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Evans DB, Mayer JB. Surgeon compensation in academic medicine. Surgery 2024; 175:1611-1618. [PMID: 38448278 DOI: 10.1016/j.surg.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 03/08/2024]
Abstract
Academic surgery is the best career one could ever aspire to have; however, given the long duration of training and the anticipated education debt, surgeon compensation has not kept pace with the compensation of other comparable careers. As surgeon compensation has experienced increased downward pressure, it has become of growing importance to those in academic medicine/surgery. Competitive compensation is necessary, even if not sufficient, for successful faculty recruitment and retention. The optimal compensation system should encourage the best possible patient care, inspire teamwork, maximize the department's or physician practice's ability to recruit and retain faculty, support all missions, and be viewed as equitable and transparent. The goal of an optimal compensation system is to have faculty minds focused on things other than compensation-those elements of their job that are most important, such as career development, multidisciplinary clinical programs, research, and education. One way to ensure that compensation stays in the background for academic surgeons is for leadership to keep this front and center. Compensation plans can influence behavior and time management and affect the clinical, academic, and educational contributions of surgeons and physicians of all specialties. As we strive to optimize the productivity and engagement of a health system's most valuable resource-those who deliver surgical care and create new knowledge-compensation is an important variable in need of constant attention.
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Affiliation(s)
- Douglas B Evans
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
| | - Jon B Mayer
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
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Brodell RT. JAAD Game Changer: Improved patient access and outcomes with the integration of an eConsult program (teledermatology) within a large academic medical center. J Am Acad Dermatol 2024; 90:1322. [PMID: 37742843 DOI: 10.1016/j.jaad.2023.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/19/2023] [Indexed: 09/26/2023]
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Rezaeiahari M, Brown CC, Schmit T, Tilford JM. Economic Report of General Inpatient Hospice in an Academic Medical Center. Am J Hosp Palliat Care 2024; 41:800-804. [PMID: 37772492 DOI: 10.1177/10499091231204971] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
This study examined if there was difference in cost of care after implementation of scattered bed inpatient hospice, first implemented in October 2021 in an Academic Medical Center in Arkansas. This retrospective, cross-sectional study compared the cost of care during the pre-implementation phase (n = 121, July 2020-March 2021) to patients admitted to hospice care (n = 84, October 2021-June 2022). Hospice length of stay (LOS) was 4 times longer than the LOS after a Do Not Resuscitate order (DNR) was placed for patients in the pre-implementation period. The end of life costs after the implementation of inpatient hospice was 69% less than the end of life costs in the pre-implementation period.
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Affiliation(s)
- Mandana Rezaeiahari
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Clare C Brown
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Troy Schmit
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J Mick Tilford
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Banister G, Goldman J, Jones DA, Looby SE. An Effective Academic Medical Center-Based Strategy to Enhance Diversity Among Nurse Researchers. J Nurs Adm 2024; 54:E18-E22. [PMID: 38648366 DOI: 10.1097/nna.0000000000001430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
The Connell-Jones Endowed Chair Diversity Nursing Research Scholars Program was created to promote engagement in nursing research and scholarship among nurses of color. Preliminary evaluation suggests that the program was widely beneficial, resulting in enrollment in doctoral education for some. Establishing opportunities that promote exposure and participation in nursing research and scholarship among nurses of color helps cultivate cohorts of diverse nurses armed to address health disparities through the advancement of nursing knowledge.
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Affiliation(s)
- Gaurdia Banister
- Author Affiliation: Senior Project Manager (Dr Banister), Nursing and Patient Care Services; Program Manager (Dr Goldman), The Institute for Patient Care; Director Emerita (Dr Jones), The Yvonne L. Munn Center for Nursing Research; and Nurse Researcher (Dr Looby), The Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston
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5
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Britez Ferrante E, Blady S, Sheu D, Maitra MR, Drakes J, Lieberman A, Mussell A, Bair EF, Hearn CM, Thorbecke L, Zhu J, Kohn R. Operationalizing Equity, Inclusion, and Access in Research Practice at a Large Academic Institution. J Gen Intern Med 2024; 39:1037-1047. [PMID: 38302812 DOI: 10.1007/s11606-023-08539-z] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/15/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Healthcare advances are hindered by underrepresentation in prospective research; sociodemographic, data, and measurement infidelity in retrospective research; and a paucity of guidelines surrounding equitable research practices. OBJECTIVE The Joint Research Practices Working Group was created in 2021 to develop and disseminate guidelines for the conduct of inclusive and equitable research. METHODS Volunteer faculty and staff from two research centers at the University of Pennsylvania initiated a multi-pronged approach to guideline development, including literature searches, center-level feedback, and mutual learning with local experts. RESULTS We developed guidelines for (1) participant payment and incentives; (2) language interpretation and translation; (3) plain language in research communications; (4) readability of study materials; and (5) inclusive language for scientific communications. Key recommendations include (1) offer cash payments and multiple payment options to participants when required actions are completed; (2) identify top languages of your target population, map points of contact, and determine available interpretation and translation resources; (3) assess reading levels of materials and simplify language, targeting 6th- to 8th-grade reading levels; (4) improve readability through text formatting and style, symbols, and visuals; and (5) use specific, humanizing terms as adjectives rather than nouns. CONCLUSIONS Diversity, inclusion, and access are critical values for research conduct that promotes justice and equity. These values can be operationalized through organizational commitment that combines bottom-up and top-down approaches and through partnerships across organizations that promote mutual learning and synergy. While our guidelines represent best practices at one time, we recognize that practices evolve and need to be evaluated continuously for accuracy and relevance. Our intention is to bring awareness to these critical topics and form a foundation for important conversations surrounding equitable and inclusive research practices.
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Affiliation(s)
- Emma Britez Ferrante
- Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, PA, USA
| | - Shira Blady
- Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, PA, USA
| | - Dorothy Sheu
- Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, PA, USA
| | - Medha Romee Maitra
- Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, PA, USA
- University of Georgia, Athens, GA, USA
| | - Josiah Drakes
- Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, PA, USA
- Xavier University of Louisiana, New Orleans, LA, USA
| | - Adina Lieberman
- Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, PA, USA
| | - Adam Mussell
- Center for Health Incentives and Behavioral Economics (CHIBE) at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth F Bair
- Center for Health Incentives and Behavioral Economics (CHIBE) at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Caleb M Hearn
- Center for Health Incentives and Behavioral Economics (CHIBE) at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Leo Thorbecke
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, USA
- Center for Digital Health, Penn Medicine Center for Health Care Innovation, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jingsan Zhu
- Center for Health Incentives and Behavioral Economics (CHIBE) at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel Kohn
- Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania, Philadelphia, PA, USA.
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Katz-Wise SL, Shah SN, Melvin P, Boskey ER, Grice AW, Kornetsky S, Young Poussaint T, Whitley MY, Stack AM, Emans SJ, Hoerner B, Horgan JJ, Ward VL. Establishing a Pediatric Health Equity, Diversity, and Inclusion Research Review Process. Pediatrics 2024; 153:e2023062946. [PMID: 38651252 DOI: 10.1542/peds.2023-062946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Accepted: 02/12/2024] [Indexed: 04/25/2024] Open
Abstract
Equity, diversity, and inclusion (EDI) research is increasing, and there is a need for a more standardized approach for methodological and ethical review of this research. A supplemental review process for EDI-related human subject research protocols was developed and implemented at a pediatric academic medical center (AMC). The goal was to ensure that current EDI research principles are consistently used and that the research aligns with the AMC's declaration on EDI. The EDI Research Review Committee, established in January 2022, reviewed EDI protocols and provided recommendations and requirements for addressing EDI-related components of research studies. To evaluate this review process, the number and type of research protocols were reviewed, and the types of recommendations given to research teams were examined. In total, 78 research protocols were referred for EDI review during the 20-month implementation period from departments and divisions across the AMC. Of these, 67 were given requirements or recommendations to improve the EDI-related aspects of the project, and 11 had already considered a health equity framework and implemented EDI principles. Requirements or recommendations made applied to 1 or more stages of the research process, including design, execution, analysis, and dissemination. An EDI review of human subject research protocols can provide an opportunity to constructively examine and provide feedback on EDI research to ensure that a standardized approach is used based on current literature and practice.
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Affiliation(s)
- Sabra L Katz-Wise
- Divisions of Adolescent/Young Adult Medicine
- Departments of Pediatrics
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion
- Office of Health Equity and Inclusion
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Snehal N Shah
- Departments of Pediatrics
- Accountable Care and Clinical Integration
- Office of Health Equity and Inclusion
- Clinical Research Compliance
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Patrice Melvin
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion
- Office of Health Equity and Inclusion
| | - Elizabeth R Boskey
- Gynecology/Department of Surgery
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | | | - Tina Young Poussaint
- Clinical Research Compliance
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Melicia Y Whitley
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion
| | - Anne M Stack
- Emergency Medicine
- Departments of Pediatrics
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - S Jean Emans
- Divisions of Adolescent/Young Adult Medicine
- Departments of Pediatrics
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Benjamin Hoerner
- Office of the General Counsel, Boston Children's Hospital, Boston, Massachusetts
| | - James J Horgan
- Office of the General Counsel, Boston Children's Hospital, Boston, Massachusetts
| | - Valerie L Ward
- Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion
- Office of Health Equity and Inclusion
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Holder K, Feinglass J, Niznik C, Yee LM. Use of Electronic Patient Messaging by Pregnant Patients Receiving Prenatal Care at an Academic Health System: Retrospective Cohort Study. JMIR Mhealth Uhealth 2024; 12:e51637. [PMID: 38686560 DOI: 10.2196/51637] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 05/02/2024] Open
Abstract
Background The COVID-19 pandemic accelerated telemedicine and mobile app use, potentially changing our historic model of maternity care. MyChart is a widely adopted mobile app used in health care settings specifically for its role in facilitating communication between health care providers and patients with its messaging function in a secure patient portal. However, previous studies analyzing portal use in obstetric populations have demonstrated significant sociodemographic disparities in portal enrollment and messaging, specifically showing that patients who have a low income and are non-Hispanic Black, Hispanic, and uninsured are less likely to use patient portals. Objective The study aimed to estimate changes in patient portal use and intensity in prenatal care before and during the pandemic period and to identify sociodemographic and clinical disparities that continued during the pandemic. Methods This retrospective cohort study used electronic medical record (EMR) and administrative data from our health system's Enterprise Data Warehouse. Records were obtained for the first pregnancy episode of all patients who received antenatal care at 8 academically affiliated practices and delivered at a large urban academic medical center from January 1, 2018, to July 22, 2021, in Chicago, Illinois. All patients were aged 18 years or older and attended ≥3 clinical encounters during pregnancy at the practices that used the EMR portal. Patients were categorized by the number of secure messages sent during pregnancy as nonusers or as infrequent (≤5 messages), moderate (6-14 messages), or frequent (≥15 messages) users. Monthly portal use and intensity rates were computed over 43 months from 2018 to 2021 before, during, and after the COVID-19 pandemic shutdown. A logistic regression model was estimated to identify patient sociodemographic and clinical subgroups with the highest portal nonuse. Results Among 12,380 patients, 2681 (21.7%) never used the portal, and 2680 (21.6%), 3754 (30.3%), and 3265 (26.4%) were infrequent, moderate, and frequent users, respectively. Portal use and intensity increased significantly over the study period, particularly after the pandemic. The number of nonusing patients decreased between 2018 and 2021, from 996 of 3522 (28.3%) in 2018 to only 227 of 1743 (13%) in the first 7 months of 2021. Conversely, the number of patients with 15 or more messages doubled, from 642 of 3522 (18.2%) in 2018 to 654 of 1743 (37.5%) in 2021. The youngest patients, non-Hispanic Black and Hispanic patients, and, particularly, non-English-speaking patients had significantly higher odds of continued nonuse. Patients with preexisting comorbidities, hypertensive disorders of pregnancy, diabetes, and a history of mental health conditions were all significantly associated with higher portal use and intensity. Conclusions Reducing disparities in messaging use will require outreach and assistance to low-use patient groups, including education addressing health literacy and encouraging appropriate and effective use of messaging.
