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Zanting A, Frambach JM, Meershoek A, Krumeich A. Exploring the implicit meanings of 'cultural diversity': a critical conceptual analysis of commonly used approaches in medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10371-x. [PMID: 39276258 DOI: 10.1007/s10459-024-10371-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/08/2024] [Indexed: 09/16/2024]
Abstract
Existing approaches to cultural diversity in medical education may be implicitly based on different conceptualisations of culture. Research has demonstrated that such interpretations matter to practices and people concerned. We therefore sought to identify the different conceptualisations espoused by these approaches and investigated their implications for education. We critically reviewed 52 articles from eight top medical education journals and subjected these to a conceptual analysis. Via open coding, we looked for references to approaches, their objectives, implicit notions of culture, and to implementation practices. We iteratively developed themes from the collected findings. We identified several approaches to cultural diversity teaching that used four different ways to conceptualise cultural diversity: culture as 'fixed patient characteristic', as 'multiple fixed characteristics', as 'dynamic outcome impacting social interactions', and as 'power dynamics'. We discussed the assumptions underlying these different notions, and reflected upon limitations and implications for educational practice. The notion of 'cultural diversity' challenges learners' communication skills, touches upon inherent inequalities and impacts how the field constructs knowledge. This study adds insights into how inherent inequalities in biomedical knowledge construction are rooted in methodological, ontological, and epistemological principles. Although these insights carry laborious implications for educational implementation, educators can learn from first initiatives, such as: standardly include information on patients' multiple identities and lived experiences in case descriptions, stimulate more reflection on teachers' and students' own values and hierarchical position, acknowledge Western epistemological hegemony, explicitly include literature from diverse sources, and monitor diversity-integrated topics in the curriculum.
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Affiliation(s)
- Albertine Zanting
- Department of Health, Ethics and Society, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Janneke M Frambach
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Agnes Meershoek
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Anja Krumeich
- Department of Health, Ethics and Society, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Whalen Smith CN, Havercamp SM, Tosun L, Shetterly S, Munir A, Kennedy W, Feldner HA, Herrman D, Sloane BM, Weinstein FH. Training an Anti-Ableist Physical Therapist Workforce: Critical Perspectives of Health Care Education That Contribute to Health Inequities for People With Disabilities. Phys Ther 2024; 104:pzae092. [PMID: 39001711 DOI: 10.1093/ptj/pzae092] [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: 06/21/2023] [Revised: 03/22/2024] [Accepted: 07/11/2024] [Indexed: 07/15/2024]
Abstract
Americans with disabilities represent the largest historically underserved and marginalized health disparity population in the United States. This perspective piece will raise the awareness of physical therapist faculty and clinicians on gaps in health care provider knowledge about disability and provide actionable strategies, frameworks, and resources available to improve disability competence to make changes in clinical education and practice. In this perspective piece, 3 contributions are made. First, health disparities experienced by Americans with disabilities as a result of health care providers' biased assumptions about disability and lack of disability competence are described through an in-depth illustration of lived experiences of people with disabilities. Second, a discussion of disability competence in physical therapist education is provided. Finally, critical and evidence-based insights and actionable frameworks and resources to address disability competence training gaps and to promote anti-ableist practice are provided.
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Affiliation(s)
- Cara N Whalen Smith
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Susan M Havercamp
- Nisonger Center, The Ohio State University, College of Medicine, Columbus, Ohio, USA
| | - Leyla Tosun
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Samantha Shetterly
- Physical Therapy, Human Movement, and Rehabilitation Sciences, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Armin Munir
- Physical Therapy, Human Movement, and Rehabilitation Sciences, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Winston Kennedy
- Physical Therapy, Human Movement, and Rehabilitation Sciences, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Heather A Feldner
- Department of Rehabilitation Medicine, Disability Studies Program, Center for Research and Education on Accessible Technology and Experiences (CREATE), University of Washington, Seattle, Washington, USA
| | - Deana Herrman
- Doctor of Physical Therapy Program, College of Health and Human Sciences, Northern Illinois University, DeKalb, Illinois, USA
| | - Bethany M Sloane
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
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Herrman D, Pechak CM, Berg K, Magasi S. Instructing to Impact: Exploration of Doctor of Physical Therapy Education Instruction of Social Determinants of Health and Health Equity for People With Disabilities. Phys Ther 2024; 104:pzae070. [PMID: 38738784 DOI: 10.1093/ptj/pzae070] [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: 05/25/2023] [Revised: 12/21/2023] [Accepted: 05/06/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE The aim of this study was to explore the instruction of social determinants of health (SDOH) for people with disabilities (PWD) in doctor of physical therapy (DPT) education programs. METHODS A sequential mixed methods study informed by a five-member disability community advisory panel was conducted. Qualitative semi-structured interviews with educators (n = 10) across 4 DPT programs in the Midwest were conducted and analyzed thematically. The qualitative findings formed the basis of the quantitative phase. An online survey was conducted with faculty of DPT programs in the United States (n = 254) with the most knowledge of instruction of SDOH and health equity for PWD (n = 74; 29% response rate). Quantitative data were analyzed with descriptive statistics and triangulated with qualitative data. RESULTS SDOH for PWD is an emerging component of instruction in DPT curricula. Five themes included: emerging instruction of SDOH for PWD; conceptual frameworks informing instruction; instructional strategies; barriers to integration of SDOH for PWD; and facilitators to integration of SDOH for PWD. Quantitative analysis revealed that 71 respondents (95.9%) included disability in health equity discussions primarily focused on health care access. Limited time (n = 49; 66.2%) was the most frequently reported barrier, and educator interest in disability health equity was the most frequently reported facilitator (n = 62; 83.7%) to inclusion of the SDOH for PWD in health equity discussions. CONCLUSION Opportunities exist in DPT curricula to build on instructional strategies, integrate SDOH frameworks, and amplify facilitators to integration of SDOH for PWD. IMPACT To meet the needs of the 67 million Americans living with disabilities, students must have the knowledge and skills to address the complex needs of this historically marginalized population. Understanding the DPT education landscape around SDOH for PWD can guide DPT educators to more fully prepare their students to recognize and ameliorate health disparities faced by PWD.
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Affiliation(s)
- Deana Herrman
- College of Health and Human Sciences, Northern Illinois University, DeKalb, Illinois, USA
| | - Celia M Pechak
- Doctor of Physical Therapy Program, The University of Texas at El Paso, El Paso, Texas, USA
| | - Kristin Berg
- Department of Disability and Human Development, University of Illinois-Chicago, Chicago, Illinois, USA
| | - Susan Magasi
- Department of Occupational Therapy, University of Illinois-Chicago, Chicago, Illinois, USA
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Wallington SF, Kesten K, Athey E, Kokkinogenis KM. What's in your social determinants of health teaching toolbox? Nursing pedagogical considerations. J Prof Nurs 2024; 54:29-35. [PMID: 39266103 DOI: 10.1016/j.profnurs.2024.06.004] [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: 10/24/2023] [Revised: 05/27/2024] [Accepted: 06/05/2024] [Indexed: 09/14/2024]
Abstract
Although the concept of Social Determinants of Health (SDOH) has been around for more than two decades, teaching methods and standards of curricula for nursing education related to SDOH are relatively new concepts. Here, we explore pedagogical frameworks, national standards, and recent progress in the study and implementation of SDOH curricula and the top teaching strategies implemented in various nursing and healthcare disciplines and across educational levels (undergraduate and graduate programs). Selected examples are used to illustrate lessons learned across disciplines in effective teaching strategies related to SDOH. Effective teaching strategies include experiential learning, longitudinal and community-based interactions, reflective opportunities, and structured assessment.
