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Stain SC, Ellison EC, Farmer DL, Flynn TC, Freischlag JA, Matthews JB, Newman RW, Chen X, Stefanidis D, Britt LD, Buyske J, Fisher K, Sachdeva AK, Turner PL. The Blue Ribbon Committee II Report and Recommendations on Surgical Education and Training in the United States: 2024. Ann Surg 2024; 280:535-546. [PMID: 38814074 PMCID: PMC11379355 DOI: 10.1097/sla.0000000000006360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVE An expert panel made recommendations to optimize surgical education and training based on the effects of contemporary challenges. BACKGROUND The inaugural Blue Ribbon Committee (BRC I) proposed sweeping recommendations for surgical education and training in 2004. In light of those findings, a second BRC (BRC II) was convened to make recommendations to optimize surgical training considering the current landscape in medical education. METHODS BRC II was a panel of 67 experts selected on the basis of experience and leadership in surgical education and training. It was organized into subcommittees which met virtually over the course of a year. They developed recommendations, along with the Steering Committee, based on areas of focus and then presented them to the entire BRC II. The Delphi method was chosen to obtain consensus, defined as ≥80% agreement among the panel. Cronbach α was computed to assess the internal consistency of 3 Delphi rounds. RESULTS Of the 50 recommendations, 31 obtained consensus in the following aspects of surgical training (# of consensus recommendation/# of proposed): Workforce (1/5); Medical Student Education (3/8); Work Life Integration (4/6); Resident Education (5/7); Goals, Structure, and Financing of Training (5/8); Education Support and Faculty Development (5/6); Research Training (7/9); and Educational Technology and Assessment (1/1). The internal consistency was good in Rounds 1 and 2 and acceptable in Round 3. CONCLUSIONS BRC II used the Delphi approach to identify and recommend 31 priorities for surgical education in 2024. We advise establishing a multidisciplinary surgical educational group to oversee, monitor, and facilitate implementation of these recommendations.
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Affiliation(s)
| | | | - Diana L Farmer
- The University of California Davis Health System, Sacramento, CA
| | | | | | | | | | - Xiaodong Chen
- The Ohio State University College of Medicine, Columbus, OH
| | | | - L D Britt
- Eastern Virginia Medical School, Norfolk, VA
| | - Jo Buyske
- American Board of Surgery, Philadelphia, PA
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Carter TM, Weaver ML, Gilbert E, Smith BK, Perez N. Health Disparities Curricula in General Surgery Residency Programs: A Critical Scoping Review. J Surg Res 2024; 301:180-190. [PMID: 38941714 DOI: 10.1016/j.jss.2024.05.039] [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: 03/01/2024] [Revised: 05/14/2024] [Accepted: 05/18/2024] [Indexed: 06/30/2024]
Abstract
INTRODUCTION In 2021, the structural determinants of health (SDOH) were added to the Accreditation Council of Graduate Medical Education common program requirements for all accredited residency programs, including general surgery. In this study, we sought to explore the current scope of, and concepts used in, health disparities curricula for general surgery residents, specifically investigating how general surgery residents learn about health disparities and the SDOH. METHODS We searched PubMed, EMBASE, Education Research Complete (EBSCOhost), and Web of Science Core Collection using keywords related to health disparities and the SDOH. Inclusion criteria consisted of all studies published after 2005 that discussed health disparities curricula for Accreditation Council of Graduate Medical Education-accredited general surgery residency programs. Five thousand three hundred seventeen articles were screened using a two-phase process. Data extraction and analysis was performed using critical review methods. RESULTS Seventeen articles were identified. Within these articles, seven unique health disparities curricula were found. All seven of the identified curricula employed cultural frameworks as methods to mitigate health disparities. Three curricula, all published after 2011, included education on the SDOH. A wide variety of educational methods were utilized; in-person didactics was the most common. CONCLUSIONS In the current literature, culture continues to play a large role in health disparities training for general surgery residents. Though further efforts are needed to understand the methods used in programs that have not published scholarly work, it is imperative to ensure that residents are provided with the sociopolitical perspective needed to understand the SDOH and serve all patients, including those affected by health disparities.