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Affiliation(s)
- Kai Holder
- Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Joe Feinglass
- Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Charlotte Niznik
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern Medicine, Chicago, IL, United States
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern Medicine, Chicago, IL, United States
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Elias R, Sawatsky A, Ratelle J. Protected Time for Research Among Academic Hospitalists: a Qualitative Study of Hospitalist Group Leaders. J Gen Intern Med 2024; 39:723-730. [PMID: 37962727 PMCID: PMC11043272 DOI: 10.1007/s11606-023-08525-5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Protected time is an important determinant of scholarly success in academic hospital medicine but is a limited resource. OBJECTIVE To explore how hospitalists procure protected time for scholarship from the perspective of academic hospital medicine leaders. DESIGN Qualitative, thematic analysis of in-depth, semi-structured interviews. PARTICIPANTS Ten division leaders of academic hospital medicine groups in the USA (3 female, 7 male). APPROACH Thematic analysis, from a realist paradigm, of individually conducted interviews to explore how hospitalists obtain protected time with a focus from the leaders' perspectives on sources and strategies. Division leaders of groups known to have a reputation for regularly publishing peer-reviewed scholarship were purposively sampled and a snowball sampling technique was used to identify subsequent participants. Trustworthiness was verified by member-check with a subgroup of participants. KEY RESULTS Hospitalists wanting to pursue research must often start by utilizing personal time. Protected time from divisions is allocated to an individual, a project, or as administrative time. Sources of protected time are conceptualized as a hierarchy, beginning with personal time, and moving through divisional support, intramural support, and, principally for research track hospitalists, extramural support. Scaling the hierarchy is a process of demonstrating productivity and employing tactics to align projects with goals of the funders. Accessing the extramural funding tier is predicated on structured skills training, which is often acquired in early career and thus generally inaccessible to hospitalists not on a predetermined research track. CONCLUSIONS The prevailing paradigm for accessing protected time is one which encourages and rewards pursuing research work during non-work hours. As a hospitalist becomes more senior, the focus shifts from proving earnestness to becoming adept at navigating the institutional system as insiders.
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Affiliation(s)
- Richard Elias
- Division of Hospital Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Adam Sawatsky
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - John Ratelle
- Division of Hospital Medicine, Mayo Clinic, Rochester, MN, USA
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Nunna R, Tariq F, Ortiz M, Khan I, Genovese S, Santiago P. Cutting Edge Developments in Spine Surgery at the University of Missouri. Mo Med 2024; 121:142-148. [PMID: 38694605 PMCID: PMC11057865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
The treatment of spinal pathologies has evolved significantly from the times of Hippocrates and Galen to the current era. This evolution has led to the development of cutting-edge technologies to improve surgical techniques and patient outcomes. The University of Missouri Health System is a high-volume, tertiary care academic medical center that serves a large catchment area in central Missouri and beyond. The Department of Neurosurgery has sought to integrate the best available technologies to serve their spine patients. These technological advancements include intra-operative image guidance, robotic spine surgery, minimally invasive techniques, motion preservation surgery, and interdisciplinary care of metastatic disease to the spine. These advances have resulted in safer surgeries with enhanced outcomes at the University of Missouri. This integration of innovation demonstrates our tireless commitment to ensuring excellence in the comprehensive care of a diverse range of patients with complex spinal pathologies.
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Affiliation(s)
- Ravi Nunna
- Department of Neurosurgery, University of Missouri - Columbia, Columbia, Missouri
| | - Farzana Tariq
- Department of Neurosurgery, University of Missouri - Columbia, Columbia, Missouri
| | - Michael Ortiz
- Department of Neurosurgery, University of Missouri - Columbia, Columbia, Missouri
| | - Inamullah Khan
- Department of Neurosurgery, University of Missouri - Columbia, Columbia, Missouri
| | - Sabrina Genovese
- School of Medicine, University of Missouri - Columbia, Columbia, Missouri
| | - Paul Santiago
- Department of Neurosurgery, University of Missouri - Columbia, Columbia, Missouri
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Rutman SP, Borgen N, Spellen S, King DD, Decker MJ, Rand L, Cobbins A, Brindis CD. Addressing anti-black racism in an academic preterm birth initiative: perspectives from a mixed methods case study. BMC Public Health 2023; 23:2039. [PMID: 37853363 PMCID: PMC10585806 DOI: 10.1186/s12889-023-16812-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/21/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Growing recognition of racism perpetuated within academic institutions has given rise to anti-racism efforts in these settings. In June 2020, the university-based California Preterm Birth Initiative (PTBi) committed to an Anti-Racism Action Plan outlining an approach to address anti-Blackness. This case study assessed perspectives on PTBi's anti-racism efforts to support continued growth toward racial equity within the initiative. METHODS This mixed methods case study included an online survey with multiple choice and open-ended survey items (n = 27) and key informant interviews (n = 8) of leadership, faculty, staff, and trainees working within the initiative. Survey and interview questions focused on perspectives about individual and organizational anti-racism competencies, perceived areas of initiative success, and opportunities for improvement. Qualitative interview and survey data were coded and organized into common themes within assessment domains. RESULTS Most survey respondents reported they felt competent in all the assessed anti-racism skills, including foundational knowledge and responding to workplace racism. They also felt confident in PTBi's commitment to address anti-Blackness. Fewer respondents were clear on strategic plans, resources allocated, and how the anti-racism agenda was being implemented. Suggestions from both data sources included further operationalizing and communicating commitments, integrating an anti-racism lens across all activities, ensuring accountability including staffing and funding consistent with anti-racist approaches, persistence in hiring Black faculty, providing professional development and support for Black staff, and addressing unintentional interpersonal harms to Black individuals. CONCLUSIONS This case study contributes key lessons which move beyond individual-level and theoretical approaches towards transparency and accountability in academic institutions aiming to address anti-Black racism. Even with PTBi's strong commitment and efforts towards racial equity, these case study findings illustrate that actions must have sustained support by the broader institution and include leadership commitment, capacity-building via ongoing coaching and training, broad incorporation of anti-racism practices and procedures, continuous learning, and ongoing accountability for both short- and longer-term sustainable impact.
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Affiliation(s)
- Shira P Rutman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.
| | - Natasha Borgen
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Solaire Spellen
- Department of Obstetrics, Gynecology and Reproductive Sciences, California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, USA
| | - Dante D King
- Department of Obstetrics, Gynecology and Reproductive Sciences, California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, USA
| | - Martha J Decker
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Larry Rand
- Department of Obstetrics, Gynecology and Reproductive Sciences, California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, USA
| | - Alexis Cobbins
- Department of Obstetrics, Gynecology and Reproductive Sciences, California Preterm Birth Initiative, University of California, San Francisco, San Francisco, CA, USA
| | - Claire D Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
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Jagsi R, Griffith K, Krenz C, Jones RD, Cutter C, Feldman EL, Jacobson C, Kerr E, Paradis K, Singer K, Spector N, Stewart A, Telem D, Ubel P, Settles I. Workplace Harassment, Cyber Incivility, and Climate in Academic Medicine. JAMA 2023; 329:1848-1858. [PMID: 37278814 PMCID: PMC10245188 DOI: 10.1001/jama.2023.7232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/13/2023] [Indexed: 06/07/2023]
Abstract
Importance The culture of academic medicine may foster mistreatment that disproportionately affects individuals who have been marginalized within a given society (minoritized groups) and compromises workforce vitality. Existing research has been limited by a lack of comprehensive, validated measures, low response rates, and narrow samples as well as comparisons limited to the binary gender categories of male or female assigned at birth (cisgender). Objective To evaluate academic medical culture, faculty mental health, and their relationship. Design, Setting, and Participants A total of 830 faculty members in the US received National Institutes of Health career development awards from 2006-2009, remained in academia, and responded to a 2021 survey that had a response rate of 64%. Experiences were compared by gender, race and ethnicity (using the categories of Asian, underrepresented in medicine [defined as race and ethnicity other than Asian or non-Hispanic White], and White), and lesbian, gay, bisexual, transgender, queer (LGBTQ+) status. Multivariable models were used to explore associations between experiences of culture (climate, sexual harassment, and cyber incivility) with mental health. Exposures Minoritized identity based on gender, race and ethnicity, and LGBTQ+ status. Main Outcomes and Measures Three aspects of culture were measured as the primary outcomes: organizational climate, sexual harassment, and cyber incivility using previously developed instruments. The 5-item Mental Health Inventory (scored from 0 to 100 points with higher values indicating better mental health) was used to evaluate the secondary outcome of mental health. Results Of the 830 faculty members, there were 422 men, 385 women, 2 in nonbinary gender category, and 21 who did not identify gender; there were 169 Asian respondents, 66 respondents underrepresented in medicine, 572 White respondents, and 23 respondents who did not report their race and ethnicity; and there were 774 respondents who identified as cisgender and heterosexual, 31 as having LGBTQ+ status, and 25 who did not identify status. Women rated general climate (5-point scale) more negatively than men (mean, 3.68 [95% CI, 3.59-3.77] vs 3.96 [95% CI, 3.88-4.04], respectively, P < .001). Diversity climate ratings differed significantly by gender (mean, 3.72 [95% CI, 3.64-3.80] for women vs 4.16 [95% CI, 4.09-4.23] for men, P < .001) and by race and ethnicity (mean, 4.0 [95% CI, 3.88-4.12] for Asian respondents, 3.71 [95% CI, 3.50-3.92] for respondents underrepresented in medicine, and 3.96 [95% CI, 3.90-4.02] for White respondents, P = .04). Women were more likely than men to report experiencing gender harassment (sexist remarks and crude behaviors) (71.9% [95% CI, 67.1%-76.4%] vs 44.9% [95% CI, 40.1%-49.8%], respectively, P < .001). Respondents with LGBTQ+ status were more likely to report experiencing sexual harassment than cisgender and heterosexual respondents when using social media professionally (13.3% [95% CI, 1.7%-40.5%] vs 2.5% [95% CI, 1.2%-4.6%], respectively, P = .01). Each of the 3 aspects of culture and gender were significantly associated with the secondary outcome of mental health in the multivariable analysis. Conclusions and Relevance High rates of sexual harassment, cyber incivility, and negative organizational climate exist in academic medicine, disproportionately affecting minoritized groups and affecting mental health. Ongoing efforts to transform culture are necessary.
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Affiliation(s)
- Reshma Jagsi
- Medical School, University of Michigan, Ann Arbor
- Emory University, Atlanta, Georgia
| | | | - Chris Krenz
- Medical School, University of Michigan, Ann Arbor
| | | | | | | | | | - Eve Kerr
- Medical School, University of Michigan, Ann Arbor
| | | | | | - Nancy Spector
- College of Medicine, Drexel University, Philadelphia, Pennsylvania
| | - Abby Stewart
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
| | - Dana Telem
- Medical School, University of Michigan, Ann Arbor
| | - Peter Ubel
- School of Medicine, Duke University, Durham, North Carolina
| | - Isis Settles
- Department of Psychology, University of Michigan, Ann Arbor, Michigan
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12
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Affiliation(s)
- Lisa H Harris
- From the Departments of Obstetrics and Gynecology and Women's and Gender Studies, University of Michigan, Ann Arbor
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13
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Affiliation(s)
- Rahul Vanjani
- From the Division of General Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI (R.V.); the Department of Philosophy, University of North Carolina, Charlotte (A.P.); and the Department of Psychiatry, SUNY Health Science Center, New York (P.A.)
| | - Andrea Pitts
- From the Division of General Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI (R.V.); the Department of Philosophy, University of North Carolina, Charlotte (A.P.); and the Department of Psychiatry, SUNY Health Science Center, New York (P.A.)
| | - Pranav Aurora
- From the Division of General Internal Medicine, Warren Alpert Medical School, Brown University, Providence, RI (R.V.); the Department of Philosophy, University of North Carolina, Charlotte (A.P.); and the Department of Psychiatry, SUNY Health Science Center, New York (P.A.)