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Affiliation(s)
- Sherrie Flynt Wallington
- George Washington University, School of Nursing, 1919 Pennsylvania Ave, Washington, DC 20006, United States of America; George Washington University, Milken Institue School of Public Health, 950 New Hampshire Ave NW #2, Washington, DC 20037, United States of America.
| | - Karen Kesten
- George Washington University, School of Nursing, 1919 Pennsylvania Ave, Washington, DC 20006, United States of America
| | - Erin Athey
- George Washington University, School of Nursing, 1919 Pennsylvania Ave, Washington, DC 20006, United States of America; Community Concierge Care, LLC, 231 Marion Barry Ave, SE, Washington DC 20020, United States of America
| | - Kerry M Kokkinogenis
- Kitchen Table Health Communications, 86 Turner St, Boston, MA 02135, United States of America
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Escandell-Rico FM, Pérez-Fernández L. [Evaluation of healthcare for patients with diabetes in primary care: A systematic review]. Semergen 2024; 50:102214. [PMID: 38554679 DOI: 10.1016/j.semerg.2024.102214] [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: 12/31/2023] [Revised: 01/16/2024] [Accepted: 02/04/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE Have the most current evidence in relation to the evaluation of medical healthcare for patients with diabetes in primary care. METHOD During the review process, we followed the recommendations to improve the publication of systematic reviews and meta-analyses and the preferred reporting points for PRISMA systematic reviews. The bibliographic search was carried out in Cumulative Index to Nursing and Allied Health Literature (CINAHL), SCOPUS, Scielo, MedLine/ PubMed, Cochrane databases and in the Google Scholar search engine, with free and controlled language, using the MeSh search terms: «Physicians, Primary Care», «Diabetes Mellitus, Type2». Eight selected articles were analyzed. The articles were selected based on their relevance, published in peer-reviewed academic journals and published between 2019 and 2023. RESULTS The main study tool represents interventions in knowledge and practice about the care of patients with diabetes among primary care physicians. The most important discussion topics extracted in the analyzed articles refer to knowledge, clinical inertia, patients' housing challenges, adherence intervention programs, and a self-care application for patients with diabetes. CONCLUSIONS The findings of this study indicate the need to improve medical health care through knowledge, attitudes and practices in primary care regarding patients with diabetes. In this way, it could be considered a useful tool to promote medical healthcare in primary care.
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Affiliation(s)
- F M Escandell-Rico
- Profesor de enfermería, Departamento de Enfermería, Universidad de Alicante, Alicante, España.
| | - L Pérez-Fernández
- Coordinadora de enfermería, Centro de Salud Almoradí, Departamento de Salud de Orihuela, Almoradí, Alicante, España
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Abdalla ME, Taha MH, Onchonga D, Magzoub ME, Au H, O'Donnell P, Neville S, Taylor D. Integrating the social determinants of health into curriculum: AMEE Guide No. 162. MEDICAL TEACHER 2024; 46:304-316. [PMID: 37677074 DOI: 10.1080/0142159x.2023.2254920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
The World Health Organization (WHO) defines the Social Determinants of Health (SDOH) as the non-medical factors influencing health outcomes. SDOH is associated with conditions in which people are born, grow, work, and live. Medical schools and licensing bodies are increasingly recognizing the need for doctors and healthcare professionals to be aware of their patient's social context and how it impacts their states of health and disease. However, there is considerable variation in the approaches of different institutions and countries to incorporating SDOH into their curricula. In order to allow clinicians to adopt a holistic approach to patient health, equipping them with extensive knowledge of SDOH would give learners the confidence, skills, knowledge, and attitudes needed to effectively engage with patients and their families. This approach aids health professionals with knowledge of the influence of the social context and cultural factors that affect patients' behaviors in relation to health. Incorporating the SDOH in medical and health professional school curricula would contribute towards adequately preparing future healthcare practitioners to provide effective, comprehensive, and equitable care, especially to marginalized and underserved populations. The Guide will take an evidence-based approach grounded in the available contemporary literature and case studies. The focus will be on integrating SDOH into undergraduate and postgraduate medical curricula to promote an understanding of the social factors that influence patients' and communities' health. Ultimately, this guide seeks to contribute to the reduction of inequalities in health.
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Affiliation(s)
| | - Mohamed Hassan Taha
- College of Medicine and Medical Education Center, University of Sharjah, Sharjah, UAE
| | - David Onchonga
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Hosanna Au
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Siobhán Neville
- School of Medicine, University of Limerick, Limerick, Ireland
| | - David Taylor
- Gulf Medical University, Al Jurf, Ajman, United Arab Emirates
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Armitage JS, Nash SP, Hanson JT. It's "not black and white": Students' perceptions of "altruism" content in preclinical medical education. MEDICAL TEACHER 2024; 46:126-131. [PMID: 37542359 DOI: 10.1080/0142159x.2023.2240003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
OBJECTIVE This study investigated how students as stakeholders viewed behavioral and social science (BSS) content in a preclinical longitudinal course entitled "Medicine, Body, and Society" (MBS) at UT Health San Antonio Long School of Medicine (LSOM). We present students' perceptions of successes and challenges tied to "altruism" and other non-biomedical objectives outlined by this institution. METHODS We conducted a qualitative thematic analysis of MBS course evaluation data. Two researchers independently performed initial coding followed by interrater reliability checks to revise codes and a final MAXQDA lexical search to refine three themes. RESULTS Three major themes emerged: (1) Students shared pedagogical preferences strongly favoring stories. (2) Students detected deficits in the module content tied to identities. (3) Students labelled BSS content as "soft," "subjective," and "siloed" which confounded its role in the course. CONCLUSIONS Advancing altruism aligned with BSS content in preclinical medical education remains a challenge. A closer review of student evaluations framed as learner-centeredness is key to a greater understanding and resolution of competency issues in preclinical curriculum and its impact on mastery in subsequent clinical education and practice.
