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Hallowell R, Saluja S, Lewis L, Novak DA, Valentine W, Batch E, Clayton Johnson MA, Bluthenthal RN, Cousineau MR, Ben-Ari R. Advocacy for Health Justice: An Innovative Pilot Course for MD and Master of Public Policy Students. Teach Learn Med 2024; 36:198-210. [PMID: 36519450 DOI: 10.1080/10401334.2022.2155169] [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] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 11/15/2022] [Indexed: 06/17/2023]
Abstract
Problem: U.S. medical schools are searching for ways to address issues of health justice in undergraduate medical education. Physicians have not typically received training in how to be effective advocates for systemic change and individuals in policy fields are not usually equipped to understand the complex issues of health science and their intersection with the health system and society. To address this gap, medical school faculty partnered with school of public policy faculty on a collaborative learning model that engaged MD and Master of Public Policy students together to strengthen their collective knowledge of the healthcare landscape, and to build skills to work for health justice. Intervention: We hypothesized that pairing medical students with public policy students to learn about the intersections of health justice and advocacy could enhance the efficacy of each group and provide a new model of collaboration between medical and policy professionals. The students collaborated on a health justice advocacy project through which they provided consultation to an established community organization. Context: The 8-week course took place in the spring of 2021 in Los Angeles, California. Due to Covid-19 the course was taught online and included asynchronous learning modules and live Zoom sessions. The project also served as a pilot for the post-clerkship phase of a new longitudinal health justice curriculum for MD students that launched in August 2021. Impact: Analysis of student work products, course evaluations, partner interviews, and student focus groups showed that students valued learning through their interdisciplinary collaborative work which gave them new perspectives on health justice issues. The community partners indicated that the students consultative work products were useful for their initiatives, and that they found working with MD and MPP students to be a valuable way to think about how to build stronger and more inclusive coalitions to advocate for health justice. This project has the potential for national impact as it aligns with the Association of American Medical Colleges' renewed focus on the responsibility of academic medicine to partner with communities for health justice. The project also contributed to the national conversation on how to align health systems science education with the aims of health justice through our participation in the American Medical Association Accelerating Change in Medical Education Consortium. Lessons Learned: Leveraging faculty relationships with community partners was crucial for developing meaningful projects for students. Cultivating and expanding community partner networks is necessary to sustain and scale up this type of intervention. Centering the needs of communities and supporting their on-going work for health justice is essential for becoming an effective advocate. Learning communities that bring interdisciplinary students, healthcare providers, policy professionals, and community partners together to learn from one another can create key opportunities for ameliorating health inequities.
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Affiliation(s)
- Ronan Hallowell
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sonali Saluja
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - LaVonna Lewis
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
| | - Daniel A Novak
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Eric Batch
- American Heart Association, Los Angeles, California, USA
| | | | - Ricky N Bluthenthal
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael R Cousineau
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ron Ben-Ari
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Ben-Ari R, Nash K, Elliott D. Keck School of Medicine of the University of Southern California. Acad Med 2020; 95:S42-S45. [PMID: 33626641 DOI: 10.1097/acm.0000000000003294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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Novak DA, Hallowell R, Ben-Ari R, Elliott D. A Continuum of Innovation: Curricular Renewal Strategies in Undergraduate Medical Education, 2010-2018. Acad Med 2019; 94:S79-S85. [PMID: 31365397 DOI: 10.1097/acm.0000000000002909] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Since 2010, medical schools across the United States have engaged in a new cycle of curricular revision and renewal for their undergraduate medical curricula. But what structures, features, and trends have emerged in U.S. medical schools as a result of deliberate curricular redesign efforts? An analysis of the ways that medical schools have approached the reorganization of their curricula to prepare their students for the growing complexity of medical practice is presented. METHOD This study drew a total pool of 40 U.S. MD-granting programs, of which 25 met the inclusion criteria for the study. The authors used a qualitative coding approach to materials from the undergraduate medical education (UME) program websites to identify 4 dimensions of strategies that these programs used to renew their curricula. RESULTS The analysis of the curricular maps and website content of the UME programs provided evidence for a continuum approach to the description of innovation strategies: 96% of schools employed a cohort-based linear pathway, 80% of schools used thematic basic science blocks, 47% placed their Step 1 exams outside of the second year, and 68% moved their clerkships to the second year. CONCLUSIONS The Continuum of Innovation strategies will enable programs to renew their curricula in ways that promote deliberate curricular changes that are consistent with emerging needs in the field. This study and future research may be useful for UME programs with limited resources by providing consensus practices that enable them to plan curricular changes in ways that best serve their institutions.