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14
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Safavi KC, Frendl D, Ellis D, Sisodia RC, Ricciardi R, McGovern FJ, Ferris TG, Thompson RW, Del Carmen MG. Hospital at Home for Surgical Patients: A Case Series From a Pioneer Program at a Large Academic Medical Center. Ann Surg 2022; 275:e275-e277. [PMID: 34914664 DOI: 10.1097/sla.0000000000005074] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kyan C Safavi
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
- Massachusetts General Physicians Organization, Boston, MA
| | - Daniel Frendl
- Massachusetts General Physicians Organization, Boston, MA
- Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Dan Ellis
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
- Massachusetts General Physicians Organization, Boston, MA
| | - Rachel Clark Sisodia
- Massachusetts General Physicians Organization, Boston, MA
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
| | - Rocco Ricciardi
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Timothy G Ferris
- Massachusetts General Physicians Organization, Boston, MA
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Ryan W Thompson
- Massachusetts General Physicians Organization, Boston, MA
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Marcela G Del Carmen
- Massachusetts General Physicians Organization, Boston, MA
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA
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15
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Warner MA, Schulte PJ, Hanson AC, Madde NR, Burt JM, Higgins AA, Andrijasevic NM, Kreuter JD, Jacob EK, Stubbs JR, Kor DJ. Implementation of a Comprehensive Patient Blood Management Program for Hospitalized Patients at a Large United States Medical Center. Mayo Clin Proc 2021; 96:2980-2990. [PMID: 34736775 PMCID: PMC8649051 DOI: 10.1016/j.mayocp.2021.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/08/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess changes in inpatient transfusion utilization and patient outcomes with implementation of a comprehensive patient blood management (PBM) program at a large US medical center. PATIENTS AND METHODS This is an observational study of graduated PBM implementation for hospitalized adults (age ≥18 years) from January 1, 2010, through December 31, 2017, at two integrated hospital campuses at a major academic US medical center. Allogeneic transfusion utilization and clinical outcomes were assessed over time through segmented regression with multivariable adjustment comparing observed outcomes against projected outcomes in the absence of PBM activities. RESULTS In total, 400,998 admissions were included. Total allogeneic transfusions per 1000 admissions decreased from 607 to 405 over the study time frame, corresponding to an absolute risk reduction for transfusion of 6.0% (95% confidence interval [CI]: 3.6%, 8.3%; P<.001) and a 22% (95% CI: 6%, 37%; P=.006) decrease in the rate of transfusions over projected. The risk of transfusion decreased for all blood components except cryoprecipitate. Transfusion reductions were experienced for all major surgery types except liver transplantation, which remained stable over time. Hospital length of stay (multiplicative increase in geometric mean 0.85 [95% CI: 0.81, 0.89]; P<.001) and incident in-hospital adverse events (absolute risk reduction: 1.5% [95% CI: 0.1%, 3.0%]; P=.04) were lower than projected at the end of the study time frame. CONCLUSION Patient blood management implementation for hospitalized patients in a large academic center was associated with substantial reductions in transfusion utilization and improved clinical outcomes. Broad-scale implementation of PBM in US hospitals is feasible without signal for patient harm.
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Affiliation(s)
- Matthew A Warner
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN; Patient Blood Management Program, Mayo Clinic, Rochester, MN.
| | - Phillip J Schulte
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Andrew C Hanson
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | - Jennifer M Burt
- Patient Blood Management Program, Mayo Clinic, Rochester, MN
| | | | - Nicole M Andrijasevic
- Anesthesia Clinical Research Unit, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Justin D Kreuter
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Eapen K Jacob
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - James R Stubbs
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Daryl J Kor
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN; Patient Blood Management Program, Mayo Clinic, Rochester, MN
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16
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Trout LJ, Weisman A, Miller JS, Kramer C, Keshavjee S, Kleinman AM, Kulkarni S, Baldwin T, Tobey ML, Buffey T, Harris NS. Siamit: A Novel Academic-Tribal Health Partnership in Northwest Alaska. Acad Med 2021; 96:1560-1563. [PMID: 34261866 DOI: 10.1097/acm.0000000000004239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PROBLEM American Indians and Alaska Natives hold a state-conferred right to health, yet significant health and health care disparities persist. Academic medical centers are resource-rich institutions committed to public service, yet few are engaged in responsive, equitable, and lasting tribal health partnerships to address these challenges. APPROACH Maniilaq Association, a rural and remote tribal health organization in Northwest Alaska, partnered with Massachusetts General Hospital and Harvard Medical School to address health care needs through physician staffing, training, and quality improvement initiatives. This partnership, called Siamit, falls under tribal governance, focuses on supporting community health leaders, addresses challenges shaped by extreme geographic remoteness, and advances the mission of academic medicine in the context of tribal health priorities. OUTCOMES Throughout the 2019-2020 academic year, Siamit augmented local physician staffing, mentored health professions trainees, provided continuing medical education courses, implemented quality improvement initiatives, and provided clinical care and operational support during the COVID-19 pandemic. Siamit began with a small budget and limited human resources, demonstrating that relatively small investments in academic-tribal health partnerships can support meaningful and positive outcomes. NEXT STEPS During the 2020-2021 academic year, the authors plan to expand Siamit's efforts with a broader social medicine curriculum, additional attending staff, more frequent trainee rotations, an increasingly robust mentorship network for Indigenous health professions trainees, and further study of the impact of these efforts. Such partnerships may be replicable in other settings and represent a significant opportunity to advance community health priorities, strengthen tribal health systems, support the next generation of Indigenous health leaders, and carry out the academic medicine mission of teaching, research, and service.
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Affiliation(s)
- Lucas J Trout
- L.J. Trout is managing partner, Siamit, Sayaqagvik director, Maniilaq Social Medicine, and lecturer on global health and social medicine, Harvard Medical School, Kotzebue, Alaska; ORCID: https://orcid.org/0000-0002-5074-6092
| | - Ashley Weisman
- A. Weisman is emergency medicine faculty, Siamit, and assistant professor of emergency medicine, Department of Surgery, University of Vermont Medical Center, Burlington, Vermont
| | - James S Miller
- J.S. Miller is internal medicine faculty, Siamit, and a fellow in global medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Corina Kramer
- C. Kramer is social medicine faculty and community director, Della Keats Fellowship in Indigenous Health Equity, Siamit, and lead Qargi facilitator, Maniilaq Social Medicine, Kotzebue, Alaska
| | - Salmaan Keshavjee
- S. Keshavjee is faculty advisor, Siamit, director, Harvard Medical School Center for Global Health Delivery, and professor of global health and social medicine, Harvard Medical School, Boston, Massachusetts
| | - Arthur M Kleinman
- A.M. Kleinman is faculty advisor, Siamit, Esther and Sidney Rabb Professor of Anthropology, Harvard University, professor of medical anthropology in global health and social medicine, and professor of psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Suchitra Kulkarni
- S. Kulkarni is senior program coordinator, Siamit and Harvard Medical School Center for Global Health Delivery, Boston, Massachusetts
| | - Teressa Baldwin
- T. Baldwin is Sayaqagvik youth counselor, Maniilaq Social Medicine, and a Della Keats Fellow in Indigenous Health Equity, Siamit, Kotzebue, Alaska
| | - Matthew L Tobey
- M.L. Tobey is rural medicine faculty, Siamit, and rural health leadership fellowship director, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Timothy Buffey
- T. Buffey is medical director, Department of Medicine, Maniilaq Health Services, Kotzebue, Alaska
| | - N Stuart Harris
- N.S. Harris is emergency medicine faculty, Siamit, associate professor of emergency medicine, Harvard Medical School, and chief, Division of Wilderness Medicine, Massachusetts General Hospital, Boston, Massachusetts
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17
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Wilkins CH, Williams M, Kaur K, DeBaun MR. Academic Medicine's Journey Toward Racial Equity Must Be Grounded in History: Recommendations for Becoming an Antiracist Academic Medical Center. Acad Med 2021; 96:1507-1512. [PMID: 34432719 PMCID: PMC8542070 DOI: 10.1097/acm.0000000000004374] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The harsh realities of racial inequities related to COVID-19 and civil unrest following police killings of unarmed Black men and women in the United States in 2020 heightened awareness of racial injustices around the world. Racism is deeply embedded in academic medicine, yet the nobility of medicine and nursing has helped health care professionals distance themselves from racism. Vanderbilt University Medical Center (VUMC), like many U.S. academic medical centers, affirmed its commitment to racial equity in summer 2020. A Racial Equity Task Force was charged with identifying barriers to achieving racial equity at the medical center and medical school and recommending key actions to rectify long-standing racial inequities. The task force, composed of students, staff, and faculty, produced more than 60 recommendations, and its work brought to light critical areas that need to be addressed in academic medicine broadly. To dismantle structural racism, academic medicine must: (1) confront medicine's racist past, which has embedded racial inequities in the U.S. health care system; (2) develop and require health care professionals to possess core competencies in the health impacts of structural racism; (3) recognize race as a sociocultural and political construct, and commit to debiologizing its use; (4) invest in benefits and resources for health care workers in lower-paid roles, in which racial and ethnic minorities are often overrepresented; and (5) commit to antiracism at all levels, including changing institutional policies, starting at the executive leadership level with a vision, metrics, and accountability.
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Affiliation(s)
- Consuelo H. Wilkins
- C.H. Wilkins is senior vice president and senior associate dean for health equity and inclusive excellence, Office of Health Equity, and professor of medicine, Division of Geriatric Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mamie Williams
- M. Williams is senior director of nurse diversity, equity, and inclusion, Nursing Administration, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Karampreet Kaur
- K. Kaur is a first-year resident, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. At the time of writing, the author was a fourth-year medical student, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Michael R. DeBaun
- M.R. DeBaun is professor of pediatrics and medicine, J.C. Peterson Endowed Chair in Pediatrics, Department of Pediatrics, and director, Vanderbilt-Meharry Sickle Cell Disease Center of Excellence, Vanderbilt University Medical Center, Nashville, Tennessee
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18
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Battaglia TA, Megrath K, Spencer N, Pamphile J, Crossno C, Maschke A, Bak S, O'Connor GT, Clark CR, Sarfaty S. Communicating to Engage: An Improvisational Theater-Based Communication Training Designed to Support Community-Academic Partnership Development. Acad Med 2021; 96:1564-1568. [PMID: 34406131 PMCID: PMC8551044 DOI: 10.1097/acm.0000000000004367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PROBLEM The potential for community-engaged research to address health inequity requires deliberate effort to create trusting and equitable community-academic partnerships. A lack of evidence-based opportunities for cultivating such partnerships remains a barrier. APPROACH In 2017 and 2018, the authors designed, facilitated, and evaluated a mixed stakeholder training, Communicating to Engage, at 2 urban academic medical centers involved in the All of Us research program, Boston Medical Center and Mass General Brigham. The goal was to bring together researchers and community members to develop communication skills through improvisational theater-based co-learning. The curriculum was inspired by several evidence-based learning frameworks including community-based participatory research principles and improvisational theater techniques. A self-administered survey completed before and after the training session measured participants' communication skills using the Self-Perceived Communication Competence Scale (SPCCS) and comfort with specific communication styles as outlined in the program's training objectives. Paired t tests were used to measure changes in scaled responses among combined participants and separately among self-identified community members and researchers. OUTCOMES Sixty-nine total participants across 6 workshops completed training evaluations. Overall, pre-post survey analysis demonstrated significant mean score improvement for both the SPCCS and comfort with specific communication styles. In stratified analysis, both community members (n = 26) and researchers (n = 38) reported significant improvement in scores related to comfort with specific communication styles. Only researchers, but not community members, had significant improvement in SPCCS scores. NEXT STEPS The Communicating to Engage program brought community and researcher stakeholders together and demonstrated improvement in self-perceived communication styles, yet researcher participants benefited more than community participants. Future innovation is necessary to further target community stakeholder communication training needs. Mixed stakeholder improvisational theater-based learning provides deliberate opportunities to build new community-academic partnerships that may enhance health equity initiatives.