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Affiliation(s)
| | - Sue P Nash
- Department of Sociology, St. Mary's University, TX, USA
| | - Joshua T Hanson
- UT Health San Antonio Long School of Medicine, Long School of Medicine, TX, USA
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Onchonga D, Abdalla ME. Integrating social determinants of health in medical education: a bibliometric analysis study. Public Health 2023; 224:203-208. [PMID: 37826887 DOI: 10.1016/j.puhe.2023.09.005] [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: 06/19/2023] [Revised: 08/15/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES Social determinants of health (SDH) are the prevalent enablers of health among populations, and integrating them in medical education will advance clinical care by integrating social and economic risk data into medical diagnosis and treatment. Despite the numerous publications on SDH and medical education, the publication trends are not known. The study aims to analyse publication trends in integrating SDH into medical education and the corresponding thematic areas. STUDY DESIGN This was a bibliometric analysis study. METHODS Bibliometric was used. Data from Scopus databases from January 2006 to June 2023 were retrieved with no language restriction. VOSviewer software was used for analysis. Bibliographic coupling was used to identify the clusters of published literature on the integration of SDH into medical education, followed by the analysis of annual distribution and growth trends, authors and co-author relationships and collaborations. RESULTS A total of 1047 articles were retrieved. The annual research publication exhibited a swift surge in the studies conducted during the reviewed period. Five clusters of information were derived: relating to curriculum development, community engagement and service-learning, stakeholder collaborations, development of assessment methods and tools for SDH, and the impact of integrating SDH into medical education. CONCLUSION Bibliometric analysis has revealed a growing trend in the field of integrating SDH into medical education, and the study has highlighted the research impact through bibliographic coupling by identifying the five thematic areas. This study lays a foundation for advancing knowledge on what has been published and possible areas for improvement in the integration of SDH into medical education.
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Affiliation(s)
- D Onchonga
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland; Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, SR1 3SD, England.
| | - M E Abdalla
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland
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Peebles ER, Pack R, Goldszmidt M. From helplessness to transformation: An analysis of clinician narratives about the social determinants of health and their implications for training and practice. MEDICAL EDUCATION 2023; 57:1054-1067. [PMID: 37621235 DOI: 10.1111/medu.15184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/15/2023] [Accepted: 07/12/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Medical curricula are attempting to prepare trainees to address the social determinants of health, however the life circumstances of patients are often beyond physician control. Little is known about how physicians cope with this dilemma; we sought to examine their perspectives when faced with this challenge to help better prepare trainees for practice. METHODS We undertook a critical analysis of physician narratives from January 2018 to June 2020. In total, 268 physician-written narrative social determinant of health pieces from four high impact medical journals were screened and 47 met the inclusion criteria and were analysed. RESULTS We identified four storylines that described the physician experience and strategies for coping with the social determinants of health. While Helplessness stories described authors' experiences of emotional distress when unable to support their patients, the other story types described ways they could make a difference. In Shortcoming and Transformation stories, the realisations about shortcomings led to transformation. In Doctor-patient relationship stories, authors described its importance in theirs and patients' lives, and in System advocacy stories, they described the need for greater advocacy to help change broken systems. CONCLUSIONS Current approaches to teaching the social determinants of health often focus on the role of physicians in recognising and altering social circumstances. However, the realities of practice do not easily allow physicians to do so and, for some, may lead to distress and burnout. There are other ways to cope and make a difference by improving ourselves, investing in getting to know our patients, and advocating. These results can help better support trainees and physicians for the realities of practice.
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Affiliation(s)
- Erin R Peebles
- Division of General Pediatrics, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Rachael Pack
- Centre for Education Research & Innovation (CERI), Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Mark Goldszmidt
- Centre for Education Research & Innovation (CERI), Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Division of General Internal Medicine, Department of Medicine, Western University, London, ON, Canada
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Sandhu S, Solomon L, Gottlieb LM. Awareness, Adjustment, Assistance, Alignment, and Advocacy: Operationalizing Social Determinants of Health Topics in Undergraduate Medical Education Curricula. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:876-881. [PMID: 37000825 DOI: 10.1097/acm.0000000000005223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Social and economic factors, such as those related to food, housing, and transportation, are major drivers of health and health inequities. Multiple national professional organizations have articulated roles for physicians in identifying and addressing social determinants of health (SDOH) and the need to include SDOH in all stages of physician education. Despite encouragement from these professional organizations, medical schools still do not routinely offer SDOH education alongside basic and clinical sciences curricula. A recent national expert consensus process identified priority SDOH knowledge domains and professional skills for medical students but lacked an organizing schema and specific pedagogical examples to help translate prioritized skills into routine pedagogical practice. One such schema is the 5As framework developed by the National Academies of Sciences, Engineering, and Medicine, which elaborates on 5 strategies to strengthen social care: awareness, adjustment, assistance, alignment, and advocacy. In this article, the authors highlight and provide examples of how mapping SDOH skills to the 5As framework can help educators meaningfully operationalize SDOH topics into specific curricular activities during the preclinical and clinical stages of undergraduate medical education. As a foundational first step in this direction, medical schools should conduct an internal curricular review of social care content (ideally mapped to the 5As framework) and identify opportunities to integrate these topics into existing courses when relevant (e.g., in social medicine, population health, and health systems science courses). Given that health and social care integration is highly context dependent, each medical school will likely need to tailor curricular changes based on their own institutional needs, mission, patient populations, and ties to the community. To increase interinstitutional alignment, medical schools might consider using or adapting peer-reviewed materials and assessments curated and centralized by the National Collaborative for Education to Address the Social Determinants of Health.
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Affiliation(s)
- Sahil Sandhu
- S. Sandhu is a medical student, Harvard Medical School, Boston, Massachusetts
| | - Loel Solomon
- L. Solomon is professor, Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Laura M Gottlieb
- L.M. Gottlieb is professor, Department of Family and Community Medicine, and codirector, Social Interventions Research and Evaluation Network, University of California San Francisco, San Francisco, California
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Ozone S, Haruta J, Takayashiki A, Maeno T, Maeno T. Three-year evaluation of a program teaching social determinants of health in community-based medical education: a general inductive approach for qualitative data analysis. BMC MEDICAL EDUCATION 2023; 23:332. [PMID: 37173722 PMCID: PMC10176298 DOI: 10.1186/s12909-023-04320-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Social determinants of health (SDH) are intricately intertwined with various social and economic factors. Reflection is essential for learning about SDH. However, only a few reports have focused on reflection in SDH programs; most were cross-sectional studies. We aimed to longitudinally evaluate a SDH program in a community-based medical education (CBME) curriculum that we introduced in 2018 based on the level of reflection and content on SDH in students' reports. METHODS Study design: General inductive approach for qualitative data analysis. Education program: A 4-week mandatory clinical clerkship in general medicine and primary care at the University of Tsukuba School of Medicine in Japan was provided to all fifth- and sixth-year medical students. Students underwent a 3-week rotation in community clinics and hospitals in suburban and rural areas of Ibaraki Prefecture. After a lecture on SDH on the first day, students were instructed to prepare a structural case description based on encounters during the curriculum. On the final day, students shared their experiences in a small group session and submitted a report on SDH. The program was continuously improved and faculty development was provided. STUDY PARTICIPANTS Students who completed the program during October 2018-June 2021. ANALYSIS Levels of reflection were categorized as reflective, analytical, or descriptive. The content was analyzed based on the Solid Facts framework. RESULTS We analyzed 118 reports from 2018-19, 101 reports from 2019-20, and 142 reports from 2020-21. There were 2 (1.7%), 6 (5.9%), and 7 (4.8%) reflective reports; 9 (7.6%), 24 (23.8%), and 52 (35.9%) analytical reports; and 36 (30.5%), 48 (47.5%), and 79 (54.5%) descriptive reports, respectively. The others were not evaluable. The number of Solid Facts framework items in reports were 2.0 ± 1.2, 2.6 ± 1.3, and 3.3 ± 1.4, respectively. CONCLUSIONS Students' understanding of SDH deepened as the SDH program in the CBME curriculum improved. Faculty development might have contributed to the results. Reflective understanding of SDH might require more faculty development and integrated education of social science and medicine.