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Affiliation(s)
- Daniel A Novak
- D.A. Novak is assistant professor of clinical medical education, Department of Medical Education, Keck School of Medicine of the University of Southern California, Los Angeles, California. R. Hallowell is assistant professor of clinical medical education, Department of Medical Education, Keck School of Medicine of the University of Southern California, Los Angeles, California. R. Ben-Ari is associate professor of clinical medicine, associate dean for continuing medical education, and associate dean for curriculum, Keck School of Medicine of the University of Southern California, Los Angeles, California. D. Elliott is professor of clinical pediatrics and medical education, vice dean for medical education, and chair, Department of Medical Education, Keck School of Medicine of the University of Southern California, Los Angeles, California
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Affiliation(s)
- Daniel A London
- Orthopaedic surgery resident, Icahn School of Medicine at Mount Sinai, New York, New York. He was a medical student, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, when this project was undertaken; . Medical student, University of Colorado School of Medicine, Aurora, Colorado. Medical student, University of Texas Southwestern Medical School, Dallas, Texas. MD/PhD student, New York University School of Medicine, New York, New York. Vice chair for educational affairs, Department of Medicine, associate dean for continuing medical education and professional development, and assistant dean for curriculum, Keck School of Medicine of University of Southern California, Los Angeles, California. Associate professor of clinical pediatrics and family medicine, associate dean for curriculum, and director, Program in Medical Humanities, Arts, and Ethics, Keck School of Medicine of University of Southern California, Los Angeles, California
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Ben-Ari R, Robbins RJ, Pindiprolu S, Goldman A, Parsons PE. The costs of training internal medicine residents in the United States. Am J Med 2014; 127:1017-23. [PMID: 25063649 DOI: 10.1016/j.amjmed.2014.06.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 06/26/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Ron Ben-Ari
- Keck School of Medicine of the University of Southern California, Los Angeles.
| | - Richard J Robbins
- Department of Medicine, Houston Methodist Hospital, Houston, Tex; Weill Cornell Medical College, New York, NY
| | | | - Allan Goldman
- University of South Florida College of Medicine, Tampa
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Hochman ME, Asch S, Jibilian A, Chaudry B, Ben-Ari R, Hsieh E, Berumen M, Mokhtari S, Raad M, Hicks E, Sanford C, Aguirre N, Tseng CH, Vangala S, Mangione CM, Goldstein DA. Patient-centered medical home intervention at an internal medicine resident safety-net clinic. JAMA Intern Med 2013; 173:1694-701. [PMID: 24006034 PMCID: PMC4254756 DOI: 10.1001/jamainternmed.2013.9241] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The patient-centered medical home (PCMH) model holds promise for improving primary care delivery, but it has not been adequately tested in teaching settings. DESIGN, SETTING, AND PARTICIPANTS We implemented an intervention guided by PCMH principles at a safety-net teaching clinic with resident physician providers. Two similar clinics served as controls. MAIN OUTCOMES AND MEASURES Using a cross-sectional design, we measured the effect on patient and resident satisfaction using the Consumer Assessment of Healthcare Providers and Systems survey and a validated teaching clinic survey, respectively. Both surveys were conducted at baseline and 1 year after the intervention. We also measured the effect on emergency department and hospital utilization. RESULTS Following implementation of our intervention, the clinic’s score on the National Committee for Quality Assurance’s PCMH certification tool improved from 35 to 53 of 100 possible points, although our clinic did not achieve all must-pass elements to qualify as a PCMH. During the 1-year study period, 4676 patients were exposed to the intervention; 39.9% of these used at least 1 program component. Compared with baseline, patient-reported access and overall satisfaction improved to a greater extent in the intervention clinic, and the composite satisfaction rating increased from 48% to 65% in the intervention clinic vs from 50% to 59% in the control sites (P = .04). The improvements were particularly notable for questions relating to access. For example, satisfaction with urgent appointment scheduling increased from 12% to 53% in the intervention clinic vs from 14% to 18% in the control clinics (P < .001). Resident satisfaction also improved in the intervention clinic: the composite satisfaction score increased from 39% to 51% in the intervention clinic vs a decrease from 46% to 42% in the control clinics (P = .01). Emergency department utilization did not differ significantly between the intervention and control clinics, and hospitalizations increased from 26 to 27 visits per 1000 patients per month in the intervention clinic vs a decrease from 28 to 25 in the control clinics (P = .02). CONCLUSIONS AND RELEVANCE Our PCMH-guided intervention, which represented a modest but substantive step toward the PCMH vision, had favorable effects on patient and resident satisfaction at a safety-net teaching clinic but did not reduce emergency department or hospital utilization in the first year. Our experience may provide lessons for other teaching clinics in safety-net settings hoping to implement PCMH-guided reforms.