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Affiliation(s)
- Tracy A Battaglia
- T.A. Battaglia is associate professor of medicine and epidemiology, Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center and Women's Health Interdisciplinary Research Center, Boston University School of Medicine, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-8475-1212
| | - Kyle Megrath
- K. Megrath is communication and training coordinator, Women's Health Unit, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts
| | - Nikki Spencer
- N. Spencer is community project manager, Women's Health Unit, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts
| | - Jennifer Pamphile
- J. Pamphile is community engagement coordinator, Women's Health Unit, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts
| | - Chase Crossno
- C. Crossno is assistant artistic director and assistant professor of medical education, Texas Christian University and University of North Texas Health Science Center School of Medicine, Fort Worth, Texas
| | - Ariel Maschke
- A. Maschke is senior research assistant, Women's Health Unit, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts
| | - Sharon Bak
- S. Bak is assistant director, Women's Health Unit, Section of General Internal Medicine, Boston Medical Center, Boston, Massachusetts
| | - George T O'Connor
- G.T. O'Connor is professor of medicine, Division of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts; ORCID: http://orcid.org/0000-0002-6476-3926
| | - Cheryl R Clark
- C.R. Clark is assistant professor of medicine, Harvard Medical School, Brigham and Women's Hospital, Division of General Medicine and Primary Care, Boston, Massachusetts
| | - Suzanne Sarfaty
- S. Sarfaty is assistant dean of medical education and associate professor of medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
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19
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Godley BF, Lawley TJ, Rubenstein A, Pizzo PA. How Academic Medical Centers Can Navigate the Pandemic and Its Aftermath: Solutions for 3 Major Issues. Acad Med 2021; 96:1529-1533. [PMID: 33983136 PMCID: PMC8541886 DOI: 10.1097/acm.0000000000004155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The COVID-19 crisis has seriously affected academic medical centers (AMCs) on multiple levels. Combined with many trends that were already under way pre pandemic, the current situation has generated significant disruption and underscored the need for change within and across AMCs. In this article, the authors explore some of the major issues and propose actionable solutions in 3 areas of concentration. First, the impact on medical students is considered, particularly the trade-offs associated with online learning and the need to place greater pedagogical emphasis on virtual care delivery and other skills that will be increasingly in demand. Solutions described include greater utilization of technology, building more public health knowledge into the curriculum, and partnering with a wide range of academic disciplines. Second, leadership recruiting, vital to long-term success for AMCs, has been complicated by the crisis. Pressures discussed include adapting to the dynamics of competitive physician labor markets as well as attracting candidates with the skill sets to meet the requirements of a shifting AMC leadership landscape. Solutions proposed in this domain include making search processes more focused and streamlined, prioritizing creativity and flexibility as core management capabilities to be sought, and enhancing efforts with assistance from outside advisors. Finally, attention is devoted to the severe financial impact wrought by the pandemic, creating challenges whose resolution is central to planning future AMC directions. Specific challenges include recovery of lost clinical revenue and cash flow, determining how to deal with research funding, and the precarious economic balancing act engendered by the need to continue distance education. A full embrace of telehealth, collaborative policy-making among the many AMC constituencies, and committing fully to being in the vanguard of the transition to value-based care form the solution set offered.
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Affiliation(s)
- Bernard F. Godley
- B.F. Godley is adjunct professor, Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, Texas
| | - Thomas J. Lawley
- T.J. Lawley is William P. Timmie Professor of Dermatology and former dean, Emory School of Medicine, Atlanta, Georgia
| | - Arthur Rubenstein
- A. Rubenstein is professor, Department of Medicine and the Division of Endocrinology, and former dean and executive vice president, Raymond and Ruth Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Philip A. Pizzo
- P.A. Pizzo is David and Susan Heckerman Professor of Pediatrics and of Microbiology and Immunology, former dean, Stanford School of Medicine, and founding director, Stanford Distinguished Careers Institute, Stanford University, Stanford, California; ORCID: https://orcid.org/0000-0002-1000-6516
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20
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Abstract
In his Leadership Plenary at the Association of American Medical Colleges (AAMC) annual meeting, "Learn Serve Lead 2020: The Virtual Experience," president and CEO David Skorton emphasized that the traditional tripartite mission of academic medicine-medical education, clinical care, and research-is no longer enough to achieve health justice for all. Today, collaborating with diverse communities deserves equal weight among academic medicine's missions. This means going beyond "delivering care" to establishing and expanding ongoing, two-way community dialogues that push the envelope of what is possible in service to what is needed. It means appreciating community assets and creating ongoing pathways for listening to and learning from the needs, lived experiences, perspectives, and wisdom of patients, families, and communities. It means working with community-based organizations in true partnership to identify and address needs, and jointly develop, test, and implement solutions. This requires bringing medical care and public/population health concepts together and addressing upstream fundamental causes of health inequities. The authors call on academic medical institutions to do more to build a strong network of collaborators across public and population health, government, community groups, and the private sector. We in academic medicine must hold ourselves accountable for weaving community collaborations consistently throughout research, medical education, and clinical care. The authors recognize the AAMC can do better to support its member institutions in doing so and discuss new initiatives that signify a shift in emphasis through the association's new strategic plan and AAMC Center for Health Justice. The authors believe every area of academic medicine could grow and better serve communities by listening and engaging more and bringing medical care, public health, and other sectors closer together.
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Affiliation(s)
- Philip Alberti
- P. Alberti is founding director, AAMC Center for Health Justice, and senior director, health equity research and policy, Association of American Medical Colleges, Washington, DC
| | - Malika Fair
- M. Fair is senior director, equity and social accountability, Association of American Medical Colleges, Washington, DC
| | - David J Skorton
- D.J. Skorton is president and CEO, Association of American Medical Colleges, Washington, DC
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21
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Golden SH, Galiatsatos P, Wilson C, Page KR, Jones V, Tolson T, Lugo A, McCann N, Wilson A, Hill-Briggs F. Approaching the COVID-19 Pandemic Response With a Health Equity Lens: A Framework for Academic Health Systems. Acad Med 2021; 96:1546-1552. [PMID: 34705750 PMCID: PMC8541896 DOI: 10.1097/acm.0000000000003999] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Racially and ethnically diverse and socioeconomically disadvantaged communities have historically been disproportionately affected by disasters and public health emergencies in the United States. The U.S. Department of Health and Human Services' Office of Minority Health established the National Consensus Panel on Emergency Preparedness and Cultural Diversity to provide guidance to agencies and organizations on developing effective strategies to advance emergency preparedness and eliminate disparities among racially and ethnically diverse communities during these crises. Adopting the National Consensus Panel recommendations, the Johns Hopkins Medicine Office of Diversity, Inclusion, and Health Equity; Language Services; and academic-community partnerships used existing health equity resources and expertise to develop an operational framework to support the organization's COVID-19 response and to provide a framework of health equity initiatives for other academic medical centers. This operational framework addressed policies to support health equity patient care and clinical operations, accessible COVID-19 communication, and staff and community support and engagement, which also supported the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care. Johns Hopkins Medicine identified expanded recommendations for addressing institutional policy making and capacity building, including unconscious bias training for resource allocation teams and staff training in accurate race, ethnicity, and language data collection, that should be considered in future updates to the National Consensus Panel's recommendations.
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Affiliation(s)
- Sherita H. Golden
- S.H. Golden is professor of medicine, Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, professor of epidemiology, Johns Hopkins University Bloomberg School of Public Health, and vice president and chief diversity officer, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, Maryland
| | - Panagis Galiatsatos
- P. Galiatsatos is assistant professor of medicine, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, and health equity colead, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, Maryland
| | - Cheri Wilson
- C. Wilson is diversity and inclusion education and training program manager, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, Maryland
| | - Kathleen R. Page
- K.R. Page is associate professor of medicine, Division of Infectious Disease Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vanya Jones
- V. Jones is associate professor, Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Tina Tolson
- T. Tolson is senior director, Office of Language Services, Johns Hopkins Medicine, Baltimore, Maryland
| | - April Lugo
- A. Lugo is diversity, inclusion, and health equity program coordinator, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, Maryland
| | - Nicki McCann
- N. McCann is vice president for payer/provider transformation, Presidents Office Administration, Johns Hopkins Health System, Baltimore, Maryland
| | - Alicia Wilson
- A. Wilson is vice president for economic development, Presidents Office Administration for Johns Hopkins University and Johns Hopkins Health System, Baltimore, Maryland
| | - Felicia Hill-Briggs
- F. Hill-Briggs is professor, Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, and health equity senior lead, Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Medicine, Baltimore, Maryland
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22
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Vickers SM, Agarwal A, Patel N, Benveniste EN, Bulgarella D, Fouad MN, Hoesley C, Jones K, Kimberly RP, Rogers DA, Larson JA, Leeth TR, Mack L, Dorman P, Furgerson T, Longshore J, Watts RL. Returning to Growth: One Academic Medical Center's Successful Five-Step Approach to Change Management. Acad Med 2021; 96:1401-1407. [PMID: 33830950 DOI: 10.1097/acm.0000000000004116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The University of Alabama at Birmingham academic medical center (UAB AMC) had achieved great success and growth during the 50 years since its founding. However, the challenging and more competitive environment of the 2000s left the UAB AMC on a downward trajectory. The UAB AMC had to overcome difficult internal cultural and structural barriers that stood in the way of the transformational change needed to remain competitive. Competition rather than collaborative and strategic financial investment were the primary cultural barriers for the UAB AMC, while people were the primary structural barrier. Leadership identified 5 steps that were critical for the transformation that occurred between 2013 and 2018: alignment of leadership; creating a compelling and credible shared vision; identifying cultural and structural barriers; creating a thoughtful, data-driven intervention; and improved communication and accountability. Following these steps enabled the UAB AMC to transform its institutional structure and culture. As a result, the UAB AMC thrived, returning to substantial growth in research and clinical care. UAB AMC School of Medicine grew by $100 million in National Institutes of Health funding and moved up 10 spots in ranking. In 2018, UAB Hospital had 10 specialties ranked by U.S. News & World Report, 7 more than in 2013. This article outlines the approach taken and provides a conceptual framework for other AMCs eager to transform their structure and culture and position themselves for growth.
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Affiliation(s)
- Selwyn M Vickers
- S.M. Vickers is senior vice president for medicine and dean, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Anupam Agarwal
- A. Agarwal is executive vice dean, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama; ORCID: https://orcid.org/0000-0003-4276-5186
| | - Nisha Patel
- N. Patel is executive director of operations, wellness, and administration, Dean's Office, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Etty N Benveniste
- E.N. Benveniste is senior vice dean for research, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Dawn Bulgarella
- D. Bulgarella is chief financial officer, UAB Health System, Birmingham, Alabama
| | - Mona N Fouad
- M.N. Fouad is senior associate dean for diversity and inclusion, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Craig Hoesley
- C. Hoesley is senior associate dean for medical education, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama; ORCID: https://orcid.org/0000-0003-2654-9141
| | - Keith Jones
- K. Jones is senior associate dean for clinical affairs, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Robert P Kimberly
- R.P. Kimberly is senior associate dean for clinical and translational research, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - David A Rogers
- D.A. Rogers is senior associate dean for faculty affairs and professional development, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Jean Ann Larson
- J.A. Larson is senior associate dean for leadership development, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Toni R Leeth
- T.R. Leeth is associate dean for strategic planning and administration, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - LaKisha Mack
- L. Mack is senior associate dean for administration and finance, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Paige Dorman
- P. Dorman is executive director of communications, Dean's Office, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Tyler Furgerson
- T. Furgerson is web communications specialist, Dean's Office, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Jane Longshore
- J. Longshore is managing editor, Dean's Office, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Ray L Watts
- R.L. Watts is president, University of Alabama at Birmingham, Birmingham, Alabama
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23
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Abstract
The value of structured development processes has been recognized and implemented in formal physician training programs such as residencies and fellowships. Physicians are seemingly viewed as a "finished product" upon completing formal training. In recent years, a number of academic medical centers have implemented formalized early-career development programs for physicians, largely those who have a major research focus. However, beyond the early stage of physicians' careers, formalized and intentional physician career development programs are rare. The lack of a philosophy of intentional, career-long individual development at academic medical centers reflects a narrow understanding of the implicit contract between employers and employees. The resulting gap leads the vast majority of physicians to fall short of their potential, further leading to long-term loss for the academic medical centers, their physicians, and society as a whole. Based on the framework of analyze-design-develop-implement-evaluate, the authors propose a robust, iterative model for physician career development that goes beyond skills and knowledge maintenance toward leveraging a broad range of individual capabilities, needs, and contexts along the career lifespan. The model provides a means for harnessing physicians' strengths and passions in concert with the needs of their organization to create greater physician fulfillment and success, which in turn would benefit the patients they care for and the academic medical centers in which they work.
