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Caldarelli E, Hess JJ, Weaver E, Buckley R, Swan RR, Schumacher J, Kostelanetz S, Davidson MA, Whitey M, Black R, Terhune KP. A Graduate Medical Orientation Intervention Focused on Local Health Inequities. J Grad Med Educ 2023; 15:442-446. [PMID: 37637328 PMCID: PMC10449351 DOI: 10.4300/jgme-d-23-00016.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/22/2023] [Accepted: 05/30/2023] [Indexed: 08/29/2023] Open
Abstract
Background Residents must understand the social drivers of health in the communities they serve to deliver quality care. While resident orientation provides an opportunity to introduce residents to social and structural drivers of health, inequity, and care delivery relevant to the patient population in their new communities, many graduate medical education orientation curricula do not include this content. Objective To report the development and implementation of a novel, patient-centered health equity orientation curriculum, including initial feasibility and acceptability data as well as preliminary self-reported outcomes. Methods The curriculum was developed by academic faculty in collaboration with institutional and local health equity champions. Content centered on the history of inequities and racism within the local communities and included didactic presentations, asynchronous video, and virtual site visits to community resource groups. The curriculum was administered to all 2021 incoming Vanderbilt University Medical Center medical and surgical residents (N=270) over 2 half-days, both in-person and via Zoom. Data were collected anonymously via pre- and post-surveys. Results A total of 216 residents (80% response rate) provided pre-survey response data, but only 138 residents (51.1%) provided post-survey data, including self-reported demographics (eg, underrepresented in medicine status) and level of agreement with 10 competency-based statements coded as pertaining to knowledge, skills, behaviors, or attitudes (KSBAs). Primary outcomes included improvement in residents' KSBAs from pre- to post-survey. The greatest increases in percentages occurred with content that was specific to local history and population. Conclusions In a class of incoming residents, this study demonstrated feasibility, acceptability, and pre-post curriculum improvement in self-reported KSBAs when addressing health equity issues.
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Affiliation(s)
- Emily Caldarelli
- Emily Caldarelli, EdD, is a Doctoral Candidate, Peabody College of Vanderbilt University, and Director of GME Accreditation, Temple University Hospital
| | - Jennifer J. Hess
- Jennifer J. Hess, MD, is Assistant Professor, Department of Emergency Medicine, Vanderbilt University Medical Center
| | - Eleanor Weaver
- Eleanor Weaver, MD, is Assistant Professor of Medicine, Vanderbilt University Medical Center
| | - Ryan Buckley
- Ryan Buckley, MD, is Assistant Professor of Clinical Internal Medicine, Vanderbilt University Medical Center
| | - Rebecca R. Swan
- Rebecca R. Swan, MD, is Vice Chair for Education, Department of Pediatrics, and Assistant Dean, Graduate Medical Education, Vanderbilt University Medical Center
| | - Julie Schumacher
- Julie Schumacher, PhD, is Professor and Vice Chair for Education, Department of Psychiatry and Human Behavior, University of Mississippi Medical Center
| | - Sophia Kostelanetz
- Sophia Kostelanetz, MD, MPH, is Assistant Clinical Professor and Health Equity Lead, Department of Medicine, One Brooklyn Health, and Associate Program Director in Health Equity, Interfaith Internal Medicine Residency Program, Vanderbilt University School of Medicine
| | - Mario A. Davidson
- Mario A. Davidson, PhD, MS, MAS, MA, is Associate Professor and EDP Director for Classroom Peer Reviews, Department of Biostatistics, Vanderbilt University School of Medicine
| | - Megan Whitey
- Megan Whitey, C-TAGME, is Lead Program Manager, Graduate Medical Education, Vanderbilt University Medical Center
| | - Reena Black
- Reena Black, MBA, C-TAGME, is Senior Program Manager, Graduate Medical Education, Vanderbilt University Medical Center; and
| | - Kyla P. Terhune
- Kyla P. Terhune, MD, MBA, is Associate Dean for Graduate Medical Education, Vanderbilt School of Medicine
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Marrast LM, Chim C, Tocco J, Coletti DJ, Nouryan C, Block L, Martinez J. Expanding Knowledge and Changing Attitudes About Poverty: An Interactive, Interprofessional Approach. J Prim Care Community Health 2022; 13:21501319221079446. [PMID: 35225052 PMCID: PMC8891831 DOI: 10.1177/21501319221079446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Poverty negatively affects the lives and health of the poor. However, health professionals often have limited personal experience and receive little formal education on surviving under conditions of poverty in the United States, which may contribute to suboptimal patient care and outcomes. PURPOSE We conducted a 3-h, interactive, experiential poverty simulation workshop with an interprofessional group of pre-professional health students to increase their comprehension about the realities of poverty. METHOD As part of the evaluation, participants completed a self-assessment of their attitudes and skills using a Likert scale and open-ended questions; a reflection prompt about how the workshop might affect their professional practice; and a pre- and post-assessment questionnaire. DISCUSSION Participants' attitudes about low-income patients became more favorable; they gained awareness and expressed empathy through the role-play experience. Our analysis revealed increased understanding of social determinants of health, of life challenges that patients face outside of healthcare, and that solutions must be collaborative as the challenges facing poor patients are multifactorial. CONCLUSION The workshop allowed interprofessional students to learn from and with each other about the experiences of poor patients. Future sessions should emphasize interprofessional skill-building and action, potentially in virtual formats.
