montréal, QC, Canada
| | - Brandon Tang
- Master of Medical Sciences in Medical Education Program, Harvard Medical School, Boston, MA, USA
- Division of General Internal Medicine, University of Toronto, Toronto, ON, Canada
| | - Carrie G Wade
- Countway Library of Medicine, Harvard Medical School, Boston, MA, USA
| | - Daniele D Olveczky
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Rose L Molina
- Department of Obstetrics and Gynecology, Division of Global and Community Health, Beth Israel Deaconess Medical Center, Boston, MA, USA
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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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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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Lewis BE, Naik AR. A scoping review to identify and organize literature trends of bias research within medical student and resident education. BMC MEDICAL EDUCATION 2023; 23:919. [PMID: 38053172 DOI: 10.1186/s12909-023-04829-6] [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: 03/14/2023] [Accepted: 11/01/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Physician bias refers to the unconscious negative perceptions that physicians have of patients or their conditions. Medical schools and residency programs often incorporate training to reduce biases among their trainees. In order to assess trends and organize available literature, we conducted a scoping review with a goal to categorize different biases that are studied within medical student (MS), resident (Res) and mixed populations (MS and Res). We also characterized these studies based on their research goal as either documenting evidence of bias (EOB), bias intervention (BI) or both. These findings will provide data which can be used to identify gaps and inform future work across these criteria. METHODS Online databases (PubMed, PsycINFO, WebofScience) were searched for articles published between 1980 and 2021. All references were imported into Covidence for independent screening against inclusion criteria. Conflicts were resolved by deliberation. Studies were sorted by goal: 'evidence of bias' and/or 'bias intervention', and by population (MS or Res or mixed) andinto descriptive categories of bias. RESULTS Of the initial 806 unique papers identified, a total of 139 articles fit the inclusion criteria for data extraction. The included studies were sorted into 11 categories of bias and showed that bias against race/ethnicity, specific diseases/conditions, and weight were the most researched topics. Of the studies included, there was a higher ratio of EOB:BI studies at the MS level. While at the Res level, a lower ratio of EOB:BI was found. CONCLUSIONS This study will be of interest to institutions, program directors and medical educators who wish to specifically address a category of bias and identify where there is a dearth of research. This study also underscores the need to introduce bias interventions at the MS level.
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Affiliation(s)
- Brianne E Lewis
- Department of Foundational Sciences, Central Michigan University College of Medicine, Mt. Pleasant, MI, 48859, USA
| | - Akshata R Naik
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI, 48309, USA.
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Mardian AS, Villarroel L, Quist HE, Chang LE, Mintert JS, Su TN, Dhanjal-Reddy A, Hanson ER. Flipping the hidden curriculum to transform pain education and culture. FRONTIERS IN PAIN RESEARCH 2023; 4:1197374. [PMID: 37404692 PMCID: PMC10317194 DOI: 10.3389/fpain.2023.1197374] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/06/2023] [Indexed: 07/06/2023] Open
Abstract
Though long-sought, transformation of pain management practice and culture has yet to be realized. We propose both a likely cause-entrenchment in a biomedical model of care that is observed and then replicated by trainees-and a solution: deliberately leveraging the hidden curriculum to instead implement a sociopsychobiological (SPB) model of care. We make use of Implicit Bias Recognition and Management, a tool that helps teams to first recognize and "surface" whatever is implicit and to subsequently intervene to change whatever is found to be lacking. We describe how a practice might use iterations of recognition and intervention to move from a biomedical to a SPB model by providing examples from the Chronic Pain Wellness Center in the Phoenix Veterans Affairs Health Care System. As pain management practitioners and educators collectively leverage the hidden curriculum to provide care in the SPB model, we will not only positively transform our individual practices but also pain management as a whole.