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Affiliation(s)
- Sachiko Ozone
- Department of Family Medicine, Institute of Medicine, General Practice and Community Health, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Junji Haruta
- Department of Primary Care and Medical Education, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
- Medical Education Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Ayumi Takayashiki
- Department of Primary Care and Medical Education, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takami Maeno
- Department of Primary Care and Medical Education, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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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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Brown MEL, George RE. Supporting critically conscious integrated care: A toolbox for the health professions. CLINICAL TEACHER 2023:e13569. [PMID: 36883581 DOI: 10.1111/tct.13569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/17/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Megan E L Brown
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Riya E George
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Robin Brook Centre, St Bartholomew's Hospital, London, UK
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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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Okoro ON, DeVuyst-Miller SA, MacDonald DA, Montag-Schafer KG, Pereira CR, Schweiss SK, Yapel AM. Integrating social determinants into pharmacotherapy courses: A case-based learning approach. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:1438-1447. [PMID: 36154989 DOI: 10.1016/j.cptl.2022.09.023] [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: 05/19/2022] [Revised: 08/05/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The recognition of social determinants as major drivers of health outcomes has important implications for health care providers, including pharmacists. It is therefore imperative that providers have the requisite knowledge, skills, and attitudes to adequately address the contributions of social determinants of health (SDOH) alongside the impact of medical care on health and treatment outcomes. Case-based learning is a common practice in pharmacy education. Patient cases used in pharmacotherapy courses typically highlight clinical parameters and quantitative indices, often to the exclusion of sociocultural contexts. In actual practice, pharmacists (and other health care providers) must consider both clinical information and the context of SDOH in order to deliver responsive and effective patient care. EDUCATIONAL ACTIVITY AND SETTING The aim of the project was to build patient cases that reflect both aspects. The intent is to use these cases in the core pharmacy curriculum to teach students how to concurrently consider both clinical and social elements in patient care. Eleven pharmacists and educators participated in three work groups to develop 10 cases for pharmacotherapy courses in cardiovascular disease, diabetes management, and mental health. Two of the cases were facilitated with fourth year students on advanced pharmacy practice experiences. SUMMARY Feedback from case developers and students highlights features of the cases that lend them to utility in the pharmacy curriculum. The integration of SDOH in patient cases provides opportunity for students to build the relevant competencies that will enable them to provide holistic patient care.
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Affiliation(s)
- Olihe N Okoro
- University of Minnesota, College of Pharmacy, 235 Life Science, 1110 Kirby, Drive, Duluth, MN 55812-3003, United States.
| | | | - Danielle A MacDonald
- Essentia Health and Duluth Family Medicine Clinic, Duluth, MN, United States; University of Minnesota, College of Pharmacy, Duluth, MN, United States; University of Minnesota, Department of Family Medicine and Community Health, Duluth, MN, United States
| | | | - Chrystian R Pereira
- University of Minnesota, College of Pharmacy, Minneapolis, MN, United States
| | - Sarah K Schweiss
- University of Minnesota, College of Pharmacy, Duluth, MN, United States
| | - Ann M Yapel
- Essentia Health and Duluth Family Medicine Clinic, Duluth, MN, United States; University of Minnesota, College of Pharmacy, Duluth, MN, United States; University of Minnesota, Department of Family Medicine and Community Health, Duluth, MN, United States
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Adams SB. Uncovering Hidden Resources: Using Historical Narrative to Teach Social Determinants of Health. J Nurs Educ 2021; 60:522-525. [PMID: 34467814 DOI: 10.3928/01484834-20210708-07] [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: 11/20/2022]
Abstract
BACKGROUND Introducing population health concepts, such as social determinants of health (SDH), into undergraduate nursing programs is essential for the development of nurses who understand the impact of social environment on health outcomes. METHOD Story, in the form of historical narrative, was used in an introductory, sophomore-level, population health course as an exemplar of SDH and other population health concepts. Reflective verbal and written data were collected from students (n = 38) and analyzed for content. RESULTS Student comments reflected an emerging understanding of SDH, health disparities, stigma, evidence, and advocacy, and how these concepts intersect and apply to current nursing practice. CONCLUSION Using humanities content such as historical narrative has the potential to be a powerful exemplar for addressing multiple population health concepts in the nursing classroom. [J Nurs Educ. 2021;60(9):522-525.].
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Chandratilake M, Nadarajah VD, Mohd Sani RMB. IMoCC - Measure of cultural competence among medical students in the Malaysian context. MEDICAL TEACHER 2021; 43:S53-S58. [PMID: 32248710 DOI: 10.1080/0142159x.2020.1741530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cultural beliefs and practices impact heavily on health outcomes of patients. Doctors' ability to deal with such issues in clinical practice, i.e. cultural competence, is widely studied in the west. It has yet to be given due importance in non-western contexts. This study aimed to develop a valid and reliable measure of cultural competence in the Malaysian cultural context and to assess cultural competence among Malaysian medical students. Thirty-five cultural issues faced by Malaysian doctors were identified with a series of interviews to develop a preliminary tool. The responses of students to these cultural issues were evaluated against the extent of inquiry and advocacy based on a theoretical framework of cultural competence. The responses were subjected to statistical analysis to determine the internal structure of the tool and to reduce the number of items in the tool. The final tool (IMU Measure of Cultural Competence - IMoCC) comprised of 22 issues, which deemed to be reliable in the second round of testing. In both tools, student cohorts demonstrated an acceptable level of cultural competence with room for improvement. However, they appeared to learn how to deal with cultural issues primarily through informal means and not in the formal curriculum.
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Affiliation(s)
- Madawa Chandratilake
- IMU Centre for Education, International Medical University, Kuala Lumpur, Malaysia
- Department of Medical Education, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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Rockey NG, Weiskittel TM, Linder KE, Ridgeway JL, Wieland ML. A mixed methods study to evaluate the impact of a student-run clinic on undergraduate medical education. BMC MEDICAL EDUCATION 2021; 21:182. [PMID: 33766015 PMCID: PMC7992336 DOI: 10.1186/s12909-021-02621-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/16/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the extent to which a longitudinal student-run clinic (SRC) is meeting its stated learning objectives, including providing critical community services and developing physicians who more fully appreciate the social factors affecting their patients' health. METHODS This was a mixed methods program evaluation of an SRC at Mayo Clinic Alix School of Medicine (MCASOM). A survey was conducted of medical students who had participated in the clinic and seven interviews and three focus groups were conducted with SRC patients, students, faculty, staff, and board members. Transcripts were coded for systematic themes and sub-themes. Major themes were reported. Survey and interview data were integrated by comparing findings and discussing areas of convergence or divergence in order to more fully understand program success and potential areas for improvement. RESULTS Greater than 85% of student survey respondents (N = 90) agreed or strongly agreed that the SRC met each of its objectives: to provide a vital community service, to explore social determinants of health (SDH), to understand barriers to healthcare access and to practice patience-centered examination. Qualitative data revealed that the SRC contextualized authentic patient care experiences early in students' medical school careers, but the depth of learning was variable between students. Furthermore, exposure to SDH through the program did not necessarily translate to student understanding of the impact of these social factors on patient's health nor did it clearly influence students' future practice goals. CONCLUSIONS The MCASOM SRC experience met core learning objectives, but opportunities to improve long-term impact on students were identified. Participation in the SRC enabled students to engage in patient care early in training that is representative of future practices. SRCs are an avenue by which students can gain exposure to real-world applications of SDH and barriers to healthcare access, but additional focus on faculty development and intentional reflection may be needed to translate this exposure to actionable student understanding of social factors that impact patient care.