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Affiliation(s)
- Taylor M Carter
- Office of Surgical Education, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah; Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - M Libby Weaver
- Division of Vascular and Endovascular Surgery, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Emily Gilbert
- Information Services & Research Department, Library of the Health Sciences, University of Illinois Chicago, Chicago, Illinois
| | - Brigitte K Smith
- Division of Vascular Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Nicole Perez
- Department of Medical Education, University of Illinois - Chicago, Chicago, Illinois
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Mukhopadhyay B, Thambinathan V, Kinsella EA. Towards anti-racist futures: a scoping review exploring educational interventions that address systemic racism in post graduate medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10343-1. [PMID: 38874647 DOI: 10.1007/s10459-024-10343-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/19/2024] [Indexed: 06/15/2024]
Abstract
Since 2020, brought to the forefront by movements such as Black Lives Matter and Idle No More, it has been widely acknowledged that systemic racism contributes to racially differentiated health outcomes. Health professional educators have been called to address such disparities within healthcare, policy, and practice. To tackle structural racism within healthcare, one avenue that has emerged is the creation of medical education interventions within postgraduate residency medical programming. The objective of this scoping review is to examine the current literature on anti-racist educational interventions, that integrate a systemic or structural view of racism, within postgraduate medical education. Through the identification and analysis of 23 papers, this review identified three major components of interest across medical interventions, including (a) conceptualization, (b) pedagogical issues, and (c) outcomes & evaluation. There were overlapping points of discussion and analysis within each of these components. Conceptualization addressed how researchers conceptualized racism in different ways, the range of curricular content educators chose to challenge racism, and the absence of community's role in curricular development. Pedagogical issues addressed knowledge vs. skills-based teaching, and tensions between one-time workshops and integrative curriculum. Outcomes and evaluation highlighted self-reported Likert scales as dominant types of evaluation, self-evaluation in educational interventions, and misalignments between intervention outcomes and learning objectives. The findings are unique in their in-depth exploration of anti-racist medical interventions within postgraduate medical education programming, specifically in relation to efforts to address systemic and structural racism. The findings contribute a meaningful review of the current state of the field of medical education and generate new conversations about future possibilities for a broader anti-racist health professions curriculum.
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Affiliation(s)
- Baijayanta Mukhopadhyay
- Office of Social Accountability and Community Engagement, Faculty of Medicine and Health Sciences, Institute of Health Sciences Education, McGill University, Montreal, QC, Canada.
| | - Vivetha Thambinathan
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
| | - Elizabeth Anne Kinsella
- Department of Equity, Ethics and Policy, Faculty of Medicine and Health Sciences, Institute of Health Sciences Education, McGill University, Montreal, QC, Canada
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Mora R, Maze M. The role of cultural competency training to address health disparities in surgical settings. Br Med Bull 2024; 150:42-59. [PMID: 38465857 DOI: 10.1093/bmb/ldae005] [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] [Accepted: 02/16/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Disparities in health care delivered to marginalized groups are unjust and result in poor health outcomes that increase the cost of care for everyone. These disparities are largely avoidable and health care providers, have been targeted with education and specialised training to address these disparities. SOURCES OF DATA In this manuscript we have sought out both peer-reviewed material on Pubmed, as well as policy statements on the potential role of cultural competency training (CCT) for providers in the surgical care setting. The goal of undertaking this work was to determine whether there is evidence that these endeavours are effective at reducing disparities. AREAS OF AGREEMENT The unjustness of health care disparities is universally accepted. AREAS OF CONTROVERSY Whether the outcome of CCT justifies the cost has not been effectively answered. GROWING POINTS These include the structure/content of the CCT and whether the training should be delivered to teams in the surgical setting. AREAS TIMELY FOR DEVELOPING RESEARCH Because health outcomes are affected by many different inputs, should the effectiveness of CCT be improvement in health outcomes or should we use a proxy or a surrogate of health outcomes.