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Affiliation(s)
- Aram S. Mardian
- Chronic Pain Wellness Center, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, United States
- Department of Family, Community and Preventive Medicine, University of Arizona College of Medicine–Phoenix, Phoenix, AZ, United States
| | - Lisa Villarroel
- Arizona Department of Health Services, Public Health Services, Phoenix, AZ, United States
| | - Heidi E. Quist
- Chronic Pain Wellness Center, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, United States
| | - Lynn E. Chang
- Chronic Pain Wellness Center, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, United States
| | - Jeffrey S. Mintert
- Chronic Pain Wellness Center, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, United States
| | - Tiffany N. Su
- Chronic Pain Wellness Center, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, United States
| | - Amrita Dhanjal-Reddy
- Chronic Pain Wellness Center, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, United States
- Department of Family, Community and Preventive Medicine, University of Arizona College of Medicine–Phoenix, Phoenix, AZ, United States
| | - Eric R. Hanson
- Chronic Pain Wellness Center, Phoenix Veterans Affairs Health Care System, Phoenix, AZ, United States
- Department of Psychiatry, University of Arizona College of Medicine–Phoenix, Phoenix, AZ, United States
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Racic M, Roche-Miranda MI, Fatahi G. Twelve tips for implementing and teaching anti-racism curriculum in medical education. MEDICAL TEACHER 2023:1-6. [PMID: 37134226 DOI: 10.1080/0142159x.2023.2206534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Racism has implicit and explicit manifestations that perpetuate disparities and negatively influence patient-centered health outcomes. Subsequently, a list of action items was provided to assist medical schools in becoming anti-racist institutions. A deep subject matter knowledge, beliefs, and reflections were a driving force for the management of medical schools or faculty members involved in undergraduate and postgraduate medical education to move forward toward inclusion of anti-racism in traditional medical curriculum or adapting existing training modules on diversity, equity, and inclusion. This paper proposes twelve practical and specific tips for implementing and teaching anti-racism in medical education. These twelve tips elaborate on the proposed actions for leaders in undergraduate and postgraduate medical education, valuable for designing future curricula and educational activities.
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Affiliation(s)
- Maja Racic
- Comprehensive Cancer Center, Ohio State University, Columbus, OH, USA
| | - Marcos I Roche-Miranda
- School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, PR, USA
| | - Gina Fatahi
- Comprehensive Cancer Center, Ohio State University, Columbus, OH, USA
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Gonzalez CM, Onumah CM, Walker SA, Karp E, Schwartz R, Lypson ML. Implicit bias instruction across disciplines related to the social determinants of health: a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:541-587. [PMID: 36534295 DOI: 10.1007/s10459-022-10168-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/27/2022] [Indexed: 05/11/2023]
Abstract
One criticism of published curricula addressing implicit bias is that few achieve skill development in implicit bias recognition and management (IBRM). To inform the development of skills-based curricula addressing IBRM, we conducted a scoping review of the literature inquiring, "What interventions exist focused on IBRM in professions related to social determinants of health: education, law, social work, and the health professions inclusive of nursing, allied health professions, and medicine?"Authors searched eight databases for articles published from 2000 to 2020. Included studies: (1) described interventions related to implicit bias; and (2) addressed knowledge, attitude and/or skills as outcomes. Excluded were interventions solely focused on reducing/neutralizing implicit bias. Article review for inclusion and data charting occurred independently and in duplicate. Investigators compared characteristics across studies; data charting focused on educational and assessment strategies. Fifty-one full-text articles for data charting and synthesis, with more than 6568 learners, were selected. Educational strategies included provocative/engagement triggers, the Implicit Association Test, reflection and discussion, and various active learning strategies. Most assessments were self-report, with fewer objective measures. Eighteen funded studies utilized federal, foundation, institutional, and private sources. This review adds to the literature by providing tangible examples of curricula to complement existing frameworks, and identifying opportunities for further research in innovative skills-based instruction, learner assessment, and development and validation of outcome metrics. Continued research addressing IBRM would enable learners to develop and practice skills to recognize and manage their implicit biases during clinical encounters, thereby advancing the goal of improved, equitable patient outcomes.