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Affiliation(s)
- Nathan G. Rockey
- Mayo Clinic Alix School of Medicine, 200 First Street SW, Rochester, MN 55905 USA
| | - Taylor M. Weiskittel
- Mayo Clinic Graduate School of Biomedical Sciences, 200 First Street SW, Rochester, MN 55905 USA
| | - Katharine E. Linder
- Mayo Clinic Alix School of Medicine, 200 First Street SW, Rochester, MN 55905 USA
| | - Jennifer L. Ridgeway
- Center for the Science of Healthcare Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
| | - Mark L. Wieland
- Division of Community Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA
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McKinley DW, Ghaffarifar S. The necessity of examining patients' social behavior and teaching behavior change theories: curricular innovations induced by the COVID-19 pandemic. BMC MEDICAL EDUCATION 2021; 21:150. [PMID: 33685439 PMCID: PMC7938272 DOI: 10.1186/s12909-021-02582-2] [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: 06/15/2020] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
During the COVID-19 pandemic, despite many widespread calls for social distancing, recommendations have not been followed by some people and the high rate of non-compliance has significantly affected lives all around the world. It seems that the rate of non-compliance with the recommendations among medical students has been as high as the rest of the other youth. In the time that students are removed from clinical environments and most physician teachers are strained in providing services to patients, medical students can be trained in interdisciplinary behavior change counseling programs and they can be employed in delivering virtual consultations to the patients referred to medical centers.In this quick review, we provide an argument regarding the importance of integrating the topic of patients' social history into the undergraduate medical curriculum and the necessity of teaching theories of behavior change to medical students. Hypotheses are proposed that focus on the importance of integrating behavioral and social sciences into the medical curriculum and to teach theories or models of behavior change to students. Health professions educators can design and implement interventions to teach hypothesized models of behavioral change to medical students and evaluate the effectiveness of those interventions. The impacts of such educational interventions on increasing people's compliance with recommendations to improve public health can be evaluated as well.
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Affiliation(s)
- Danette Waller McKinley
- Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, USA
| | - Saeideh Ghaffarifar
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Goyal RK, Dawson CA, Epstein SB, Brach RJ, Finnie SM, Lounsbury KM, Lahey T, Eldakar-Hein ST. The design and implementation of a longitudinal social medicine curriculum at the University of Vermont's Larner College of Medicine. BMC MEDICAL EDUCATION 2021; 21:131. [PMID: 33627097 PMCID: PMC7903930 DOI: 10.1186/s12909-021-02533-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Despite an abundant literature advocating that social determinants of health (SDH) be taught during undergraduate medical education, there are few detailed descriptions of how to design and implement longitudinal core curricula that is delivered to all students and accomplishes this goal. METHODS In this paper, we describe the design and implementation of a social medicine curriculum at the University of Vermont's Larner College of Medicine (UVM Larner). Using Kern's principles, we designed a longitudinal curriculum that extends through both preclinical and clinical training for all students and focused on integrating SDH material directly into basic science and clinical training. RESULTS We successfully developed and implemented two primary tools, a "Social Medicine Theme of the Week" (SMTW) in preclinical training, and SDH rounds in the clinical setting to deliver SDH content to all learners at UVM Larner. CONCLUSIONS Extensive student-faculty partnerships, robust needs assessment, and focusing on longitudinal and integrated SDH content delivery to all students were key features that contributed to successful design and implementation.
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Affiliation(s)
- Raghav K Goyal
- University of Vermont's Larner College of Medicine, UVMMC, 111 Colchester Ave, Smith 2, Burlington, VT, 05401, USA
| | - Christina A Dawson
- University of Vermont's Larner College of Medicine, UVMMC, 111 Colchester Ave, Smith 2, Burlington, VT, 05401, USA
| | - Samuel B Epstein
- University of Vermont's Larner College of Medicine, UVMMC, 111 Colchester Ave, Smith 2, Burlington, VT, 05401, USA
| | - Richard J Brach
- University of Vermont's Larner College of Medicine, UVMMC, 111 Colchester Ave, Smith 2, Burlington, VT, 05401, USA
| | - Sheridan M Finnie
- University of Vermont's Larner College of Medicine, UVMMC, 111 Colchester Ave, Smith 2, Burlington, VT, 05401, USA
| | - Karen M Lounsbury
- University of Vermont's Larner College of Medicine, UVMMC, 111 Colchester Ave, Smith 2, Burlington, VT, 05401, USA
| | - Timothy Lahey
- University of Vermont's Larner College of Medicine, UVMMC, 111 Colchester Ave, Smith 2, Burlington, VT, 05401, USA.
| | - Shaden T Eldakar-Hein
- University of Vermont's Larner College of Medicine, UVMMC, 111 Colchester Ave, Smith 2, Burlington, VT, 05401, USA
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Goez H, Lai H, Rodger J, Brett-MacLean P, Hillier T. The DISCuSS model: Creating connections between community and curriculum - A new lens for curricular development in support of social accountability. MEDICAL TEACHER 2020; 42:1058-1064. [PMID: 32608298 DOI: 10.1080/0142159x.2020.1779919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Medicine's social mandate recognizes the importance of introducing changes to systems and practices to meet the healthcare needs of marginalized populations. Social accountability efforts encompass a wide array of actions, including equity, diversity and inclusion initiatives, and adapting knowledge relevant to practice across education, research, and clinical domains. To influence change in education, ongoing structures and processes are needed to ensure adequacy, relevance, and effectiveness of curricular coverage. In support of this, we created an innovative and creative approach to developing curricular modules to prepare medical students to provide care that is responsive to the cultural, economic, and psychosocial realities of diverse patient populations. The DISCuSS model (Diversity, Identify, Search, Create module (with community engagement), Sustainability, Social accountability) provides a community-engaged, iterative approach to curriculum development relevant to social accountability. Over the past 5 years, we have created nine curricular modules focused on health-related inequities and social concerns, including modules on Indigenous and refugee health, sexual and gender minority health, human trafficking, and addiction. AFMC Graduation Questionnaire results have shown a statistically significant increase in our students 'preparedness to provide care to diverse populations.' The DISCuSS model, which continues to evolve, can be adapted and used in other settings.