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Affiliation(s)
- R Thomas Collins
- R.T. Collins II is clinical associate professor, Departments of Pediatrics and Internal Medicine, Stanford University School of Medicine, Palo Alto, California; ORCID: http://orcid.org/0000-0002-3387-6629
| | - Rania Sanford
- R. Sanford is director, Faculty Professional Development, Stanford University School of Medicine, Palo Alto, California
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24
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Nadjarian A, LeClair J, Mahoney TF, Awtry EH, Bhatia JS, Caruso LB, Clay A, Greer D, Hingorani KS, Horta LFB, Ibrahim M, Ieong MH, James T, Kulke MH, Lim R, Lowe RC, Moses JM, Murphy J, Nozari A, Patel AD, Silver B, Theodore AC, Wang RS, Weinstein E, Wilson SA, Cervantes-Arslanian AM. Validation of a Crisis Standards of Care Model for Prioritization of Limited Resources During the Coronavirus Disease 2019 Crisis in an Urban, Safety-Net, Academic Medical Center. Crit Care Med 2021; 49:1739-1748. [PMID: 34115635 PMCID: PMC8439631 DOI: 10.1097/ccm.0000000000005155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The coronavirus disease 2019 pandemic has overwhelmed healthcare resources even in wealthy nations, necessitating rationing of limited resources without previously established crisis standards of care protocols. In Massachusetts, triage guidelines were designed based on acute illness and chronic life-limiting conditions. In this study, we sought to retrospectively validate this protocol to cohorts of critically ill patients from our hospital. DESIGN We applied our hospital-adopted guidelines, which defined severe and major chronic conditions as those associated with a greater than 50% likelihood of 1- and 5-year mortality, respectively, to a critically ill patient population. We investigated mortality for the same intervals. SETTING An urban safety-net hospital ICU. PATIENTS All adults hospitalized during April of 2015 and April 2019 identified through a clinical database search. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 365 admitted patients, 15.89% had one or more defined chronic life-limiting conditions. These patients had higher 1-year (46.55% vs 13.68%; p < 0.01) and 5-year (50.00% vs 17.22%; p < 0.01) mortality rates than those without underlying conditions. Irrespective of classification of disease severity, patients with metastatic cancer, congestive heart failure, end-stage renal disease, and neurodegenerative disease had greater than 50% 1-year mortality, whereas patients with chronic lung disease and cirrhosis had less than 50% 1-year mortality. Observed 1- and 5-year mortality for cirrhosis, heart failure, and metastatic cancer were more variable when subdivided into severe and major categories. CONCLUSIONS Patients with major and severe chronic medical conditions overall had 46.55% and 50.00% mortality at 1 and 5 years, respectively. However, mortality varied between conditions. Our findings appear to support a crisis standards protocol which focuses on acute illness severity and only considers underlying conditions carrying a greater than 50% predicted likelihood of 1-year mortality. Modifications to the chronic lung disease, congestive heart failure, and cirrhosis criteria should be refined if they are to be included in future models.
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Affiliation(s)
- Albert Nadjarian
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
| | - Jessica LeClair
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Taylor F Mahoney
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Eric H Awtry
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Medicine, Section of Cardiology, Boston Medical Center, Boston, MA
| | - Jasvinder S Bhatia
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Medicine, Section of Nephrology, Boston Medical Center, Boston, MA
| | - Lisa B Caruso
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, MA
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
- Department of Medicine, Section of Cardiology, Boston Medical Center, Boston, MA
- Department of Medicine, Section of Nephrology, Boston Medical Center, Boston, MA
- Department of Neurology, Boston Medical Center, Boston, MA
- Department of Medicine, Section of Pulmonary, Allergy, and Critical Care Medicine, Boston Medical Center, Boston, MA
- Department of Emergency Medicine, Boston Medical Center, Boston, MA
- Department of Medicine, Section of Hematology and Oncology, Boston Medical Center, Boston, MA
- Department of Medicine, Section of Gastroenterology, Boston Medical Center, Boston, MA
- Department of Pediatrics, Boston Medical Center, Boston, MA
- Department of Quality and Patient Safety, Boston Medical Center, Boston, MA
- Department of Anesthesiology, Boston Medical Center, Boston, MA
- Office of the General Counsel, Boston Medical Center, Boston, MA
- Department of Family Medicine, Boston Medical Center, Boston, MA
- Department of Medicine, Section of Infectious Disease, Boston Medical Center, Boston, MA
- Department of Neurosurgery, Boston Medical Center, Boston, MA
| | - Alexis Clay
- Boston Medical Center, Boston, MA
- Department of Neurology, Boston Medical Center, Boston, MA
| | - David Greer
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Neurology, Boston Medical Center, Boston, MA
| | - Karan S Hingorani
- Boston Medical Center, Boston, MA
- Department of Neurology, Boston Medical Center, Boston, MA
| | - L F B Horta
- Boston Medical Center, Boston, MA
- Department of Neurology, Boston Medical Center, Boston, MA
| | - Michel Ibrahim
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Medicine, Section of Cardiology, Boston Medical Center, Boston, MA
| | - Michael H Ieong
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Medicine, Section of Pulmonary, Allergy, and Critical Care Medicine, Boston Medical Center, Boston, MA
| | - Thea James
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Emergency Medicine, Boston Medical Center, Boston, MA
| | - Matthew H Kulke
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Medicine, Section of Hematology and Oncology, Boston Medical Center, Boston, MA
| | | | - Robert C Lowe
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Medicine, Section of Gastroenterology, Boston Medical Center, Boston, MA
| | - James M Moses
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Pediatrics, Boston Medical Center, Boston, MA
- Department of Quality and Patient Safety, Boston Medical Center, Boston, MA
| | - Jaime Murphy
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Medicine, Section of Pulmonary, Allergy, and Critical Care Medicine, Boston Medical Center, Boston, MA
- Department of Quality and Patient Safety, Boston Medical Center, Boston, MA
| | - Ala Nozari
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Anesthesiology, Boston Medical Center, Boston, MA
| | - Anuj D Patel
- Boston Medical Center, Boston, MA
- Department of Neurology, Boston Medical Center, Boston, MA
| | - Brent Silver
- Boston Medical Center, Boston, MA
- Department of Neurology, Boston Medical Center, Boston, MA
| | - Arthur C Theodore
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Medicine, Section of Pulmonary, Allergy, and Critical Care Medicine, Boston Medical Center, Boston, MA
| | - Ryan Shufei Wang
- Boston Medical Center, Boston, MA
- Department of Neurology, Boston Medical Center, Boston, MA
| | - Ellen Weinstein
- Department of Quality and Patient Safety, Boston Medical Center, Boston, MA
- Office of the General Counsel, Boston Medical Center, Boston, MA
| | - Stephen A Wilson
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Family Medicine, Boston Medical Center, Boston, MA
| | - Anna M Cervantes-Arslanian
- Boston University School of Medicine, Boston, MA
- Boston Medical Center, Boston, MA
- Department of Neurology, Boston Medical Center, Boston, MA
- Department of Medicine, Section of Infectious Disease, Boston Medical Center, Boston, MA
- Department of Neurosurgery, Boston Medical Center, Boston, MA
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25
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Lindsell CJ, Gatto CL, Dear ML, Buie R, Rice TW, Pulley JM, Hartert TV, Kripalani S, Harrell FE, Byrne DW, Edgeworth MC, Steaban R, Dittus RS, Bernard GR. Learning From What We Do, and Doing What We Learn: A Learning Health Care System in Action. Acad Med 2021; 96:1291-1299. [PMID: 33635834 DOI: 10.1097/acm.0000000000004021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Different models of learning health systems are emerging. At Vanderbilt University Medical Center, the Learning Health Care System (LHS) Platform was established with the goal of creating generalizable knowledge. This differentiates the LHS Platform from other efforts that have adopted a quality improvement paradigm. By supporting pragmatic trials at the intersection of research, operations, and clinical care, the LHS Platform was designed to yield evidence for advancing content and processes of care through carefully designed, rigorous study. The LHS Platform provides the necessary infrastructure and governance to leverage translational, transdisciplinary team science to inform clinical and operational decision making across the health system. The process transforms a clinical or operational question into a research question amenable to a pragmatic trial. Scientific, technical, procedural, and human infrastructure is maintained for the design and execution of individual LHS projects. This includes experienced pragmatic trialists, project management, data science inclusive of biostatistics and clinical informatics, and regulatory support. Careful attention is paid to stakeholder engagement, including health care providers and the community. Capturing lessons from each new study, the LHS Platform continues to mature with plans to integrate implementation science and to complement clinical and process outcomes with cost and value considerations. The Vanderbilt University Medical Center LHS Platform is now a pillar of the health care system and leads the evolving culture of learning from what we do and doing what we learn.
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Affiliation(s)
- Christopher J Lindsell
- C.J. Lindsell is professor of biostatistics, associate director, Center for Clinical Quality and Implementation Research, director, Vanderbilt Institute for Clinical and Translational Research Methods Program, and co-director, Center for Health Data Science, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cheryl L Gatto
- C.L. Gatto is research assistant professor of biostatistics and associate director, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary Lynn Dear
- M.L. Dear is project manager, Learning Health Care System Platform, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Reagan Buie
- R. Buie is health policy service analyst, Learning Health Care System Platform, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd W Rice
- T.W. Rice is associate professor of medicine, Department of Allergy, Pulmonary and Critical Care Medicine, vice president for clinical trial innovation and operations, Vanderbilt Institute for Clinical and Translational Research, and medical director, Vanderbilt Human Research Protection Program, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jill M Pulley
- J.M. Pulley is research associate professor of medicine, Department of Allergy, Pulmonary and Critical Care Medicine, and executive director, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tina V Hartert
- T.V. Hartert is professor of medicine, Department of Allergy, Pulmonary and Critical Care Medicine, director, Center for Asthma Research, assistant vice president for translational science, and Lulu H. Owen Chair in Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sunil Kripalani
- S. Kripalani is professor of medicine, Department of General Internal Medicine and Public Health, director, Center for Clinical Quality and Implementation Research, and co-director, Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Frank E Harrell
- F.E. Harrell is professor and founding chair, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel W Byrne
- D.W. Byrne is senior associate in biostatistics and director, Quality Improvement and Program Evaluation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mitchell C Edgeworth
- M.C. Edgeworth was chief executive officer, Vanderbilt University Hospital, Vanderbilt University Medical Center, Nashville, Tennessee, at the time this manuscript was written
| | - Robin Steaban
- R. Steaban is chief nursing officer, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert S Dittus
- R.S. Dittus is the Albert and Bernard Werthan Professor of Medicine, Division of General Internal Medicine and Public Health, senior vice president and chief innovation officer, Vanderbilt Health Affiliated Network, executive vice president for public health and health care, and senior associate dean for population health sciences, Vanderbilt University Medical Center and VA Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center, Nashville, Tennessee
| | - Gordon R Bernard
- G.R. Bernard is the Melinda Owen Bass Professor of Medicine, Department of Allergy, Pulmonary and Critical Care Medicine, executive vice president for research, senior associate dean for clinical sciences, and director, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
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26
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McEvoy MD, Dear ML, Buie R, Fowler LC, Miller B, Fleming GM, Moore D, Rice TW, Bernard GR, Lindsell CJ. Embedding Learning in a Learning Health Care System to Improve Clinical Practice. Acad Med 2021; 96:1311-1314. [PMID: 33570841 PMCID: PMC8349926 DOI: 10.1097/acm.0000000000003969] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PROBLEM In an ideal learning health care system (LHS), clinicians learn from what they do and do what they learn, closing the evidence-to-practice gap. In operationalizing an LHS, great strides have been made in knowledge generation. Yet, considerable challenges remain to the broad uptake of identified best practices. To bridge the gap from generating actionable knowledge to applying that knowledge in clinical practice, and ultimately to improving outcomes, new information must be disseminated to and implemented by frontline clinicians. To date, the dissemination of this knowledge through traditional avenues has not achieved meaningful practice change quickly. APPROACH Vanderbilt University Medical Center (VUMC) developed QuizTime, a smartphone application learning platform, to provide a mechanism for embedding workplace-based clinician learning in the LHS. QuizTime leverages spaced education and retrieval-based practice to facilitate practice change. Beginning in January 2020, clinician-researchers and educators at VUMC designed a randomized, controlled trial to test whether the QuizTime learning system influenced clinician behavior in the context of recent evidence supporting the use of balanced crystalloids rather than saline for intravenous fluid management and new regulations around opioid prescribing. OUTCOMES Whether spaced education and retrieval-based practice influence clinician behavior and patient outcomes at the VUMC system level will be tested using the data currently being collected. NEXT STEPS These findings will inform future directions for developing and deploying learning approaches at scale in an LHS, with the goal of closing the evidence-to-practice gap.