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Affiliation(s)
- Cristina M Gonzalez
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA.
| | - Chavon M Onumah
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sydney A Walker
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Elisa Karp
- Department of Pediatrics, North Central Bronx Hospital, Bronx, NY, USA
| | | | - Monica L Lypson
- Columbia University Irving Medical Center, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
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Hamadi H, Tafili A, Kates FR, Larson SA, Ellison C, Song J. Exploring an Innovative Approach to Enhance Discussion Board Engagement. TECHTRENDS : FOR LEADERS IN EDUCATION & TRAINING 2023; 67:1-11. [PMID: 37362586 PMCID: PMC10124679 DOI: 10.1007/s11528-023-00850-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 06/28/2023]
Abstract
Online discussion boards are a standard learning management system (LMS) instructional tool used in the emerging online learning pedagogy. This pilot study examined an innovative approach that differs from how discussion boards have been commonly used. Using a retrospective, cross-sectional design, we evaluated the effect of shifting from traditional teacher and student-generated prompts to using student-generated videos with higher-order discussion questions to gauge student perceptions of peer feedback and engagement. Participants were graduate students in a health care administration course at a large university. Overall students' perceptions of creating and responding to student-generated prompts were positive. Students responded that they were more engaged and thought more critically about the content with this shift from the traditional way of using discussion boards. As digital technology reshapes higher education, it is essential to reflect and evaluate the effectiveness of current LMS applications and standard procedures to improve educational delivery.
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Affiliation(s)
- Hanadi Hamadi
- Department of Health Administration Brooks College of Health, University of North Florida, 1 UNF Drive, Jacksonville, FL 32224 USA
| | - Aurora Tafili
- Department of Health Services Administration School of Health Professions, The University of Alabama at Birmingham, 1716 9th Avenue South, AL 35233 Birmingham, USA
| | - Frederick R. Kates
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, PO Box 100195, Gainesville, FL 32611 USA
| | - Samantha A. Larson
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, PO Box 100195, Gainesville, FL 32611 USA
| | - Carlyn Ellison
- Department of Occupational Therapy, College of Public Health and Health Professions, University of Florida, PO Box 100195, Gainesville, FL 32611 USA
| | - Jihee Song
- Department of Family, Youth and Community Sciences, Institute of Food and Agricultural Sciences, University of Florida, PO Box 100195, Gainesville, FL 32611 USA
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Tjia J, Pugnaire M, Calista J, Eisdorfer E, Hale J, Terrien J, Valdman O, Potts S, Garcia M, Yazdani M, Puerto G, Okero M, Duodu V, Sabin J. Using Simulation-Based Learning with Standardized Patients (SP) in an Implicit Bias Mitigation Clinician Training Program. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231175033. [PMID: 37324051 PMCID: PMC10265320 DOI: 10.1177/23821205231175033] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 04/24/2023] [Indexed: 06/17/2023]
Abstract
Objectives To describe the development and refinement of an implicit bias recognition and management training program for clinical trainees. Methods In the context of an NIH-funded clinical trial to address healthcare disparities in hypertension management, research and education faculty at an academic medical center used a participatory action research approach to engage local community members to develop and refine a "knowledge, awareness, and skill-building" bias recognition and mitigation program. The program targeted medical residents and Doctor of Nursing Practice students. The content of the two-session training included: didactics about healthcare disparities, racism and implicit bias; implicit association test (IAT) administration to raise awareness of personal implicit bias; skill building for bias-mitigating communication; and case scenarios for skill practice in simulation-based encounters with standardized patients (SPs) from the local community. Results The initial trial year enrolled n = 65 interprofessional participants. Community partners and SPs who engaged throughout the design and implementation process reported overall positive experiences, but SPs expressed need for greater faculty support during in-person debriefings following simulation encounters to balance power dynamics. Initial year trainee participants reported discomfort with intensive sequencing of in-person didactics, IATs, and SP simulations in each of the two training sessions. In response, authors refined the training program to separate didactic sessions from IAT administration and SP simulations, and to increase safe space, and trainee and SP empowerment. The final program includes more interactive discussions focused on identity, race and ethnicity, and strategies to address local health system challenges related to structural racism. Conclusion It is possible to develop and implement a bias awareness and mitigation skills training program that uses simulation-based learning with SPs, and to engage with local community members to tailor the content to address the experience of local patient populations. Further research is needed to measure the success and impact of replicating this approach elsewhere.