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Affiliation(s)
- Roberto Mora
- Department of Anesthesia and Perioperative Care, University of California, 1001 Potrero Avenue, San Francisco, CA 94110, USA
| | - Mervyn Maze
- Department of Anesthesia and Perioperative Care, University of California, 1001 Potrero Avenue, San Francisco, CA 94110, USA
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Pressimone C, Indralingam R, Metz CD, Levine AS. The Patient-Physician Relationship: Medical Students' Perceptions in a Novel Course. J Gen Intern Med 2024; 39:1492-1495. [PMID: 38600399 PMCID: PMC11169161 DOI: 10.1007/s11606-024-08759-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024]
Abstract
The patient-physician relationship, especially in the case of severely ill patients, is often fraught with anxiety, grief, and guilt in the physician who may come to feel that he or she has failed the patient and thereby becomes a "second victim." This notion was first explored in a 1973 publication (Artiss and Levine N Engl J Med 288(23):1210-4, 1973) that described a novel interactive seminar series for oncology fellows that had been designed to address and possibly remedy the frequent disquiet experienced by young physicians in this setting. Fifty years later, the medical student co-authors of this Perspective enrolled in an elective course that comprised a similar series of interactive seminars, now addressing the contemporary patient-physician relationship. The earlier paper was employed as a historical background, and the framework of the course then broadened such that the students considered the current environmental changes in medical practice (social, cultural, financial, legal, policy) that may be linked to the character of individual patient-physician relationships. This essay reports on the students' perception of such relationships, and on the environmental elements that may be helpful or harmful to the well-being of both patients and physicians.
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Affiliation(s)
| | | | | | - Arthur S Levine
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Thompson CM, Bishop MJ, Dillard TC, Maurice JM, Rollins DD, Pulido MD, Salas MJ, Mendelson EA, Yan J, Gerlikovski ER, Benevento SV, Zeinstra C, Kesavadas T. Healing Health Care Disparities: Development and Pilot Testing of a Virtual Reality Implicit Bias Training Module for Physicians in the Context of Black Maternal Health. HEALTH COMMUNICATION 2024:1-12. [PMID: 38711251 DOI: 10.1080/10410236.2024.2347000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Grounded in communication models of cultural competence, this study reports on the development and testing of the first module in a larger virtual reality (VR) implicit bias training for physicians to help them better: (a) recognize implicit bias and its effects on communication, patients, and patient care; (b) identify their own implicit biases and exercise strategies for managing them; and (c) learn and practice communicating with BIPOC patients in a culture-centered manner that demonstrates respect and builds trust. Led by communication faculty, a large, interdisciplinary team of researchers, clinicians, and engineers developed the first module tested herein focused on training goal (a). Within the module, participants observe five scenes between patient Marilyn Hayes (a Black woman) and Dr. Richard Flynn (her obstetrician, a White man) during a postpartum visit. The interaction contains examples of implicit bias, and participants are asked to both identify and consider how implicit bias impacts communication, the patient, and patient care. The team recruited 30 medical students and resident physicians to participate in a lab-based study that included a pretest, a training experience of the module using a head-mounted VR display, and a posttest. Following the training, participants reported improved attitudes toward implicit bias instruction, greater importance of determining patients' beliefs and perspectives for history-taking, treatment, and providing quality health care; and greater communication efficacy. Participants' agreement with the importance of assessing patients' perspectives, opinions, and psychosocial and cultural contexts did not significantly change. Implications for medical education about cultural competency and implicit bias are discussed.
