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Fanny SA, Tam RP, Rule A, Barnes A, Haq H. Transforming Pediatric Global Health Education Through Antiracist and Anticolonial Principles. Pediatrics 2024; 153:e2023062612. [PMID: 38173415 DOI: 10.1542/peds.2023-062612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
| | | | - Amy Rule
- Emory School of Medicine, Atlanta, Georgia
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Adelaide Barnes
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Heather Haq
- Baylor College of Medicine, Houston, Texas
- Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children's Hospital, Houston, Texas
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Stryker SD, Conway K, Kaeppler C, Porada K, Tam RP, Holmberg PJ, Schubert C. Underprepared: influences of U.S. medical students' self-assessed confidence in immigrant and refugee health care. Med Educ Online 2023; 28:2161117. [PMID: 36594616 PMCID: PMC9815430 DOI: 10.1080/10872981.2022.2161117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/19/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND United States (U.S.) census data from 2017 indicates that the percentage of persons born outside of the U.S. is increasing. However, no studies describe the amount of class time focused on immigrant and refugee health during medical school in the U.S. nor on incoming residents' confidence in providing culturally sensitive care. The objective of this study is to characterize final-year medical students' exposure to immigrant and refugee health and their confidence in caring for these populations. METHODS A voluntary, cross-sectional survey was sent electronically to fourth-year medical students at twelve U.S. medical schools in 2020, with 707 respondents (46% response rate). Questions addressed respondents' curricular exposure to immigrant and refugee health care during medical school and their confidence in providing culturally sensitive care. Chi-square tests were used to assess relationships between categorical variables, and odds ratios were calculated for dichotomized variables. RESULTS Most students (70.6%) described insufficient class time dedicated to culturally sensitive care, and many (64.5%) reported insufficient clinical exposure in caring for immigrants/refugees. The odds that incoming residents felt 'usually' or 'always' confident in their ability to provide culturally sensitive care to immigrants and refugees were higher in those with more class time on culturally sensitive care (OR 5.2 [3.6-7.4]), those with more clinical opportunities to care for immigrants and refugees (OR 7.2 [5.1-10.2]), and those who participated in a domestic low-resource or international elective (OR 1.4 [1.02-1.9]). More than half (55.3%) of respondents reported feeling 'not at all' or only 'sometimes' confident in their ability to provide culturally sensitive care to immigrants/refugees. CONCLUSIONS Most fourth-year U.S. medical students entering residency feel unprepared to deliver culturally sensitive care to immigrants and refugees. This may be mediated by increased exposure to didactic curricula class time and/or experiential clinical activities, as those factors are associated with improved student confidence.
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Affiliation(s)
- Shanna D. Stryker
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Katharine Conway
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, Dayton, Ohio, USA
| | - Caitlin Kaeppler
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin,USA
| | - Kelsey Porada
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin,USA
| | - Reena P. Tam
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Charles Schubert
- Department of Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Umphrey L, Paasi G, Windsor W, Abongo G, Evert J, Haq H, Keating EM, Lam SK, McHenry MS, Ndila C, Nwobu C, Rule A, Tam RP, Olson D, Olupot-Olupot P. Perceived roles, benefits and barriers of virtual global health partnership initiatives: a cross-sectional exploratory study. Glob Health Res Policy 2022; 7:11. [PMID: 35478077 PMCID: PMC9046069 DOI: 10.1186/s41256-022-00244-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/27/2022] [Indexed: 12/02/2022] Open
Abstract
Background Virtual global health partnership initiatives (VGHPIs) evolved rapidly during the COVID-19 pandemic to ensure partnership continuity. However the current landscape for VGHPI use and preference is unknown. This study aimed to increase understanding of GH partners’ perspectives on VGHPIs.
Methods From 15 October to 30 November 2020, An online, international survey was conducted using snowball sampling to document pandemic-related changes in partnership activities, preferences for VGHPIs, and perceived acceptability and barriers. The survey underwent iterative development within a diverse author group, representing academic and clinical institutions, and the non-profit sector. Participants from their professional global health networks were invited, including focal points for global health partnerships while excluding trainees and respondents from the European Economic Area. Analysis stratified responses by country income classification and partnership type. Authors used descriptive statistics to characterize responses, defining statistical significance as α = 0.05. Results A total of 128 respondents described 219 partnerships. 152/219 (69%) partnerships were transnational, 157/219 (72%) were of > 5 years duration, and 127/219 (60%) included bidirectional site visits. High-income country (HIC) partners sent significantly more learners to low- to middle-income country (LMIC) partner sites (p < 0.01). Participants commented on pandemic-related disruptions affecting 217/219 (99%) partnerships; 195/217 (90%) were disruption to activities; 122/217 (56%) to communication; 73/217 (34%) to access to professional support; and 72/217 (33%) to funding. Respondents indicated that VGHPIs would be important to 206/219 (94%) of their partnerships moving forward. There were overall differences in resource availability, technological capacity, and VGHPI preferences between LMIC and HIC respondents, with a statistically significant difference in VGHPI acceptability (p < 0.001). There was no significant difference between groups regarding VGHPIs’ perceived barriers. Conclusions The pandemic disrupted essential partnership elements, compounding differences between LMIC and HIC partners in their resources and preferences for partnership activities. VGHPIs have the potential to bridge new and existing gaps and maximize gains, bi-directionality, and equity in partnerships during and after COVID-19.