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Affiliation(s)
- Matthew D McEvoy
- M.D. McEvoy is professor of anesthesiology and surgery, vice chair for educational affairs, program director of the perioperative medicine fellowship, and director of the Center for Innovation in Perioperative Health, Education, and Research, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary Lynn Dear
- M.L. Dear is project manager, Learning Healthcare System Platform, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Reagan Buie
- R. Buie is health policy service analyst, Learning Healthcare System Platform, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Leslie C Fowler
- L.C. Fowler is director of the Educational Development and Research Office of Educational Affairs, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bonnie Miller
- B. Miller is professor of medical education and administration and vice president for educational affairs, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Geoffrey M Fleming
- G.M. Fleming was professor of pediatrics and associate director of the pediatric critical care fellowship, Monroe Carell Jr. Children's Hospital, and vice president, Continuous Professional Development, Office of Health Sciences Education, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Don Moore
- D. Moore is professor of medical education and administration and director of the Office for Continuing Professional Development, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Todd W Rice
- T.W. Rice is associate professor of medicine, Department of Allergy, Pulmonary and Critical Care Medicine, and medical director, Vanderbilt Human Research Protection Program, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gordon R Bernard
- G.R. Bernard is the Melinda Owen Bass Professor of Medicine, executive vice president for research, senior associate dean for clinical sciences, and director of the Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher J Lindsell
- C.J. Lindsell is professor of biostatistics, associate director of the Center for Clinical Quality and Implementation Research, director of the Vanderbilt Institute for Clinical and Translational Research Methods Program, and director of the Center for Health Data Science, Vanderbilt University Medical Center, Nashville, Tennessee
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27
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Clements C, Barsamian J, Burnham N, Cruz C, Darcy AMG, Duphiney L, FitzGerald J, Holland S, Joyce C, DeSanto-Madeya S. Supporting Frontline Staff During the COVID-19 Pandemic. Am J Nurs 2021; 121:46-55. [PMID: 34438429 DOI: 10.1097/01.naj.0000790632.18077.c1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The coronavirus disease 2019 (COVID-19) pandemic that emerged in early 2020 put unprecedented physical, mental, and emotional strain on the staff of health care organizations, who have been caring for a critically ill patient population for more than a year and a half. Amid the ongoing pandemic, health care workers have struggled to keep up with new information about the disease, while also coping with the anxiety associated with caring for affected patients. It has also been a continual challenge for nurse leaders to provide adequate support for staff members and keep them informed about frequently changing practices and protocols. In this article, nursing leaders at an academic medical center in Boston reflect on the initial COVID-19 patient surge, which occurred from March to June 2020, and identify key actions taken to provide clinical and emotional support to frontline staff who cared for these patients. Lessons learned in this period provide insight into the management of redeployed staff, use of emotional support and debriefing, and relationship between access to information and staff morale. The knowledge gained through these initial experiences has been a vital resource as health care workers continue to face challenges associated with the ongoing pandemic.
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Affiliation(s)
- Charlotte Clements
- Charlotte Clements is a nurse educator at Beth Israel Deaconess Medical Center in Boston, where Jennifer Barsamian and Ann Marie Grillo Darcy are nurse specialists, Nicolette Burnham , Claire Cruz , and Jacqueline FitzGerald are nursing directors, Lindsay Duphiney is a nurse educator, Susan Holland is a patient safety coordinator and risk manager, Christine Joyce is a resource nurse, and Susan DeSanto-Madeya is a nurse scientist. Contact author: Charlotte Clements, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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28
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Affiliation(s)
| | - Anil K Rustgi
- Office of the Dean, Columbia University Irving Medical Center, New York, New York
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29
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Patel NR, El-Karim GA, Mujoomdar A, Mafeld S, Jaberi A, Kachura JR, Tan KT, Oreopoulos GD. Overall Impact of the COVID-19 Pandemic on Interventional Radiology Services: A Canadian Perspective. Can Assoc Radiol J 2021; 72:564-570. [PMID: 32864995 PMCID: PMC7459179 DOI: 10.1177/0846537120951960] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The aim of this national survey was to assess the overall impact of the coronavirus disease 2019 (COVID-19) pandemic on the provision of interventional radiology (IR) services in Canada. METHODS An anonymous electronic survey was distributed via national and regional radiology societies, exploring (1) center information and staffing, (2) acute and on-call IR services, (3) elective IR services, (4) IR clinics, (5) multidisciplinary rounds, (6) IR training, (7) personal protection equipment (PPE), and departmental logistics. RESULTS Individual responses were received from 142 interventional radiologists across Canada (estimated 70% response rate). Nearly half of the participants (49.3%) reported an overall decrease in demand for acute IR services; on-call services were maintained at centers that routinely provide these services (99%). The majority of respondents (73.2%) were performing inpatient IR procedures at the bedside where possible. Most participants (88%) reported an overall decrease in elective IR services. Interventional radiology clinics and multidisciplinary rounds were predominately transitioned to virtual platforms. The vast majority of participants (93.7%) reported their center had disseminated an IR specific PPE policy; 73% reported a decrease in case volume for trainees by at least 25% and a proportion of trainees will either have a delay in starting their careers as IR attendings (24%) or fellowship training (35%). CONCLUSION The COVID-19 pandemic has had a profound impact on IR services in Canada, particularly for elective cases. Many centers have utilized virtual platforms to provide multidisciplinary meetings, IR clinics, and training. Guidelines should be followed to ensure patient and staff safety while resuming IR services.
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Affiliation(s)
- Neeral R. Patel
- Division of Interventional Radiology,
University
Health Network, Toronto, Ontario,
Canada
| | - Ghassan Awad El-Karim
- Division of Interventional Radiology,
University
Health Network, Toronto, Ontario,
Canada
| | - Amol Mujoomdar
- Division of Interventional Radiology,
London Health
Sciences Centre, London, Ontario,
Canada
| | - Sebastian Mafeld
- Division of Interventional Radiology,
University
Health Network, Toronto, Ontario,
Canada
| | - Arash Jaberi
- Division of Interventional Radiology,
University
Health Network, Toronto, Ontario,
Canada
| | - John R. Kachura
- Division of Interventional Radiology,
University
Health Network, Toronto, Ontario,
Canada
| | - Kong Teng Tan
- Division of Interventional Radiology,
University
Health Network, Toronto, Ontario,
Canada
| | - George D. Oreopoulos
- Division of Interventional Radiology,
University
Health Network, Toronto, Ontario,
Canada
- Division of Vascular Surgery, University Health
Network, Toronto, Ontario, Canada
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30
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Melazzini F, Colaneri M, Fumoso F, Freddi G, Lenti MV, Pieri TC, Piloni D, Noris P, Pieresca C, Preti PS, Russo M, Corsico A, Tavazzi G, Baldanti F, Triarico A, Mojoli F, Bruno R, Di Sabatino A. Venous thromboembolism and COVID-19: a single center experience from an academic tertiary referral hospital of Northern Italy. Intern Emerg Med 2021; 16:1141-1152. [PMID: 33161478 PMCID: PMC7648897 DOI: 10.1007/s11739-020-02550-6] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/22/2020] [Indexed: 01/08/2023]
Abstract
Preliminary evidence supports the notion that COVID-19 patients may have an increased susceptibility to develop venous thromboembolism (VTE). However, the magnitude of this association still needs to be defined. Furthermore, clinical predictors of thrombogenesis, and the relationship with the inflammatory status are currently unknown. On this basis, we conducted a retrospective, observational study on 259 consecutive COVID-19 patients admitted to an academic tertiary referral hospital in Northern Italy between March 19th and April 6th, 2020. Records of COVID-19 patients with a definite VTE event were reviewed for demographic information, co-morbidities, risk factors for VTE, laboratory tests, and anticoagulation treatment. Twenty-five cases among 259 COVID-19 patients developed VTE (9.6%), all of them having a Padua score > 4, although being under standard anticoagulation prophylaxis since hospital admission. In the VTE subcohort, we found a significant positive correlation between platelet count (PLT) and either C reactive protein (CRP) (p < 0.0001) or lactate dehydrogenase (LDH) (p = 0.0013), while a significant inverse correlation was observed between PLT and mean platelet volume (p < 0.0001). Platelet-to-lymphocyte ratio significantly correlated with CRP (p < 0.0001). The majority of VTE patients was male and younger compared to non-VTE patients (p = 0.002 and p = 0.005, respectively). No significant difference was found in D-dimer levels between VTE and non VTE patients, while significantly higher levels of LDH (p = 0.04) and IL-6 (p = 0.04) were observed in VTE patients in comparison to non-VTE patients. In conclusion, our findings showed a quite high prevalence of VTE in COVID-19 patients. Raised inflammatory indexes and increased serum levels of pro-inflammatory cytokines should raise the clinical suspicion of VTE.
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Affiliation(s)
- Federica Melazzini
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Marta Colaneri
- Department of Infectious Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Federica Fumoso
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Giulia Freddi
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Teresa Chiara Pieri
- Department of Infectious Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Davide Piloni
- Department of Respiratory Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Patrizia Noris
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Carla Pieresca
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Paola Stefania Preti
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Mariaconcetta Russo
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Angelo Corsico
- Department of Respiratory Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Guido Tavazzi
- Department of Intensive Care, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Microbiology and Virology Department, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Triarico
- Chief Medical Direction, San Matteo Hospital Foundation, Pavia, Italy
| | - Francesco Mojoli
- Department of Intensive Care, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Raffaele Bruno
- Department of Infectious Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
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31
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Abstract
PROBLEM There is an unmet need for economically feasible, valid, reliable, and contextually relevant assessments of interprofessional collaborative knowledge and skills, particularly at the early stages of health professions education. This study sought to develop and gather content and internal structure validity for an Interprofessional Situational Judgement Test (IPSJT), a tool for the measurement of students' interprofessional collaborative intentions during the early stages of their professional development. APPROACH After engaging in an item development and refinement process (January-June 2018), an 18-question IPSJT was administered to 953 first-year students enrolled in 10 health professions degree programs at the University of Florida Health Science Center in October 2018. The IPSJT's performance was evaluated using item-level analyses, item difficulty, test-retest reliability, and exploratory factor analysis. OUTCOMES Seven hundred thirty-seven (77.3%) students consented to the use of their data. Student IPSJT scores ranged from 0 to 69, averaging 42.68 (standard deviation = 12.28), with some statistically significant differences in student performance by health professions degree program. IPSJT item difficulties ranged from 0.13 to 0.92. Once one item with poor properties was excluded from analysis, the IPSJT demonstrated an overall reliability of 0.62. Students were more successful at identifying the least effective than the most effective responses. Test-retest reliability provided evidence of consistency (r = 0.50, P < .001) and similar item difficulty across administrations. An exploratory factor analysis indicated a 3-factor model with multiple cross-factor loadings. NEXT STEPS This work represents the first step toward the development of a valid, reliable IPSJT for early learners. The emergent 3-factor model provides evidence that multiple competencies can be assessed in early learners via this tool. Additional research is necessary to build a more robust question bank, explore different scoring and response methods, and gather additional sources of validity evidence, including relations to other variables.
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Affiliation(s)
- Erik W Black
- E.W. Black is associate professor of pediatrics and education, Department of Pediatrics, University of Florida College of Medicine, and associate director, UF Health Office of Interprofessional Education, Gainesville, Florida; ORCID: http://orcid.org/0000-0002-5284-135X
| | - Bailey Schrock
- B. Schrock is a talent management consultant, Integer Holdings, Plano, Texas
| | - Matthew S Prewett
- M.S. Prewett is associate professor of psychology, Department of Psychology, Central Michigan University, Mount Pleasant, Michigan; ORCID: http://orcid.org/0000-0003-4645-238X
| | - Amy V Blue
- A.V. Blue is associate vice president of interprofessional education, UF Health Office of Interprofessional Education, Gainesville, Florida; ORCID: http://orcid.org/0000-0003-0161-6790
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Gettel CJ, Venkatesh AK. Career Development Considerations for Academic Physician Mentees and Mentors in the Time of COVID-19: Jump in or Just Dip a Toe? Acad Med 2021; 96:974-978. [PMID: 33769338 PMCID: PMC8243790 DOI: 10.1097/acm.0000000000004076] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic has disrupted medical research, pushing mentors and mentees to decide if COVID-19 research would be germane to the early career investigator's developing research portfolio. With COVID-19 halting hundreds of federal trials involving non-COVID-19 research, mentors and mentees must also consider the broader moral calling of contributing to COVID-19 research. At the time of writing, the National Institutes of Health had responded to the pandemic with significant funding for COVID-19 research. However, because this pandemic is a new phenomenon, few mentors have expertise in the disease and relevant established resources. As a result, many mentors are unable to provide insight on COVID-19 research to early career investigators considering a pivot toward research related to this disease. The authors suggest 4 ways for mentees and mentors to respond to the changes the pandemic has brought to research funding and opportunities: (1) include COVID-19 research in existing portfolios to diversify intellectual opportunities and reduce funding risks; (2) negotiate the mentor-mentee relationship and roles and expectations early in project discussions-considering, as relevant, the disproportionate burden of home responsibilities often borne by early career faculty members who are women and/or from a minority group; (3) address any mentor limitations in content expertise; and (4) if the decision is to pivot to COVID-19 research, select projects with implications generalizable beyond this pandemic to other infectious outbreaks or to the redesign of health care delivery. Mentors and mentees must weigh the relevance of COVID-19 research projects to the postpandemic world and the amount of available funding against the developing interests of early career investigators. Academic medical centers nationwide must enable seasoned and early career researchers to contribute meaningfully to COVID-19 and non-COVID-19 research.