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Kreitenberg AJ, Quismorio FP, Hsieh EP, Ben-Ari R, Panush RS. Improving the Care of Patients With Rheumatic Diseases Who Have Cardiovascular Risk: Comment on the Article by Gossec et al. Arthritis Care Res (Hoboken) 2013; 65:1548-9. [DOI: 10.1002/acr.22002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Adam J. Kreitenberg
- Keck School of Medicine at University of Southern California; Los Angeles; CA
| | | | - Eric P. Hsieh
- Keck School of Medicine at University of Southern California; Los Angeles; CA
| | - Ron Ben-Ari
- Keck School of Medicine at University of Southern California; Los Angeles; CA
| | - Richard S. Panush
- Keck School of Medicine at University of Southern California; Los Angeles; CA
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Leifer ND, Johnson VS, Ben-Ari R, Gan H, Lehnes JM, Guo R, Lu W, Muffoletto BC, Reddy T, Stallworth PE, Greenbaum SG. Solid-State NMR Studies of Chemically Lithiated CF. J Electrochem Soc 2010; 157:A148-A154. [PMID: 20676233 PMCID: PMC2911803 DOI: 10.1149/1.3267042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Three types of fluorinated carbon, all in their original form and upon sequential chemical lithiations via n-butyllithium, were investigated by (13)C and (19)F solid-state NMR methods. The three starting CF(x) materials [where x = 1 (nominally)] were fiber based, graphite based, and petroleum coke based. The aim of the current study was to identify, at the atomic/molecular structural level, factors that might account for differences in electrochemical performance among the different kinds of CF(x). Differences were noted in the covalent F character among the starting compounds and in the details of LiF production among the lithiated samples.
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Affiliation(s)
- N. D. Leifer
- Department of Physics, Hunter College of The City University of New York, New York, New York 10065, USA
| | - V. S. Johnson
- Department of Physics, Hunter College of The City University of New York, New York, New York 10065, USA
| | - R. Ben-Ari
- Department of Physics, Hunter College of The City University of New York, New York, New York 10065, USA
| | - H. Gan
- Greatbatch, Incorporated, Clarence, New York 14031, USA
| | - J. M. Lehnes
- Greatbatch, Incorporated, Clarence, New York 14031, USA
| | - R. Guo
- Greatbatch, Incorporated, Clarence, New York 14031, USA
| | - W. Lu
- Greatbatch, Incorporated, Clarence, New York 14031, USA
| | | | - T. Reddy
- Department of Materials Science and Engineering, Rutgers University, New Brunswick, New Jersey 08854, USA
| | - P. E. Stallworth
- Department of Physics, Hunter College of The City University of New York, New York, New York 10065, USA
| | - S. G. Greenbaum
- Department of Physics, Hunter College of The City University of New York, New York, New York 10065, USA
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Beyar R, Ben-Ari R, Gibbons-Kroeker CA, Tyberg JV, Sideman S. Effect of interconnecting collagen fibres on left ventricular function and intramyocardial compression. Cardiovasc Res 1993; 27:2254-63. [PMID: 8313436 DOI: 10.1093/cvr/27.12.2254] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE The aim was to study the effects of the collagen mesh that interconnects the myocardial fibres on left ventricular mechanics and intramyocardial pressure. METHODS An earlier model which integrates a symmetrical left ventricular geometry and transmural muscle fibre structure with muscle fibre mechanics was expanded to include radial stiffness generated by dynamically stretched radial collagen fibres. The calculated end systolic pressure-volume relationship (ESPVR) was compared to left ventricular pressure and volume data from six open chest dogs, obtained over a wide load range. Midwall intramyocardial pressure measurements by flat intramyocardial transducer in six different dogs were also used. RESULTS Consistent with the experiments, inclusion of radial stiffness yielded an ESPVR that was more curvilinear than the collagen-free model, and modified global left ventricular function in that the end systolic volume increased. A diastolic suction effect, manifested by a negative pressure with a steep diastolic pressure-volume relationship at low end systolic volumes, was predicted. The intramyocardial pressure was higher than the left ventricular pressure at the end of isovolumetric relaxation, when radial stretch is maximal and fibre stresses are relaxed. This is attributed to the radial fibre stress component. Intramyocardial pressure was only weakly dependent on left ventricular cavity pressure under wide load manipulations at constant contractility. The experiments also confirmed model predictions that (1) peak intramyocardial pressure is insensitive to load, (2) intramyocardial pressure is markedly higher than left ventricular pressure at the end of isovolumetric relaxation, and (3) intramyocardial pressure continues to rise during ejection towards a maximum value near end ejection. CONCLUSIONS The transverse radial stiffness due to radial collagen interconnections between myocardial fibrils affects the global systolic left ventricular function, the diastolic suction effect, and the mechanism of systolic coronary compression.
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Affiliation(s)
- R Beyar
- Julius Silver Institute, Department of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa
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