Supplementary Information The online version contains supplementary material available at 10.1186/s41256-022-00244-4.
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Affiliation(s)
- Lisa Umphrey
- Department of Pediatrics, University of Colorado School of Medicine, 13123 E 16th Ave, B302, Aurora, CO, 80045, USA. .,Center for Global Health, Colorado School of Public Health, 13199 E Montview Blvd, Ste 310, A090, Aurora, CO, 80045, USA.
| | - George Paasi
- Mbale Clinical Research Institute, Plot 29, 33 Pallisa, Mbale, Uganda
| | - William Windsor
- Center for Global Health, Colorado School of Public Health, 13199 E Montview Blvd, Ste 310, A090, Aurora, CO, 80045, USA
| | - Grace Abongo
- Mbale Clinical Research Institute, Plot 29, 33 Pallisa, Mbale, Uganda
| | - Jessica Evert
- Child Family Health International, 11135 San Pablo Ave #929, El Cerrito, CA, 94530, USA
| | - Heather Haq
- Department of Pediatrics, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
| | - Elizabeth M Keating
- Division of Pediatric Emergency Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Suet Kam Lam
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, EC-10 Cleveland Clinic, 9501 Euclid Ave, Cleveland, OH, 44195, USA
| | - Megan S McHenry
- Department of Pediatrics, Indiana University School of Medicine, 340 W 10th St, Indianapolis, IN, 46202, USA
| | - Carolyne Ndila
- Mbale Clinical Research Institute, Plot 29, 33 Pallisa, Mbale, Uganda
| | - Charles Nwobu
- Child Family Health International, 11135 San Pablo Ave #929, El Cerrito, CA, 94530, USA.,Child Family Health International, Accra, Ghana
| | - Amy Rule
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Reena P Tam
- Department of Pediatrics, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Daniel Olson
- Department of Pediatrics, University of Colorado School of Medicine, 13123 E 16th Ave, B302, Aurora, CO, 80045, USA.,Center for Global Health, Colorado School of Public Health, 13199 E Montview Blvd, Ste 310, A090, Aurora, CO, 80045, USA
| | - Peter Olupot-Olupot
- Mbale Clinical Research Institute, Plot 29, 33 Pallisa, Mbale, Uganda.,Busitema University, P.O. Box 1460, Mbale, Uganda
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Purtell R, Tam RP, Avondet E, Gradick K. We are part of the problem: the role of children's hospitals in addressing health inequity. Hosp Pract (1995) 2021; 49:445-455. [PMID: 35061953 DOI: 10.1080/21548331.2022.2032072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
Racism is an ongoing public health crisis that undermines health equity for all children in hospitals across our nation. The presence and impact of institutionalized racism contributes to health inequity and is under described in the medical literature. In this review, we focus on key interdependent areas to foster inclusion, diversity, and equity in Children's Hospitals, including 1) promotion of workforce diversity 2) provision of anti-racist, equitable hospital patient care, and 3) prioritization of academic scholarship focused on health equity research, quality improvement, medical education, and advocacy. We discuss the implications for clinical and academic practice.Plain Language Summary: Racism in Children's Hospitals harms children. We as health-care providers and hospital systems are part of the problem. We reviewed the literature for the best ways to foster inclusion, diversity, and equity in hospitals. Hospitals can be leaders in improving child health equity by supporting a more diverse workforce, providing anti-racist patient care, and prioritizing health equity scholarship.
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Affiliation(s)
- Rebecca Purtell
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Reena P Tam
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Erin Avondet
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Katie Gradick
- Assistant Professor of Pediatrics, Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Kaeppler C, Holmberg P, Tam RP, Porada K, Stryker SD, Conway K, Schubert C. The impact of global health opportunities on residency selection. BMC Med Educ 2021; 21:384. [PMID: 34266446 PMCID: PMC8280583 DOI: 10.1186/s12909-021-02795-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/11/2021] [Indexed: 06/11/2023]
Abstract
BACKGROUND An increasing number of medical trainees across specialties desire and expect Global Health (GH) experiences during training. It is useful for residency programs to know the impact that offering GH opportunities has on resident recruitment. The study objectives were to explore the importance of GH opportunities in residency selection among fourth-year medical students, examine the relationship between interest in GH and career plans, and describe students' perspectives on prior GH experiences. METHODS The authors administered an electronic survey to all fourth-year medical students attending 12 different US institutions in February 2020. Data from the ten schools who were able to comply with the survey distribution methodology and with response rates above 25% were analyzed using descriptive statistics and Pearson's correlation. RESULTS A total of 707 fourth-year medical students from the included schools completed the survey out of 1554 possible students (46% response rate). One third of respondents ranked the presence of GH experiences in residency as moderately or very important and 26% felt that the presence of a formal GH curriculum was at least moderately important, with variation noted among specialties. After training, 65% of students envision practicing internationally in some capacity. A desire to care for underserved patients in their careers was significantly correlated with an interest in GH experiences during residency. CONCLUSIONS The opportunity to be involved in GH experiences during training can be an important factor for many medical students when considering residency choice, and the availability of these opportunities may be a valuable recruitment tool. Students valuing GH opportunities during residency are more interested in working with underserved populations in their future careers.