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Affiliation(s)
| | | | - Jack Tocco
- Northwell Health, Center for Equity of Care, New Hyde Park, NY, USA
| | - Daniel J Coletti
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | | | - Lauren Block
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Johanna Martinez
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Klein M, Hanson E, Lichtenstein C, Mogilner L, Falusi O, Tolliver DG, Lungelow L, Chamberlain L. Poverty Related Education in Pediatrics: Current State, Gaps and Call to Action. Acad Pediatr 2021; 21:S177-S183. [PMID: 34740426 DOI: 10.1016/j.acap.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/27/2021] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
Children are the poorest age group in our country, with 1 in 6, or 12 million, living in poverty. This sobering statistic became even more appalling in spring 2020 when COVID-19 magnified existing inequities. These inequities are particularly important to pediatricians, because poverty, along with racism and other interrelated social factors, significantly impact overall child health and well-being. It is imperative that pediatric educators redouble their efforts to train learners to recognize and address health inequities related to poverty and all of its counterparts. In this paper, we describe the current state of poverty-related training in pediatric undergraduate, graduate, and continuing medical education as well as opportunities for growth. We highlight gaps in the current curricula, particularly around the intersectionality between poverty and racism, as well as the need for robust evaluation. Using a logic model framework, we outline content, learning strategies, and outcomes for poverty-related education. We include opportunities for the deployment of best practice learning strategies and the incorporation of newer technologies to deliver the content. We assert that collaboration with community partners is critical to shape the depth and breadth of education. Finally, we emphasize the paramount need for high-quality faculty development and accessible career paths to create the cadre of role models and mentors necessary to lead this work. We conclude with a call for collaboration between institutions, accrediting bodies, and policymakers to promote meaningful, outcome-oriented, poverty-related education, and training throughout the medical education continuum.
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Affiliation(s)
- Melissa Klein
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine (M Klein), Cincinnati, Ohio.
| | - Elizabeth Hanson
- Joe R. and Teresa Lozano Long School of Medicine, UT Health San Antonio (E Hanson), San Antonio, Tex
| | - Cara Lichtenstein
- The George Washington University School of Medicine and Health Sciences, Children's National Hospital (C Lichtenstein), Washington, DC
| | - Leora Mogilner
- Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital (L Mogilner), New York, NY
| | - Olanrewaju Falusi
- The George Washington University School of Medicine and Health Sciences, Children's National Hospital (O Falusi), Washington, DC
| | - Destiny G Tolliver
- Yale National Clinician Scholars Program, Yale School of Medicine (DG Tolliver), New Haven, Conn
| | - Lisha Lungelow
- Cincinnati Children's Hospital Medical Center (L Lungelow), Cincinnati, Ohio
| | - Lisa Chamberlain
- Stanford University School of Medicine (L Chamberlain), Stanford, Calif
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Chang AY, Bass TL, Duwell M, Berger JS, Bangalore R, Lee NS, Amdur RL, Andrews M, Fahnestock E, Kahsay L, El-Bayoumi J. The Impact of "See the City You Serve" Field Trip: An Educational Tool for Teaching Social Determinants of Health. J Grad Med Educ 2017; 9:118-122. [PMID: 28261406 PMCID: PMC5319610 DOI: 10.4300/jgme-d-16-00212.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND There has been limited evaluation of tools for teaching social determinants of health (SDOH). OBJECTIVE We evaluated a field trip as a tool for teaching SDOH to incoming medical interns. METHODS Incoming interns from The George Washington University participated in a bus field trip of Washington, DC, guided by community partners. The field trip introduced trainees to local neighborhoods. Pre- and postactivity surveys developed by the authors were analyzed using a Wilcoxon signed rank test. Reflection responses were recorded and counted for recurrent themes. RESULTS Incoming interns participated in 2015 (85 of 90, 94%) and in 2016 (96 of 116, 83%). Postactivity, basic knowledge of DC geographic health disparities increased, and a greater percentage of interns reported being at least somewhat comfortable understanding the neighborhoods from which their patients come (2015: 58% versus 89%, P < .0001; 2016: 65% versus 88%, P < .0001); identifying challenges to health care that affect low-income patients (2015: 74% versus 90%, P < .0023); describing community resources (2015: 29% versus 67%, P < .0001; 2016: 29% versus 50%, P < .0001); and referring patients to local community resources (2015: 25% versus 64%, P < .0001; 2016: 36% versus 52%, P < .0001). Interns reported that this experience improved their understanding of patients' background and local resources, and that they would change the way they practice. CONCLUSIONS A bus field trip guided by community partners is a feasible way to increase residents' perception of their understanding of local disparities and comfort in addressing SDOH.