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Affiliation(s)
- Cameron J Gettel
- C.J. Gettel is a postdoctoral fellow, National Clinician Scholars Program, and instructor, Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut; ORCID: http://orcid.org/0000-0002-6249-1023
| | - Arjun K Venkatesh
- A.K. Venkatesh is associate professor, Department of Emergency Medicine, and scientist, Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut
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Canoutas DA, Gregor A, Gertner AK. An Interdisciplinary, Service-Learning Effort to Address Personal Protective Equipment Shortages. Acad Med 2021; 96:942. [PMID: 33656005 DOI: 10.1097/acm.0000000000004037] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Demitra A Canoutas
- Fourth-year medical student, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina;
| | - Alex Gregor
- Fourth-year medical student, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina; ORCID: https://orcid.org/0000-0002-3556-2260
| | - Alex K Gertner
- Fourth-year medical student, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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Abstract
PURPOSE Student-run clinics (SRCs) are increasingly recognized as an educational experience in many health professions' curricula. Several benefits have been documented, including students with SRC experience using patient-centered approaches to care, showing interest in working with marginalized populations, and more fully appreciating the care provided by interprofessional teams. Yet, few studies have explored student experiences within SRCs or examined how these experiences affect and shape these documented attitudes. This study explored the experiences of students at an SRC and the effect of these experiences on their learnings. METHOD From November 2016 to July 2017, 23 students in the Community Health Initiative by University Students SRC at the University of British Columbia participated in 2 focus group interviews: the first after their first clinic day and the second on their final clinic day. Open- and closed-ended questions were used to explore participants' learnings from the SRC. Using a grounded theory approach, the authors iteratively analyzed the transcribed interviews, adjusting questions for subsequent focus groups as new themes evolved. Three investigators each separately coded the data; the full team then collectively consolidated the themes and developed explanatory models for each theme. RESULTS Two themes were identified from the focus group input: (1) through managing real, complex patients-in situations unlike those offered in classroom and case-based learning environments-students gained insights into the intricacies of incorporating the patient's perspective into their definition and management of the patient's problem, and (2) by working as a team instead of focusing on delineating scopes of practice, students gained a meaningful understanding of the roles of practitioners from other health professions. CONCLUSIONS This study provides insights into the unique opportunities SRCs offer health care students early in their training, enabling them to develop a richer understanding and appreciation of holistic and interprofessional approaches to patient care.
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Affiliation(s)
- Kelly Huang
- K. Huang is a second-year resident, Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mona Maleki
- M. Maleki is a second-year resident, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Glenn Regehr
- G. Regehr is professor, Department of Surgery, and scientist, Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: https://orcid.org/0000-0002-3144-331X
| | - Heather McEwen
- H. McEwen is clinical associate professor, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
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Gruber A, Ghiringhelli M, Edri O, Abboud Y, Shiti A, Shaheen N, Ballan N, Neuberger A, Caspi O. Literature Review and Knowledge Distribution During an Outbreak: A Methodology for Managing Infodemics. Acad Med 2021; 96:1005-1009. [PMID: 33788792 DOI: 10.1097/acm.0000000000004073] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PROBLEM The COVID-19 pandemic has challenged health care systems in an unprecedented way by imposing new demands on health care resources and scientific knowledge. There has also been an exceedingly fast accumulation of new information on this novel virus. As the traditional peer-review process takes time, there is currently a significant gap between the ability to generate new data and the ability to critically evaluate them. This problem of an excess of mixed-quality data, or infodemic, is echoing throughout the scientific community. APPROACH The authors aimed to help their colleagues at the Rambam Medical Center, Haifa, Israel, manage the COVID-19 infodemic with a methodologic solution: establishing an in-house mechanism for continuous literature review and knowledge distribution (March-April 2020). Their methodology included the following building blocks: a dedicated literature review team, artificial intelligence-based research algorithms, brief written updates in a graphical format, large-scale webinars and online meetings, and a feedback loop. OUTCOMES During the first month (April 2020), the project produced 21 graphical updates. After consideration of feedback from colleagues and final editing, 13 graphical updates were uploaded to the center's website; of these, 31% addressed the clinical presentation of the disease and 38% referred to specific treatments. This methodology as well as the graphical updates it generated were adopted by the Israeli Ministry of Health and distributed in a hospital preparation kit. NEXT STEPS The authors believe they have established a novel methodology that can assist in the battle against COVID-19 by making high-quality scientific data more accessible to clinicians. In the future, they expect this methodology to create a favorable uniform standard for evidence-guided health care during infodemics. Further evolution of the methodology may include evaluation of its long-term sustainability and impact on the day-to-day clinical practice and self-confidence of clinicians who treat COVID-19 patients.
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Affiliation(s)
- Amit Gruber
- A. Gruber is an MD-PhD candidate, The B. Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Matteo Ghiringhelli
- M. Ghiringhelli is postdoctoral researcher, The B. Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Oded Edri
- O. Edri is an MD-PhD candidate, The B. Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Yousef Abboud
- Y. Abboud is a PhD candidate, The B. Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Assad Shiti
- A. Shiti is an MD-PhD candidate, The B. Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Naim Shaheen
- N. Shaheen is an MD-PhD candidate, The B. Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Nimer Ballan
- N. Ballan is an MD-PhD candidate, The B. Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ami Neuberger
- A. Neuberger is senior consultant for infectious diseases, Rambam Medical Center and The B. Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Oren Caspi
- O. Caspi is head of the advanced heart failure unit, Rambam Medical Center and The B. Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Abstract
IMPORTANCE There is widespread concern that clinical notes have grown longer and less informative over the past decade. Addressing these concerns requires a better understanding of the magnitude, scope, and potential causes of increased note length and redundancy. OBJECTIVE To measure changes between 2009 and 2018 in the length and redundancy of outpatient progress notes across multiple medical specialties and investigate how these measures associate with author experience and method of note entry. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted at Oregon Health & Science University, a large academic medical center. Participants included clinicians and staff who wrote outpatient progress notes between 2009 and 2018 for a random sample of 200 000 patients. Statistical analysis was performed from March to August 2020. EXPOSURES Use of a comprehensive electronic health record to document patient care. MAIN OUTCOMES AND MEASURES Note length, note redundancy (ie, the proportion of text identical to the patient's last note), and percentage of templated, copied, or directly typed note text. RESULTS A total of 2 704 800 notes written by 6228 primary authors across 46 specialties were included in this study. Median note length increased 60.1% (99% CI, 46.7%-75.2%) from a median of 401 words (interquartile range [IQR], 225-660 words) in 2009 to 642 words (IQR, 399-1007 words) in 2018. Median note redundancy increased 10.9 percentage points (99% CI, 7.5-14.3 percentage points) from 47.9% in 2009 to 58.8% in 2018. Notes written in 2018 had a mean value of just 29.4% (99% CI, 28.2%-30.7%) directly typed text with the remaining 70.6% of text being templated or copied. Mixed-effect linear models found that notes with higher proportions of templated or copied text were significantly longer and more redundant (eg, in the 2-year model, each 1% increase in the proportion of copied or templated note text was associated with 1.5% [95% CI, 1.5%-1.5%] and 1.6% [95% CI, 1.6%-1.6%] increases in note length, respectively). Residents and fellows also wrote significantly (26.3% [95% CI, 25.8%-26.7%]) longer notes than more senior authors, as did more recent hires (1.8% for each year later [95% CI, 1.3%-2.4%]). CONCLUSIONS AND RELEVANCE In this study, outpatient progress notes grew longer and more redundant over time, potentially limiting their use in patient care. Interventions aimed at reducing outpatient progress note length and redundancy may need to simultaneously address multiple factors such as note template design and training for both new and established clinicians.
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Affiliation(s)
- Adam Rule
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Steven Bedrick
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
| | - Michael F. Chiang
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Michelle R. Hribar
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
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Abstract
PURPOSE Developing medical students' clinical reasoning requires a structured longitudinal curriculum with frequent targeted assessment and feedback. Performance-based assessments, which have the strongest validity evidence, are currently not feasible for this purpose because they are time-intensive to score. This study explored the potential of using machine learning technologies to score one such assessment-the diagnostic justification essay. METHOD From May to September 2018, machine scoring algorithms were trained to score a sample of 700 diagnostic justification essays written by 414 third-year medical students from the Southern Illinois University School of Medicine classes of 2012-2017. The algorithms applied semantically based natural language processing metrics (e.g., coherence, readability) to assess essay quality on 4 criteria (differential diagnosis, recognition and use of findings, workup, and thought process); the scores for these criteria were summed to create overall scores. Three sources of validity evidence (response process, internal structure, and association with other variables) were examined. RESULTS Machine scores correlated more strongly with faculty ratings than faculty ratings did with each other (machine: .28-.53, faculty: .13-.33) and were less case-specific. Machine scores and faculty ratings were similarly correlated with medical knowledge, clinical cognition, and prior diagnostic justification. Machine scores were more strongly associated with clinical communication than were faculty ratings (.43 vs .31). CONCLUSIONS Machine learning technologies may be useful for assessing medical students' long-form written clinical reasoning. Semantically based machine scoring may capture the communicative aspects of clinical reasoning better than faculty ratings, offering the potential for automated assessment that generalizes to the workplace. These results underscore the potential of machine scoring to capture an aspect of clinical reasoning performance that is difficult to assess with traditional analytic scoring methods. Additional research should investigate machine scoring generalizability and examine its acceptability to trainees and educators.
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Affiliation(s)
- Anna T Cianciolo
- A.T. Cianciolo is associate professor of medical education, Southern Illinois University School of Medicine, Springfield, Illinois; ORCID: https://orcid.org/0000-0001-5948-9304
| | - Noelle LaVoie
- N. LaVoie is president, Parallel Consulting, Petaluma, California; ORCID: https://orcid.org/0000-0002-7013-3568
| | - James Parker
- J. Parker is senior research associate, Parallel Consulting, Petaluma, California
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Streed CG, Lunn MR, Siegel J, Obedin-Maliver J. Meeting the Patient Care, Education, and Research Missions: Academic Medical Centers Must Comprehensively Address Sexual and Gender Minority Health. Acad Med 2021; 96:822-827. [PMID: 32852319 DOI: 10.1097/acm.0000000000003703] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
While sociopolitical advances have improved the rights of sexual and gender minorities (i.e., lesbian, gay, bisexual, transgender, queer [LGBTQ+] persons), they continue to face a health system that discriminates against them and does not provide competent, comprehensive care. Despite calls for advancing research, there remains limited sexual and gender minority health research funding, mentorship, and institutional support. Academic medical centers are best suited to systematically tackle disparities and improve care for all sexual and gender minority people through their tripartite missions of patient care, education, and research. In this article, the authors outline discrimination experienced by LGBTQ+ persons and highlight the unique disparities they experience across access and outcomes. The authors posit that by systematically improving clinical care of, incorporating education and training about, and research with LGBTQ+ people into their core missions, academic medical centers can dramatically change the health care landscape. Academic medical centers can eliminate health disparities, expand necessary research endeavors about sexual and gender minorities, and prepare the health care workforce to address the unique needs of these overlooked populations.