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Affiliation(s)
- Caitlin Kaeppler
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
- Children's Wisconsin Corporate Center, 999 N 92nd St, Suite 560, Wauwatosa, WI, 53226, USA.
| | - Peter Holmberg
- Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
| | - Reena P Tam
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kelsey Porada
- Clinical Research Coordinator, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Shanna D Stryker
- Department of Family/Community Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kate Conway
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Charles Schubert
- Departments of Family/Community Medicine and Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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McHenry MS, Tam RP, Nafiseh AA, Etling MA, Barnes AE, Rule ARL, Crouse HL, Haq H, Morris LE, Murray BL, Umphrey LA, Keating EM. Global Health Partnerships During the COVID-19 Pandemic: Perspectives and Insights from International Partners. Am J Trop Med Hyg 2021; 105:407-412. [PMID: 34181576 PMCID: PMC8437201 DOI: 10.4269/ajtmh.21-0156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/26/2021] [Indexed: 11/23/2022] Open
Abstract
Global health partnerships (GHPs) have encountered many challenges during the coronavirus disease 2019 (COVID-19) pandemic. New perspectives and insights are needed to guide GHPs when navigating current and future collaborations. This study aimed to understand perspectives and insights of international partners regarding how the COVID-19 pandemic impacted their GHPs with institutions in the United States. We performed a cross-sectional qualitative study conducted through virtual semi-structured interviews performed between June 12, 2020 and July 22, 2020. We queried academic institutions based in the United States to refer individuals from their corresponding international GHP organizations. We invited these individuals to participate in virtual interviews that were audio-recorded and transcribed. We analyzed data qualitatively to identify themes. Eighty-four United States partners provided e-mail addresses for international partners. Ten individuals from these GHPs completed the interview. Participants reported overall positive experiences with their United States-based partners during the pandemic. The following themes emerged: imbalanced decision-making; worry about partnership continuity; opportunity to optimize communication within partnerships; interest in incorporating technology to facilitate engagement; and a desire for increased bilateral exchanges. Several challenges appeared to exist before COVID-19 and were highlighted by the pandemic. Most respondents were optimistic regarding the future of their GHPs. However, concerns were expressed regarding the implications of fewer in-person international experiences with United States trainees and the desire for stronger communication. Although our results do not represent the perspectives and insights of all GHPs, they provide considerations for the future. We urge institutions in the United States to re-examine and strive for equitable relationships with their international partners.
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Affiliation(s)
- Megan S McHenry
- Division of Pediatric Infectious Disease and Global Health and Director of Pediatric Global Health Education within the Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Reena P Tam
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Amira A Nafiseh
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Mary Ann Etling
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Adelaide E Barnes
- Section of Hospital Medicine and Associate Program Director of the Pediatrics Residency Program at The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amy R L Rule
- Divisions of Hospital Medicine and Perinatal Institute, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Heather L Crouse
- Department of Pediatrics at Baylor College of Medicine, Houston, Texas
| | - Heather Haq
- Department of Pediatrics at Baylor College of Medicine, Houston, Texas.,Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children's Hospital, Houston, Texas
| | - Lee E Morris
- Division of Pediatric Infectious Diseases and Immunology, Department of Pediatrics, Atrium Health Levine Children's Hospital, Charlotte, North Carolina
| | - Brittany L Murray
- Departments of Pediatrics and Emergency Medicine at Emory University School of Medicine, Atlanta, Georgia
| | - Lisa A Umphrey
- Center for Global Health, Colorado School of Public Health, Denver, Colorado
| | - Elizabeth M Keating
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah
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Spraker-Perlman HL, Tam RP, Bardsley T, Wilkes J, Farley L, Moore D, Sheetz J, Baker JN. The Impact of Pediatric Palliative Care Involvement in the Care of Critically Ill Patients without Complex Chronic Conditions. J Palliat Med 2019; 22:553-556. [DOI: 10.1089/jpm.2018.0469] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Holly L. Spraker-Perlman
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Reena P. Tam
- Division of Inpatient Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Tyler Bardsley
- Division of Epidemiology, University of Utah Study Design and Biostatistics Center, University of Utah School of Medicine, Salt Lake City, Utah
- Pediatric Specialty Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
| | - Jacob Wilkes
- Pediatric Specialty Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
| | - Leah Farley
- Department of Pediatrics, Beloit Health Systems, Beloit, Wisconsin
| | - Dominic Moore
- Division of Inpatient Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Joan Sheetz
- Division of Inpatient Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Justin N. Baker
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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