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Affiliation(s)
- Helly Goez
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Hollis Lai
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Joanne Rodger
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | | | - Tracey Hillier
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
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Henry ML, Lichtman JH, Hanlon K, Keene DE. Clinical management of Type II Diabetes among the unstably housed: a qualitative study of primary care physicians. Fam Pract 2020; 37:418-423. [PMID: 31781768 PMCID: PMC7377290 DOI: 10.1093/fampra/cmz085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Housing is a growing challenge for US adults in an increasingly unaffordable housing market. These housing challenges can create barriers to effective management and control of Type II Diabetes. However, little is known about how housing challenges are perceived and navigated by clinicians who care for patients with Type II Diabetes. OBJECTIVE To examine how primary care clinicians perceive and navigate their patients' housing challenges in the context of Type II Diabetes management. METHODS We conducted semi-structured interviews with 18 primary care clinicians practising in four clinical settings in New Haven, Connecticut. Two investigators systematically coded the interviews. Analysis of coded data was used to determine themes. RESULTS Participants considered housing as significant to their patients' health and a potential barrier to optimal diabetes management. Participants sought to improve their patients' housing through advocacy, referrals and interdisciplinary collaborations. They also adjusted clinical decisions to adapt to patients' housing challenges. In making clinical adjustments, participants struggled to find a balance between what they perceived to be feasible for unstably housed patients and maintaining a standard of care. Some participants navigated this balanced by employing creative strategies and individualized care. CONCLUSION In highlighting the challenges that clinicians face in maintaining a standard of care for unstably housed diabetes patients, our findings speak to the need for more guidance, resources and support to address housing in a clinical setting.
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Affiliation(s)
- Mariana L Henry
- Department of Chronic Disease Epidemiology, New Haven, CT, USA
| | | | - Kendra Hanlon
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Danya E Keene
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
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Brottman MR, Char DM, Hattori RA, Heeb R, Taff SD. Toward Cultural Competency in Health Care: A Scoping Review of the Diversity and Inclusion Education Literature. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:803-813. [PMID: 31567169 DOI: 10.1097/acm.0000000000002995] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE To explore best practices for increasing cultural competency and reducing health disparities, the authors conducted a scoping review of the existing literature. METHOD The review was guided by 2 questions: (1) Are health care professionals and medical students learning about implicit bias, health disparities, advocacy, and the needs of diverse patient populations? (2) What educational strategies are being used to increase student and educator cultural competency? In August 2016 and July 2018, the authors searched 10 databases (including Ovid MEDLINE, Embase, and Scopus) and MedEdPORTAL, respectively, using keywords related to multiple health professions and cultural competency or diversity and inclusion education and training. Publications from 2005 to August 2016 were included. Results were screened using a 2-phase process (title and abstract review followed by full-text review) to determine if articles met the inclusion or exclusion criteria. RESULTS The search identified 89 articles that specifically related to cultural competency or diversity and inclusion education and training within health care. Interventions ranged from single-day workshops to a 10-year curriculum. Eleven educational strategies used to teach cultural competency and about health disparities were identified. Many studies recommended using multiple educational strategies to develop knowledge, awareness, attitudes, and skills. Less than half of the studies reported favorable outcomes. Multiple studies highlighted the difficulty of implementing curricula without trained and knowledgeable faculty. CONCLUSIONS For the field to progress in supporting a culturally diverse patient population, comprehensive training of trainers, longitudinal evaluations of interventions, and the identification and establishment of best practices will be imperative.
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Affiliation(s)
- Melissa R Brottman
- M.R. Brottman is currently occupational therapist, Schwab Rehabilitation Hospital, Chicago, Illinois. At the time of writing, she was a third-year clinical doctorate student, Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri. D.M. Char is professor of emergency medicine and director of faculty development for emergency medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri. R.A. Hattori is senior project manager, Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri. R. Heeb was a third-year clinical doctorate student, Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri, at the time of writing. She is currently a rehabilitation and participation science doctoral student, Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri. S.D. Taff is associate professor of occupational therapy and medicine and director, Division of Professional Education, Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Loh VWK, Yip TW, Chua JCT, Goh WL. Migrant health elective: They are just like me! MEDICAL EDUCATION 2020; 54:472-473. [PMID: 32249958 DOI: 10.1111/medu.14119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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Abstract
Academic medical centers (AMCs) face challenges in conducting research among traditionally marginalized communities due to long-standing community mistrust. Evidence suggests that some AMC faculty and staff lack an understanding of the history of distrust and social determinants of health (SDH) affecting their communities. Wake Forest Clinical and Translational Science Institute Program in Community Engagement (PCE) aims to build bridges between communities and Wake Forest Baptist Health by equipping faculty, clinicians, administrators, and staff (FCAS) with a better understanding of SDH. The PCE collaborated with community partners to develop and implement community tours to improve cross-community AMC understanding and communication, enhance knowledge of SDH, and build awareness of community needs, priorities, and assets. Nine day-long tours have been conducted with 92 FCAS. Tours included routes through under-resourced neighborhoods and visits to community assets. Participant evaluations assessed program quality; 89% reported enhanced understanding of access-to-care barriers and how SDH affect health; 86% acknowledged the experience would improve future interactions with participants and patients; and 96% agreed they would recommend the tour to colleagues. This work supports the use of community tours as a strategy to improve cross-community AMC communication, build trust, and raise awareness of community needs, priorities, and assets.
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Schroeder K, Garcia B, Phillips RS, Lipman TH. Addressing Social Determinants of Health Through Community Engagement: An Undergraduate Nursing Course. J Nurs Educ 2019; 58:423-426. [DOI: 10.3928/01484834-20190614-07] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/28/2019] [Indexed: 11/20/2022]
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Sisler SM, Schapiro NA, Stephan L, Mejia J, Wallace AS. Consider the root of the problem: increasing trainee skills at assessing and addressing social determinants of health. Transl Behav Med 2019; 9:523-532. [PMID: 31094436 PMCID: PMC6520804 DOI: 10.1093/tbm/ibz046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
National pediatrics guidelines recommend screening all patients for unmet social needs to improve self-management of chronic conditions and health outcomes and to reduce costs. Practitioners involved in training pediatric clinicians need to understand how to prepare pediatric clinicians to effectively conduct social needs screening and where current training methods fall short. Our qualitative study investigated whether using "standardized" patients during trainee education improved trainees' ability to assess and address adolescent patients' social needs. Vulnerable adolescents should be prioritized in social determinants of health translational research because increased risk taking and emotionality may predispose this population to lower self-esteem and self-efficacy. We trained 23 adolescents (aged 16-18) recruited from an urban health-career education program to act as standardized patients (SPs). Two cohorts of nurse practitioner trainees (n = 36) enrolled in a simulation where the patient-actor presented with a minor chief complaint and related a fabricated complex social history. Pre-encounter, Cohort 1 (n = 18) reviewed psychosocial screeners; Cohort 2 (n = 18) were given in-depth information about social needs before meeting patients. SPs gave individualized feedback to trainees, and self-reflections were analyzed using thematic analysis. In Cohort 1, trainees identified some social needs, yet few intervened. Trainees expressed discomfort in: (a) asking socially sensitive questions and (b) triaging patient versus clinician priorities. Cohort 2 demonstrated improvements compared to Cohort 1 in identifying needs yet had similar difficulty with organization and questioning. Trainees were able to utilize a lower-stakes interaction with patient-actors to raise awareness regarding a patient's sensitive needs and to organize care surrounding these patient-centered concerns.