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Affiliation(s)
- Aileen Y. Chang
- Corresponding author: Aileen Y. Chang, MD, MSPH, The George Washington University School of Medicine and Health Sciences, Department of Medicine, 2150 Pennsylvania Ave NW, Washington, DC 20037, 202.677.6562,
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Childhood Poverty and Its Effect on Health and Well-being: Enhancing Training for Learners Across the Medical Education Continuum. Acad Pediatr 2016; 16:S155-62. [PMID: 27044694 DOI: 10.1016/j.acap.2015.12.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/21/2015] [Accepted: 12/29/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Childhood poverty is unacceptably common in the US and threatens the health, development, and lifelong well-being of millions of children. Health care providers should be prepared through medical curricula to directly address the health harms of poverty. In this article, authors from The Child Poverty Education Subcommittee (CPES) of the Academic Pediatric Association Task Force on Child Poverty describe the development of the first such child poverty curriculum for teachers and learners across the medical education continuum. METHODS Educators, physicians, trainees, and public health professionals from 25 institutions across the United States and Canada were convened over a 2-year period and addressed 3 goals: 1) define the core competencies of child poverty education, 2) delineate the scope and aims of a child poverty curriculum, and 3) create a child poverty curriculum ready to implement in undergraduate and graduate medical education settings. RESULTS The CPES identified 4 core domains for the curriculum including the epidemiology of child poverty, poverty-related social determinants of health, pathophysiology of the health effects of poverty, and leadership and action to reduce and prevent poverty's health effects. Workgroups, focused on each domain, developed learning goals and objectives, built interactive learning modules to meet them, and created evaluation and faculty development materials to supplement the core curriculum. An editorial team with representatives from each workgroup coordinated activities and are preparing the final curriculum for national implementation. CONCLUSIONS This comprehensive, standardized child poverty curriculum developed by an international group of educators in pediatrics and experts in the health effects of poverty should prepare medical trainees to address child poverty and improve the health of poor children.
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Duffy FD, Miller-Cribbs JE, Clancy GP, Van De Wiele CJ, Teague TK, Crow S, Kollaja EA, Fox MD. Changing the culture of a medical school by orienting students and faculty toward community medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:1630-1635. [PMID: 25162616 DOI: 10.1097/acm.0000000000000463] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Oklahoma's health status has been ranked among the worst in the country. In 1972, the University of Oklahoma established the Tulsa branch of its College of Medicine (COM) to expand the physician workforce for northeastern Oklahoma and to provide care for the uninsured patients of the area. In 2008, the Tulsa branch launched a distinct educational track, the University of Oklahoma COM's School of Community Medicine (SCM), to prepare providers equipped and committed to addressing prevalent health disparities.The authors describe the Tulsa branch's Summer Institute (SI), a signature program of the SCM, and how it is part of SCM's process of institutional transformation to align its education, service, and research missions toward improving the health status of the entire region. The SI is a weeklong, prematriculation immersion experience in community medicine. It brings entering medical and physician assistant students together with students and faculty from other disciplines to develop a shared culture of community medicine. The SI uses an unconventional curriculum, based on Scharmer's Theory U, which emphasizes appreciative inquiry, critical thinking, and collaborative problem solving. Also, the curriculum includes Professional Meaning conversations, small-group sessions to facilitate the integration of students' observations into their professional identities and commitments. Development of prototypes of a better health care system enables participants to learn by doing and to bring community medicine to life.The authors describe these and other curricular elements of the SI, present early evaluation data, and discuss the curriculum's incremental evolution. A longitudinal outcomes evaluation is under way.
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Affiliation(s)
- F Daniel Duffy
- Dr. Duffy is Steven Landgarten Professor of Medical Leadership and former dean, University of Oklahoma College of Medicine, School of Community Medicine, Tulsa, Oklahoma. Dr. Miller-Cribbs is professor and director, Anne and Henry Zarrow School of Social Work, University of Oklahoma-Tulsa, Tulsa, Oklahoma. Dr. Clancy is president, University of Oklahoma-Tulsa, where he is professor of psychiatry. He holds the Morningside Chair in the University of Oklahoma College of Medicine's School of Community Medicine, Tulsa, Oklahoma. Dr. Van De Wiele is assistant professor, Department of Surgery and Integrative Immunology Center, University of Oklahoma College of Medicine, School of Community Medicine, Tulsa, Oklahoma. Dr. Teague is associate professor, Departments of Surgery and Psychiatry, James Carter Todd Chair of Cancer Research, and director, Integrative Immunology Center, University of Oklahoma College of Medicine, School of Community Medicine, Tulsa, Oklahoma. Dr. Crow holds the George Kaiser Family Foundation Chair in Medical Education. She is also assistant dean for curriculum and faculty affairs and is associate professor, Department of Pediatrics, University of Oklahoma College of Medicine, School of Community Medicine, Tulsa, Oklahoma. Ms. Kollaja is project manager and research assistant, University of Oklahoma College of Medicine, School of Community Medicine, Tulsa, Oklahoma. Dr. Fox, an associate professor of internal medicine and pediatrics, holds the Julian Rothbaum Chair in Community Health Research and is associate dean for community health and research development, University of Oklahoma College of Medicine, School of Community Medicine, Tulsa, Oklahoma
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