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Affiliation(s)
- Charee M Thompson
- Department of Communication, University of Illinois Urbana-Champaign
| | - Mardia J Bishop
- Department of Communication, University of Illinois Urbana-Champaign
| | | | - Joseph M Maurice
- Department of Obstetrics & Gynecology, Creighton University School of Medicine
| | - Déjà D Rollins
- Department of Communication, University of Illinois Urbana-Champaign
| | - Manuel D Pulido
- Department of Communication Studies, California State University, Long Beach
| | - M J Salas
- School of Communication and Information, Rutgers University
| | - Emily A Mendelson
- Department of Communication, University of Illinois Urbana-Champaign
| | - Jia Yan
- Department of Communication, University of Illinois Urbana-Champaign
| | | | - Sarah V Benevento
- Department of Communication, University of Illinois Urbana-Champaign
| | | | - Thenkurussi Kesavadas
- Division of Research and Economic Development, University at Albany, The State University of New York
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O'Donnell EP, Arif SA. Validating identities: The pharmacist's role in providing affirming care and services to sexual and gender minority patients. Am J Health Syst Pharm 2024; 81:334-339. [PMID: 38156465 DOI: 10.1093/ajhp/zxad321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Indexed: 12/30/2023] Open
Affiliation(s)
| | - Sally A Arif
- Department of Pharmacy Practice, Midwestern University College of Pharmacy, Downers Grove, IL, USA
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Speer JE, Conley Q. Examining the pedagogical practices that support cultural proficiency development in graduate health science students. BMC MEDICAL EDUCATION 2024; 24:130. [PMID: 38336750 PMCID: PMC10858479 DOI: 10.1186/s12909-024-05097-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/24/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Health disparities are often a function of systemic discrimination and healthcare providers' biases. In recognition of this, health science programs have begun to offer training to foster cultural proficiency (CP) in future professionals. However, there is not yet consensus about the best ways to integrate CP into didactic and clinical education, and little is known about the role of clinical rotations in fostering CP. METHODS Here, a mixed-methods approach was used to survey students (n = 131) from a private all-graduate level osteopathic health sciences university to gain insight into the training approaches students encountered related to CP and how these may vary as a function of academic progression. The research survey included instruments designed to quantify students' implicit associations, beliefs, and experiences related to the CP training they encountered through the use of validated instruments, including Implicit Association Tests and the Ethnocultural Empathy Inventory, and custom-designed questions. RESULTS The data revealed that most students (73%) had received CP training during graduate school which primarily occurred via discussions, lectures, and readings; however, the duration and students' perception of the training varied substantially (e.g., training range = 1-100 hours). In addition, while students largely indicated that they valued CP and sought to provide empathetic care to their patients, they also expressed personal understandings of CP that often fell short of advocacy and addressing personal and societal biases. The results further suggested that clinical rotations may help students attenuate implicit biases but did not appear to be synergistic with pre-clinical courses in fostering other CP knowledge, skills, and attitudes. CONCLUSIONS These findings highlight the need to utilize evidence-based pedagogical practices to design intentional, integrated, and holistic CP training throughout health science programs that employ an intersectional lens and empowers learners to serve as advocates for their patients and address systemic challenges.
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Affiliation(s)
- Julie E Speer
- Teaching & Learning Center, A.T. Still University, 5835 E. Still Circle, Mesa, AZ, 85206, USA.
| | - Quincy Conley
- Teaching & Learning Center, A.T. Still University, 5835 E. Still Circle, Mesa, AZ, 85206, USA
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Roper KL, South AM, Palmer S, Johnson J, Sims L, Hustedde C, Mangino AA. Evaluation of a Novel Equity-Focused Curriculum for Early-Stage Medical Students. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241230755. [PMID: 38361770 PMCID: PMC10868471 DOI: 10.1177/23821205241230755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/10/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVES Medical school curricula have increasingly incorporated topics and content related to health equity and affiliated social determinants of health. However, there is limited literature to guide how programs might measure the success of these initiatives. Previous studies assessed medical student attitudes and perceived knowledge, preparedness, and skills. Based on self-reported measures of these attributes, we compared within-group and between-group differences at the onset of a novel equity-focused curriculum implementation. METHODS A multi-component approach to "thread" lectures, panel discussions, and other content dedicated to health equity concepts was assessed using adapted versions of two validated survey instruments of the measured constructs. Baseline data were collected prior to coursework and at follow-up early in students' second year assessed change attributable to the equity-focused curriculum thread, with additional comparison to a cohort of second-year students who had no exposure to the curriculum. Data were collected at the beginning of academic years 2021-2022 and 2022-2023. RESULTS The multivariate analysis of variance indicated significant change over time (p < 0.001) with the analyses of variance identifying students' perceived current skills and topic knowledge increasing over time. No significant differences were found between two separate groups of M2 students. CONCLUSIONS Students' perceived skills at working with diverse patient populations and knowledge of topics focused on health equity increased across the study, despite a much smaller response rate for the same student cohort at follow-up. Students' perception that they are prepared to care for patients of diverse backgrounds was unaffected. Attitudinal assessment revealed a ceiling effect at baseline, which should be explored further with longitudinal assessment. For the ongoing effort to evaluate the success of equity-focused curricula and programs, this study contributes evidence of change on some but not all outcomes, and can help guide other programs in determining which outcomes best reflect areas of programmatic need and impact.