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Affiliation(s)
- Shawna M Sisler
- University of Utah, College of Nursing, Salt Lake City, UT, USA
| | - Naomi A Schapiro
- University of California, San Francisco, Department of Family Health Care Nursing, San Francisco, CA, USA
| | - Linda Stephan
- University of California, San Francisco, Department of Family Health Care Nursing, San Francisco, CA, USA
| | - Jayme Mejia
- University of California, San Francisco, Department of Family Health Care Nursing, San Francisco, CA, USA
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Doobay-Persaud A, Adler MD, Bartell TR, Sheneman NE, Martinez MD, Mangold KA, Smith P, Sheehan KM. Teaching the Social Determinants of Health in Undergraduate Medical Education: a Scoping Review. J Gen Intern Med 2019; 34:720-730. [PMID: 30993619 PMCID: PMC6502919 DOI: 10.1007/s11606-019-04876-0] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND To provide optimal care, medical students should understand that the social determinants of health (SDH) impact their patients' well-being. Those charged with teaching SDH to future physicians, however, face a paucity of curricular guidance. OBJECTIVE This review's objective is to map key characteristics from publications about teaching SDH to students in undergraduate medical education (UME). METHODS In 2016, the authors searched PubMed, Embase, Web of Science, the Cochrane and ERIC databases, bibliographies, and MedEdPORTAL for articles published between January 2010 and November 2016. Four reviewers screened articles for eligibility then extracted and analyzed data descriptively. Scoping review methodology was used to map key concepts and curricular logistics as well as educator and student characteristics. RESULTS The authors screened 3571 unique articles of which 22 were included in the final review. Many articles focused on community engagement (15). Experiential learning was a common instructional strategy (17) and typically took the form of community or clinic-based learning. Nearly half (10) of the manuscripts described school-wide curricula, of which only three spanned a full year. The majority of assessment was self-reported (20) and often related to affective change. Few studies objectively assessed learner outcomes (2). CONCLUSIONS The abundance of initial articles screened highlights the growing interest in SDH in medical education. The small number of selected articles with sufficient detail for abstraction demonstrates limited SDH curricular dissemination. A lack of accepted tools or practices that limit development of robust learner or program evaluation was noted. Future research should focus on identifying and evaluating effective instructional and assessment methodologies to address this gap, exploring additional innovative teaching frameworks, and examining the specific contexts and characteristics of marginalized and underserved populations and their coverage in medical education.
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Affiliation(s)
- Ashti Doobay-Persaud
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Mark D Adler
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tami R Bartell
- Mary Ann & J. Milburn Smith Child Health Research, Outreach and Advocacy Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Natalie E Sheneman
- Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mayra D Martinez
- Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karen A Mangold
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Patricia Smith
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Karen M Sheehan
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Tiwari T, Palatta AM. An Adapted Framework for Incorporating the Social Determinants of Health into Predoctoral Dental Curricula. J Dent Educ 2019; 83:127-136. [DOI: 10.21815/jde.019.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Tamanna Tiwari
- Department of Community Dentistry and Population Health
- Center for Oral Disease Prevention and Population Health Research; School of Dental Medicine; University of Colorado Anschutz Medical Campus
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Alang SM. Mental health care among blacks in America: Confronting racism and constructing solutions. Health Serv Res 2019; 54:346-355. [PMID: 30687928 DOI: 10.1111/1475-6773.13115] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To describe reasons for unmet need for mental health care among blacks, identify factors associated with causes of unmet need, examine racism as a context of unmet need, and construct ways to improve service use. DATA SOURCES Data from the 2011-2015 National Survey on Drug Use and Health were pooled to create an analytic sample of black adults with unmet mental health need (N = 1237). Qualitative data came from focus groups (N = 30) recruited through purposive sampling. STUDY DESIGN Using sequential mixed methods, reasons for unmet need were regressed on sociodemographic, economic, and health characteristics of respondents. Findings were further explored in focus groups. PRINCIPAL FINDINGS Higher education was associated with greater odds of reporting stigma and minimization of symptoms as reasons for unmet need. The fear of discrimination based on race and on mental illness was exacerbated among college-educated blacks. Racism causes mistrust in mental health service systems. Participants expressed the importance of anti-racism education and community-driven practice in reducing unmet need. CONCLUSION Mental health systems should confront racism and engage the historical and contemporary racial contexts within which black people experience mental health problems. Critical self-reflection at the individual level and racial equity analysis at the organizational level are critical.
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Affiliation(s)
- Sirry M Alang
- Program in Health, Medicine, and Society, Department of Sociology and Anthropology, Lehigh University, Bethlehem, Pennsylvania
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Hordijk R, Hendrickx K, Lanting K, MacFarlane A, Muntinga M, Suurmond J. Defining a framework for medical teachers' competencies to teach ethnic and cultural diversity: Results of a European Delphi study. MEDICAL TEACHER 2019; 41:68-74. [PMID: 29490534 DOI: 10.1080/0142159x.2018.1439160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Medical students need to be trained in delivering diversity-responsive health care but unknown is what competencies teachers need. The aim of this study was to devise a framework of competencies for diversity teaching. METHODS An open-ended questionnaire about essential diversity teaching competencies was sent to a panel. This resulted in a list of 74 teaching competencies, which was sent in a second round to the panel for rating. The final framework of competencies was approved by the panel. RESULTS Thirty-four experts participated. The final framework consisted of 10 competencies that were seen as essential for all medical teachers: (1) ability to critically reflect on own values and beliefs; (2) ability to communicate about individuals in a nondiscriminatory, nonstereotyping way; (3) empathy for patients regardless of ethnicity, race or nationality; (4) awareness of intersectionality; (5) awareness of own ethnic and cultural background; (6) knowledge of ethnic and social determinants of physical and mental health of migrants; (7) ability to reflect with students on the social or cultural context of the patient relevant to the medical encounter; (8) awareness that teachers are role models in the way they talk about patients from different ethnic, cultural and social backgrounds; (9) empathy for students of diverse ethnic, cultural and social background; (10) ability to engage, motivate and let all students participate. CONCLUSIONS This framework of teaching competencies can be used in faculty development programs to adequately train all medical teachers.
