Predictors of Satisfying and Impactful Clinical Shadowing Experiences for Underrepresented Minority High School Students Interested in Healthcare Careers

INTRODUCTION

Diversity among healthcare professionals lags behind the increasing racial and ethnic diversity of the United States' population. Increasing diversity of the health professional workforce may be one strategy to influence healthcare disparities. This study sought to understand factors associated with highly satisfying and impactful clinical shadowing experiences among underrepresented minority (URM) students in a health professional development program for urban high school students.

METHODS

We analyzed data from students' summer clinical shadowing experiences in 2016 and 2017. We sought to determine if preceptor factors (e.g. racial and gender concordance with students), or patient related variables (e.g. racial concordance with students, the volume of patients per session) were associated with overall satisfaction with shadowing, the desire to pursue a similar career as their preceptor, and viewing their preceptor as a role model. After each shadowing experience, students completed evaluation forms. Chi-square tests were used for data analysis.

RESULTS

Over two summers, 65 high school juniors participated in an average of 14 half-day clinical shadowing sessions; 59 of these students identify as URMs. Among URM students, racial/ethnic concordance between preceptor and student was significantly associated with viewing the preceptor as a role model (p = 0.028). Witnessing a greater number of patient-provider encounters (≥five patients per session) was associated with higher satisfaction with the experience (p = 0.0002), and viewing the preceptor as a role model (p = 0.04).

CONCLUSION

To increase diversity of the healthcare workforce, URM students need high volume patient-provider encounters. Racial and/or ethnic concordance of URM students and preceptors may provide for preferable role models.

Cluster clinics for migrant Hispanic farmworkers with diabetes: perceptions, successes, and challenges

INTRODUCTION

Diabetes is a chronic disease that requires individuals to schedule multiple office visits with a multidisciplinary team to learn how to successfully manage and delay the progression of complications. To respond to the health-care and educational needs of Hispanic migrant farmworkers who travel to Minnesota and North Dakota, the Migrant Health Service Inc diabetes program coordinator implemented evening cluster clinics. The purpose of this research project was to describe Hispanic migrant farmworkers' perceptions of the services provided to them at 37 multidisciplinary cluster clinics designed to serve this rural population diagnosed with diabetes.

METHODS

This descriptive research employed a questionnaire and individual interviews. Both quantitative and qualitative data were obtained from cluster clinic clients. Quantitative data consisted of the numbers and percentages of clients providing various responses to questionnaire items. The qualitative data consisted of the verbal responses of clients to two open-ended questionnaire items and to an interview protocol.

RESULTS

The main findings of the project indicated that 75-88% of the clients rated the services provided at the 37 cluster clinics as 'excellent'; an additional 21-25% rated them as 'good.' More than 85% of the clients indicated either that 'nothing should be changed' (59%) or that 'everything was fine' (26%). These ratings and content analysis of the interview data revealed that the clients perceived they had received quality services at these cluster clinics. The authors also discuss six characteristics that they believed contributed to the successful delivery of health care and education through cluster clinics. These characteristics include: (1) provision of both direct and referral services for this underserved population; (2) comprehensive delivery of services in a single setting; (3) collaborative delivery of services; (4) access-driven delivery of services; (5) delivery of culturally-sensitive and linguistically-appropriate services; and (6) evidence-based service delivery.

CONCLUSIONS

Cluster clinics are an effective way to improve health-care services, education, and counseling for the under-served or unserved Hispanic migrant population diagnosed with diabetes. The authors conclude with four primary challenges to the implementation of these cluster clinics which include: (1) locating and preparing facilities; (2) recruiting health-care providers for the clinics; (3) achieving effective, appropriate communication with clients; and (4) securing funding.

Private investment in AIDS vaccine development: obstacles and solutions

The development of vaccines for the prevention of AIDS, malaria, tuberculosis, and other diseases requires both public and private investment. Private investment, however, has been far lower than might have been hoped, given the massive human toll of these diseases, particularly in the poorest countries. With a view to understanding this situation and exploring potential solutions, the World Bank AIDS Vaccine Task Force commissioned a study on the perspectives of the biotechnology, vaccine, and pharmaceutical industries regarding investment in research and development work on an AIDS vaccine. It was found that different obstacles to the development of an AIDS vaccine arose during the product development cycle. During the earlier phases, before obtaining proof of product, the principal barriers were scientific. The lack of consensus on which approach was likely to be effective increased uncertainty and the risks associated with investing in expensive clinical trials. The later phases, which involved adapting, testing, and scaling up production for different populations, were most influenced by market considerations. In order to raise the levels of private research and development in an AIDS vaccine there will probably have to be a combination of push strategies, which reduce the cost and scientific risk of investment, and pull strategies, which guarantee a market.