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Affiliation(s)
- Jennifer Tjia
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Michele Pugnaire
- Department of Family Medicine and Community Health, UMass Chan Medical School, Worcester, MA, USA
| | - Joanne Calista
- Department of Family Medicine and Community Health, UMass Chan Medical School, Worcester, MA, USA
- Executive Director, Center for Health Impact, Worcester, MA, USA
| | - Ethan Eisdorfer
- Department of Family Medicine and Community Health, UMass Chan Medical School, Worcester, MA, USA
| | - Janet Hale
- Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, MA, USA
| | - Jill Terrien
- Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, MA, USA
| | - Olga Valdman
- Department of Family Medicine and Community Health, UMass Chan Medical School, Worcester, MA, USA
| | - Stacy Potts
- Department of Family Medicine and Community Health, UMass Chan Medical School, Worcester, MA, USA
| | - Maria Garcia
- Department of Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Majid Yazdani
- Department of Medicine, UMass Chan Medical School, Worcester, MA, USA
| | - Geraldine Puerto
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Miriam Okero
- Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, MA, USA
| | - Vennesa Duodu
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, USA
| | - Janice Sabin
- Department of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, WA, USA
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Pincavage AT, Osman NY, Alexandraki I, Ismail NJ, Levine DL, Onumah CM, Lai CJ. AAIM Recommendations to Promote Equity in the Clerkship Clinical Learning Environment. Am J Med 2022; 135:1021-1028. [PMID: 35504324 DOI: 10.1016/j.amjmed.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | - Nora Y Osman
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Irene Alexandraki
- Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso
| | - Nadia J Ismail
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Diane L Levine
- Department of Medicine, Wayne State University School of Medicine, Detroit, Mich
| | - Chavon M Onumah
- Department of Medicine, George Washington School of Medicine and Health Sciences, Washington, DC
| | - Cindy J Lai
- Department of Medicine, University of California, San Francisco, School of Medicine
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Crites K, Johnson J, Scott N, Shanks A. Increasing Diversity in Residency Training Programs. Cureus 2022; 14:e25962. [PMID: 35855255 PMCID: PMC9286021 DOI: 10.7759/cureus.25962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 11/05/2022] Open
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Perry TT, Patel MR, Li JT. Elevating Health Disparities Education Among Trainees and Physicians. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:918-922. [PMID: 35033699 DOI: 10.1016/j.jaip.2022.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/08/2021] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
Health disparities disproportionately affect patients in racial and ethnic minority groups, and these disparities are linked to economic, environmental, and social disadvantage. It is widely known that health disparities impact patients with allergic and immunologic conditions, yet universal and comprehensive training in health disparities is lacking. More robust educational opportunities are needed to fully equip trainees with tools to recognize and develop effective strategies to reduce the burden of health disparities. Also, there are no universal standards or requirements for professional medical boards in their respective maintenance of certification programs that will ensure ongoing training for practicing providers that will help them identify and manage individual or societal issues such as social determinants that contribute to health disparities. Further, the long-term impact of systematic discrimination, implicit and overt bias, and medical mistrust among populations most often affected by disparities compounds the complexity of the methods and types of training that is desperately needed to overcome health disparities. We provide a commentary on important topics that should be addressed during allergy and immunology training and beyond. We further highlight strategies and tools that should be used to tackle this important issue affecting millions of patients under our specialty care. It is past time for us to go beyond the bedside and comprehensively integrate health disparities training in our fellowship programs and in our practices.
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Affiliation(s)
- Tamara T Perry
- University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, Ark.
| | - Minal R Patel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Mich
| | - James T Li
- Division of Allergy and Immunology, Mayo Clinic, Rochester, Minn
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