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Affiliation(s)
- Rowan Hordijk
- a Academic Medical Centre, University of Amsterdam, Amsterdam Public Health Research Institute , Amsterdam , The Netherlands
| | - Kristin Hendrickx
- b Department of Primary and Interdisciplinary Care , University of Antwerp , Antwerp , Belgium
| | - Katja Lanting
- a Academic Medical Centre, University of Amsterdam, Amsterdam Public Health Research Institute , Amsterdam , The Netherlands
| | | | | | - Jeanine Suurmond
- a Academic Medical Centre, University of Amsterdam, Amsterdam Public Health Research Institute , Amsterdam , The Netherlands
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Mincey K, Gross T. Training the Next Generation: Developing Health Education Skills in Undergraduate Public Health Students at a Historically Black College and University. Front Public Health 2017; 5:274. [PMID: 29104865 PMCID: PMC5654946 DOI: 10.3389/fpubh.2017.00274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/25/2017] [Indexed: 11/16/2022] Open
Abstract
With the looming workforce crisis, undergraduate public health students could be an important link in filling this demand. As public health continues to face challenges in the future, it is important that the future workforce is not only diverse but also trained in a manner that exposes them to real-world experiences that give them an opportunity to apply coursework to solve problems. This article outlines how a health program planning course was taught at a Historically Black College and University using assignments that promote active learning. Students were assessed on their ability to plan and implement a health activity based on a developed metric. Student and instructor reflections were collected from final assessments of the health programs by both groups. All elements of the course are discussed from course design, structure, assignments, and outcomes along with student and instructor reflections and lessons learned. Results suggest that including assignments focused on active learning are beneficial to helping students learn course material. As public health continues to change, more work needs to focus on teaching pedagogies that better prepare students to address future public health issues.
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Affiliation(s)
- Krista Mincey
- Department of Public Health Sciences, Xavier University of Louisiana, New Orleans, LA, United States
| | - Tyra Gross
- Department of Public Health Sciences, Xavier University of Louisiana, New Orleans, LA, United States
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Vyas A, Rodrigues VC, Ayres R, Myles PR, Hothersall EJ, Thomas H. Public health matters: Innovative approaches for engaging medical students. MEDICAL TEACHER 2017; 39:402-408. [PMID: 28379091 DOI: 10.1080/0142159x.2017.1294753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Public health faces the paradox of being increasingly emphasized by the key health and social care regulators and stakeholders, while remaining a largely under-represented discipline in the context of medical curricula. Enhancing medical student engagement in public health teaching is one way to address this concern. METHODS We discuss four key solutions to the challenges faced by public health educators in medical schools, and present five case studies which demonstrate innovative approaches to engaging medical students in our discipline. RESULTS Four different approaches have been piloted by members of the Public Health Educators in Medical Schools (PHEMS) network: (i) ensuring social accountability, (ii) demonstrating clinical relevance, (iii) mapping the core curriculum, and (iv) using technology enhanced learning. Preliminary student feedback suggests that these approaches can be used to position public health as an enabler of modern medical practice, and promote a more holistic understanding of medicine by linking patient-centred care to the population level. CONCLUSIONS The zeitgeist in both academia and the healthcare system supports the teaching of public health within the medical curriculum; there is also consensus at the political and pedagogical level. The challenge of ensuring engagement now needs to be met at the student-teacher interface.
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Affiliation(s)
- A Vyas
- a Public Health , Norwich Medical School, University of East Anglia , Norwich , UK
| | - V C Rodrigues
- b Public Health and Medical Education , Norwich Medical School, University of East Anglia , Norwich , UK
| | - R Ayres
- c Population Health , Plymouth Peninsula Schools of Medicine and Dentistry , Plymouth , UK
| | - P R Myles
- d Health Protection and Epidemiology, Epidemiology and Public Health , University of Nottingham , Nottingham , UK
| | - E J Hothersall
- e Public Health Medicine, Systems in Practice Convenor , Dundee Medical School and NHS Tayside , Dundee , UK
| | - H Thomas
- f Public Health and Primary Care , St George's, University of London , London , UK
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Leslie KF, Steinbock S, Simpson R, Jones VF, Sawning S. Interprofessional LGBT Health Equity Education for Early Learners. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2017; 13:10551. [PMID: 30800753 PMCID: PMC6342047 DOI: 10.15766/mep_2374-8265.10551] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
INTRODUCTION The eQuality project at the University of Louisville aims to train future physicians to deliver equitable quality care for all people by creating an integrated educational model utilizing the competencies identified in the AAMC's Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born With DSD. This foundational interprofessional health equity session for early learners addresses knowledge and attitude milestones relating to interprofessional collaboration, professionalism, and systems-based practice competencies for lesbian, gay, bisexual, and transgender (LGBT) populations. METHODS First-year medical students were assigned to interprofessional teams of approximately 10 health sciences students each. Students participated in a 75-minute session utilizing a group case study activity, including a systems lecture exploring social determinants and community resources related to LGBT health. Students collaboratively discussed the case and recorded strategies for optimal patient care. The Readiness for Interprofessional Learning Scale and health disparities attitudes and knowledge scales were administered pre-/postsession. RESULTS One hundred fifty-eight first-year medical students participated in the session. Posttest scores reflected an improvement for all disparities knowledge items (p < .001), and an increased interest in working with other health professions students on future projects (p < .001). Changes in attitudes toward systemic and social factors affecting health were also observed. However, content analysis of worksheets revealed that only 36% of teams identified specific action steps for the case scenarios. DISCUSSION This session was effective in improving knowledge and attitudes related to LGBT health equity and interprofessional education.
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Affiliation(s)
- Katie F. Leslie
- Program Director, Health Sciences Center Office of Diversity and Inclusion, University of Louisville
- Corresponding author:
| | - Stacie Steinbock
- Director, LGBT Center Satellite Office on the Health Sciences Center Campus, University of Louisville
| | - Ryan Simpson
- Assistant Director, Health Sciences Center Office of Diversity and Inclusion, University of Louisville
| | - V. Faye Jones
- Assistant Vice President, Health Affairs/Diversity Initiatives, University of Louisville School of Medicine
- Professor of Pediatrics, University of Louisville School of Medicine
| | - Susan Sawning
- Research Director, Undergraduate Medical Education, University of Louisville School of Medicine
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Bessette J, Camden C. Pre-Departure Training for Student Global Health Experiences: A Scoping Review. Physiother Can 2017; 69:343-350. [PMID: 30369702 DOI: 10.3138/ptc.2015-86gh] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The authors identify the recommended pre-departure training (PDT) practices for physiotherapy students participating in a global health experience (GHE): both the content to be covered and the preferred learning methods to be used. They also discuss the implications of these recommendations for the physiotherapy field. Method: A scoping review of scientific and grey literature was performed to identify the recommended PDT practices. A thematic analysis was then performed to identify emerging themes. Results: The recommended PDT content broke down into the following areas: global health knowledge; ethics, introspection, and critical thinking; cultural competency; cross-cultural communication; placement-specific knowledge; and personal health and safety. The recommended learning methods were a combination of didactic, reflective, and experiential components that would enhance knowledge, develop cross-cultural skills, and address attitudinal changes. Conclusion: The growing participation of Canadian physiotherapy students in GHEs requires universities to adequately prepare their students before they leave to mitigate moral hazards. Given that little empirical research has been published on the effectiveness of PDT, the authors encourage collaborative efforts to develop PDT and evaluate its effectiveness for students and its impact on host communities.
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Affiliation(s)
| | - Chantal Camden
- School of Rehabilitation, Faculty of Medicine and Health Sciences.,Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Que
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