Sustainable introduction of affordable new vaccines: the targeting strategy

Immunization prevents over 3 million child deaths from vaccine preventable diseases such as diphtheria, pertussis, tetanus, measles and polio every year. New vaccines against respiratory and diarrhoeal diseases have the potential to prevent an additional 8 million deaths. Assuring that the existing and new vaccines are available to all children in the world is a global health priority. The health benefits of new vaccines like hepatitis B and Haemophilus influenzae type B (Hib) are indisputable. In the case of hepatitis B, over 1.2 millions deaths could be prevented each year if children and at risk adults were immunized with the hepatitis B vaccine. However, despite the clear health need and benefit, many countries have been unable to provide the 'new' vaccines, like hepatitis B vaccine, to their populations. For these countries, the limitation is not the delivery structure. Most countries now have immunization delivery structures which can provide immediate access to 80% of the country's newborns. Nor is it the vaccine availability as adequate capacity exists to meet the demand. The limitation has been the inability of governments to finance the vaccine because of a combination of factors including dependence on donors, donor policy, inadequate recognition by governments of the value of vaccines and, for some countries, the absolute price of the vaccines. The successes and failures in introducing a 'new' vaccine like hepatitis B vaccine into the world have clearly illustrated that it is economics and not epidemiology which dictates introduction of the vaccine into national immunization programmes. UNICEF and the WHO Global Programme for Vaccines and Immunization (GPV), have now developed and adopted a framework which differentiates countries based on their capacity to be financially self-sufficient for their vaccine needs. This framework forms the basis of strategies designed to co-ordinate the actions of governments, donors, agencies and vaccine manufacturers in order to ensure all countries have rapid access to affordable vaccines.

A systematic method for evaluating the potential viability of local vaccine producers

Vaccine production exists in > 55 countries, but many production facilities cannot assure a reliable supply of existing or new vaccines. By analysing the characteristics of successful producers, we have identified seven critical elements for viability, each defined by several indicators. Each indicated weakness implies an investment to correct it. Thirty-one manufacturers were assessed based on these viability indicators and the implied investment costs. Three general groupings were found. 'Viable' producers scored well in all seven categories. Those with a 'low probability' of viability are weak in all areas. Facilities regarded as 'potentially viable' may produce sufficient vaccine to meet national needs, but must develop appropriate structures to effectively manage change. This analysis provides a logical system for governments and donors to evaluate the potential effectiveness of further investment in local vaccine production.

A framework for the evaluation of vaccines for use in the expanded programme on immunization

Since 1974, the Expanded Programme on Immunization (EPI) has provided technical support for the immunization of the world's children and women of childbearing age. Today, the vast majority of vaccines administered to these groups are delivered through the immunization programmes that have been established in developing countries. As these national programmes share many characteristics, the global use of a new or improved vaccine could be largely dependent on its compatibility with the priorities, existing antigens and vaccine delivery system of this network. Consequently, a framework has been developed for the systematic evaluation of candidate vaccines for use in EPI.

The crisis in vaccine supply: a framework for action

Immunization programmes, having made significant progress in protecting over 80% of the world's children against six vaccine-preventable diseases, are now facing a crisis in funding for their vaccine supply. Contributing to this situation are changing donor priorities, rising prices, increased needs for vaccines. The Task Force on Situation Analysis for Vaccine Supply (TFSA) of the Children's Vaccine Initiative (CVI) has developed a framework which provides a logical division of countries into groups that might share similar vaccine supply systems. This framework provides a basis on which to analyse the needs and potential solutions for vaccine supply in countries based on their populations, national wealth, and current ability to produce vaccine. This framework has facilitated the development of strategies to strengthen national vaccine supply systems. It has also provided guidance for governments, donors and development agencies on the most appropriate actions for assuring the objective of sustainable vaccine supply.