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Affiliation(s)
- Karen L. Roper
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Anna-Maria South
- Department of Internal Medicine, Division of Hospital Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Skyler Palmer
- University of Kentucky College of Medicine, Lexington, KY, USA
| | - Julia Johnson
- University of Kentucky College of Medicine, Lexington, KY, USA
| | - Lillian Sims
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Carol Hustedde
- Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Anthony A. Mangino
- Department of Biostatistics, University of Kentucky College of Public Health, Lexington, KY, USA
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Paetow G, Scott N, Panning A, Hopkins J, Aden M, Hart D. Culinary cultural immersion: A qualitative analysis of resident knowledge, attitudes, and behavioral changes following a brief Somali cultural immersion experience. AEM EDUCATION AND TRAINING 2023; 7:e10844. [PMID: 36733981 PMCID: PMC9883562 DOI: 10.1002/aet2.10844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 06/18/2023]
Abstract
Background Teaching cultural humility is required by the Accreditation Council for Graduate Medical Education and can improve patient satisfaction and health care outcomes. Because one-third of the 150,000 Somali immigrants and refugees in the United States live in Minnesota, we aimed to determine whether a brief cultural immersion experience, where small groups of residents share a meal with Somali interpreters at a Somali restaurant, would affect resident knowledge, attitudes, and behaviors when caring for Somali patients in a Minnesota emergency department. Methods From October 2017 to September 2018, emergency medicine residents were invited to dinners held outside of regular clinical/academic hours. Dinners took place at a Somali restaurant and were facilitated by a Somali interpreter and a faculty physician. While they were designed as learner-driven sessions, facilitators were encouraged to discuss specific themes. In addition to an evaluation survey, participants underwent semistructured interviews after the experiences, and a qualitative analysis of derived themes is reported. Results Six dinners were hosted for a total of 20 residents, with 17 (85%) completing the evaluation survey and interview. Residents strongly agreed that this experience was worth their time and would recommend the program. Residents reported an increase in their knowledge of Somali culture, health care paradigms, and diet. Behavioral changes were described, including how residents greet patients, tailor clinical visits to patient expectations, and use interpreters as cultural brokers. Attitudinal changes were reported to a lesser degree but included an increased acceptance of cultural differences and an increased sense of connectedness to this population. Finally, residents reported that the benefits of this program were due to the authenticity of the experience, the informal small-group setting, and their sense of being in the minority during the dinners. Conclusions A brief immersion experience at a Somali restaurant was sufficient to result in increased knowledge, attitudinal, and behavioral changes when caring for Somali patients.
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Affiliation(s)
- Glenn Paetow
- Emergency MedicineHennepin HealthcareMinneapolisMinnesotaUSA
| | - Nate Scott
- Emergency MedicineHennepin HealthcareMinneapolisMinnesotaUSA
| | - Ali Panning
- Emergency MedicineHennepin HealthcareMinneapolisMinnesotaUSA
| | - Jared Hopkins
- Emergency MedicineHennepin HealthcareMinneapolisMinnesotaUSA
| | - Muhiyadin Aden
- Interpreter ServicesHennepin HealthcareMinneapolisMinnesotaUSA
| | - Danielle Hart
- Emergency MedicineHennepin HealthcareMinneapolisMinnesotaUSA
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Gagliardi JP, Smith CM, Simmons KL, Tweedy DS. Racial Justice Beyond the Curriculum: Aligning Systems of Care With Anti-Racist Instruction in Graduate Medical Education. J Grad Med Educ 2022; 14:403-406. [PMID: 35991095 PMCID: PMC9380630 DOI: 10.4300/jgme-d-22-00056.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Jane P. Gagliardi
- Jane P. Gagliardi, MD, MHSc, is Associate Professor of Psychiatry and Behavioral Sciences, and Associate Professor of Medicine, Duke University School of Medicine
| | - Colin M. Smith
- Colin M. Smith, MD, is PGY-6 Chief Resident, Internal Medicine-Psychiatry, Duke University Medical Center
| | - Kirsten L. Simmons
- Kirsten L. Simmons, MD, MHSc, is a PGY-1, Department of Ophthalmology, W.K. Kellogg Eye Center, University of Michigan
| | - Damon S. Tweedy
- Damon S. Tweedy, MD, is Associate Professor of Psychiatry and Behavioral Sciences, Duke University School of Medicine, and Staff Psychiatrist, Durham VA Health Care System
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