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Affiliation(s)
- Carl G Streed
- C.G. Streed Jr is assistant professor of medicine, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, and research lead, Center for Transgender Medicine & Surgery, Boston Medical Center, Boston, Massachusetts; ORCID: http://orcid.org/0000-0003-3075-253X
| | - Mitchell R Lunn
- M.R. Lunn is assistant professor of medicine, Division of Nephrology, Department of Medicine, Stanford University School of Medicine, and co-director, The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California; ORCID: http://orcid.org/0000-0002-0068-0814
| | - Jennifer Siegel
- J. Siegel is assistant professor of medicine, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, associate program director, Internal Medicine Residency Program, Boston Medical Center, and medical director, Center for Transgender Medicine & Surgery, Boston Medical Center, Boston, Massachusetts; ORCID: https://orcid.org/0000-0002-5517-8004
| | - Juno Obedin-Maliver
- J. Obedin-Maliver is assistant professor, Department of Obstetrics and Gynecology, Stanford University School of Medicine, and co-director, The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California; ORCID: http://orcid.org/0000-0002-0945-2842
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Abstract
Advancing equity for women remains an urgent and complex problem at academic health centers. Attempts to mitigate gender gaps have ranged widely and have been both slow to occur and limited in effect. Recognizing the limitations of previously attempted solutions and fueled by the #MeToo and #TimesUp movements, the Medical College of Wisconsin (MCW) stepped outside known approaches (e.g., women's leadership plans and programming) to design and implement a strategic campaign that promotes gender equity through fostering change in systems and social norms. This campaign, IWill MCW (launched in 2019), emphasizes the power of individual responsibility for positive change. The IWill MCW campaign employs a 2-pronged approach. The first is the creation of personal call-to-action public pledges focused on 5 aspects of gender equity, along with the provision of supportive resources to reinforce positive change. The second is the use of those pledges to raise awareness of gender inequity in academic medicine by fostering meaningful dialogue meant to alter mental models of equity, relationships, and power dynamics. In the initial 6-week phase of the IWill MCW campaign, leaders reached out to all MCW faculty (2,002), staff (4,522), and learners (1,483) at multiple campuses. This outreach resulted in nearly 1,400 pledges, including 30% (n = 420) from men. The effort also engaged over 90% (n = 101) of members of MCW senior leadership teams. The feedback from the initial campaign has been positive. Lessons learned include realizing the importance of public pledges, engaging male allies, and following up. The authors suggest that the IWill MCW campaign provides a model for academic health centers to advance gender equity and shape an environment in which people of all genders can thrive.
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Affiliation(s)
- Cheryl A Maurana
- C.A. Maurana is professor of population health, senior vice president, Strategic Academic Partnerships, and founding director and board member, Kern National Network for Caring and Character in Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John R Raymond
- J.R. Raymond Sr is professor of medicine and president and chief executive officer, Medical College of Wisconsin, Milwaukee, Wisconsin; ORCID: https://orcid.org/0000-0001-9056-6654
| | - Joseph E Kerschner
- J.E. Kerschner is professor of otolaryngology and communication sciences, executive vice president, provost, and dean, the School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Elizabeth H Ellinas
- E.H. Ellinas is professor of anesthesiology, associate dean for women's leadership, and director, Center for the Advancement of Women in Science and Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; ORCID: https://orcid.org/0000-0002-7280-1355
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Abstract
IMPORTANCE How the COVID-19 pandemic has affected academic medicine faculty's work-life balance is unknown. OBJECTIVE To assess the association of perceived work-life conflict with academic medicine faculty intention to leave, reducing employment to part time, or declining leadership opportunities before and since the COVID-19 pandemic. DESIGN, SETTINGS, AND PARTICIPANTS An anonymous online survey of medical, graduate, and health professions school faculty was conducted at a single large, urban academic medical center between September 1 and September 25, 2020. MAIN OUTCOMES AND MEASURES Self-assessed intention to leave, reducing employment to part time, or turning down leadership opportunities because of work-life conflict before and since the COVID-19 pandemic. RESULTS Of the 1186 of 3088 (38%) of faculty members who answered the survey, 649 (55%) were women and 682 (58%) were White individuals. Respondents were representative of the overall faculty demographic characteristics except for an overrepresentation of female faculty respondents and underrepresentation of Asian faculty respondents compared with all faculty (female faculty: 649 [55%] vs 1368 [44%]; Asian faculty: 259 [22%] vs 963 [31%]). After the start of the COVID-19 pandemic, faculty were more likely to consider leaving or reducing employment to part time compared with before the pandemic (leaving: 225 [23%] vs 133 [14%]; P < .001; reduce hours: 281 [29%] vs 206 [22%]; P < .001). Women were more likely than men to reduce employment to part time before the COVID-19 pandemic (153 [28%] vs 44 [12%]; P < .001) and to consider both leaving or reducing employment to part time since the COVID-19 pandemic (leaving: 154 [28%] vs 56 [15%]; P < .001; reduce employment: 215 [40%] vs 49 [13%]; P < .001). Faculty with children were more likely to consider leaving and reducing employment since the COVID-19 pandemic compared with before the pandemic (leaving: 159 [29%] vs 93 [17%]; P < .001; reduce employment: 213 [40%] vs 130 [24%]; P < .001). Women with children compared with women without children were also more likely to consider leaving since the COVID-19 pandemic than before (113 [35%] vs 39 [17%]; P < .001). Working parent faculty and women were more likely to decline leadership opportunities both before (faculty with children vs without children: 297 [32%] vs 84 [9%]; P < .001; women vs men: 206 [29%] vs 47 [13%]; P < .001) and since the COVID-19 pandemic (faculty with children vs faculty without children: 316 [34%] vs 93 [10 %]; P < .001; women vs men: 148 [28%] vs 51 [14%]; P < .001). CONCLUSIONS AND RELEVANCE In this survey study, the perceived stressors associated with work-life integration were higher in women than men, were highest in women with children, and have been exacerbated by the COVID-19 pandemic. The association of both gender and parenting with increased perceived work-life stress may disproportionately decrease the long-term retention and promotion of junior and midcareer women faculty.
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Affiliation(s)
- Susan A. Matulevicius
- Office of Faculty Affairs, The University of Texas Southwestern, Dallas
- Department of Internal Medicine, The University of Texas Southwestern, Dallas
| | - Kimberly A. Kho
- Department of Obstetrics and Gynecology, The University of Texas Southwestern, Dallas
| | - Joan Reisch
- Department of Population and Data Sciences, The University of Texas Southwestern, Dallas
| | - Helen Yin
- Office of Faculty Affairs, The University of Texas Southwestern, Dallas
- Department of Physiology, The University of Texas Southwestern, Dallas
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Odei BC, Jagsi R, Diaz DA, Addison D, Arnett A, Odei JB, Mitchell D. Evaluation of Equitable Racial and Ethnic Representation Among Departmental Chairs in Academic Medicine, 1980-2019. JAMA Netw Open 2021; 4:e2110726. [PMID: 34009350 PMCID: PMC8134999 DOI: 10.1001/jamanetworkopen.2021.10726] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This cross-sectional study evaluates racial and ethnic representation among departmental chairs and faculty in academic medicine in the US from 1980 to 2019.
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Affiliation(s)
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | | | - Daniel Addison
- Department of Cardiology, Ohio State University, Columbus
| | | | - James B. Odei
- Ohio State University College of Public Health, Columbus
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Abstract
This article describes how a national nursing association and a major academic medical center responded to the coronavirus disease-2019 (COVID-19) pandemic during the first wave of the outbreak in the United States (January to August 2020). The organizations share their lived experiences as they quickly found themselves at the forefront of the crisis. The article discusses how early warning signs from a world away sparked collaboration, innovation, and action that grew to a coordinated, organization-wide response. It also explores how leaders in 2 distinct but interrelated environments rose to the challenge to leverage the best their organizations had to offer, relying on the expertise of each to navigate changes that were made to almost every aspect of work. From tentative first steps to rapid implementation of innovative policies and procedures, the organizations share lessons learned and benefits reaped. The article includes practical crisis response strategies for the nursing profession and health care systems moving forward.
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Affiliation(s)
- Rebecca Graystone
- American Nurses Credentialing Center, Silver Spring, Maryland (Ms Graystone); NewYork-Presbyterian/Columbia University Irving Medical Center, Allen/Ambulatory Care Network West, New York (Drs Hartman and Vose); and Columbia University School of Nursing, New York (Dr Vose)
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Griffith CH, de Beer F, Edwards RL, Smith C, Colvin G, Karpf M. Addressing Kentucky's Physician Shortage While Securing a Network for a Research-Intensive, Referral Academic Medical Center: Where Public Policy Meets Effective Clinical Strategic Planning. Acad Med 2021; 96:375-380. [PMID: 33661849 DOI: 10.1097/acm.0000000000003582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A critical shortage of physicians is looming in the United States. The situation in Kentucky is especially dire, especially in rural areas. Class size constraints have resulted in the University of Kentucky College of Medicine (UK COM) unable to admit over 100 qualified Kentuckians each year. This article describes how leadership at University of Kentucky committed to addressing the state physician shortage while simultaneously strengthening relationships with critical partners through the establishment of two 4-year UK COM regional medical campuses. Based on criteria (such as a commitment to educating physicians, ample patients, sufficient willing physician preceptors, etc.), partners selected were Med Center Health, the leading health care system in southwestern Kentucky, and St. Elizabeth Healthcare, the predominant health care system in northern Kentucky. These regional campuses allow UK COM to expand its class size to 201 and total enrollment to 804, increasing from historically 70 to currently 120 graduates per year expected to practice in Kentucky. Critical to the success of this expansion is the buy-in of leadership and the Admissions Committee to consider students with a wider range of Medical College Admission Test scores. The regional clinical partners have substantially increased their teaching opportunities, with a greater ability to attract physicians. Both partners have made substantial financial contributions in support of the regional campuses. These relationships have energized UK COM engagement with its area alumni and have resulted in fewer Kentuckians referred out of state for advanced specialty care. Partnerships are also occurring with UK COM to increase graduate medical education offerings at the regional sites, fulfilling the vision of "training Kentuckians in Kentucky to practice in Kentucky."
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Affiliation(s)
- Charles H Griffith
- C.H. Griffith III is vice dean for education and professor of internal medicine and pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Fred de Beer
- F. de Beer is dean emeritus and professor of internal medicine, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Robert L Edwards
- R.L. Edwards is associate vice president, Health System Administration, and chief external affairs officer, UK HealthCare, Lexington, Kentucky
| | - Connie Smith
- C. Smith is president and chief executive officer, Med Center Health, Bowling Green, Kentucky
| | - Garren Colvin
- G. Colvin is president and chief executive officer, St. Elizabeth Healthcare, Edgewood, Kentucky
| | - Michael Karpf
- M. Karpf is advisor to the president and professor of internal medicine, University of Kentucky, Lexington, Kentucky
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Ntusi NAB. Response to COVID-19 in a large academic Centre in South Africa. Eur Heart J 2021; 42:805-807. [PMID: 33247902 PMCID: PMC7799049 DOI: 10.1093/eurheartj/ehaa919] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Corresponding author. Prof. Ntobeko Ntusi, Chair and Head: Department of Medicine, University of Cape Town and Groote Schuur Hospital, J46.53, Old Main Building, Groote Schuur Hospital, Main Road, Observatory, 7925, South Africa, Tel: +27 21 406 6200,
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Abstract
SUMMARY STATEMENT Simulation played a critical role in our institution's response to the COVID-19 pandemic in New York City. With the rapid influx of critically ill patients, resource limitations, and presented safety concerns, simulation became a vital tool that provided solutions to the many challenges we faced. In this article, we describe how simulation training was deployed at our institution throughout the course of the pandemic, which included the period of our medical surge. Simulation helped refine protocols, facilitate practice changes, uncover safety gaps, and train redeployed healthcare workers in unfamiliar roles. We also discuss the obstacles we encountered with implementing simulations during the pandemic, the measures we took to adapt to our limitations, and the simulation strategies and end products that were derived from these adaptations.
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Shanafelt TD, Wang H, Leonard M, Hawn M, McKenna Q, Majzun R, Minor L, Trockel M. Assessment of the Association of Leadership Behaviors of Supervising Physicians With Personal-Organizational Values Alignment Among Staff Physicians. JAMA Netw Open 2021; 4:e2035622. [PMID: 33560424 PMCID: PMC7873777 DOI: 10.1001/jamanetworkopen.2020.35622] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Although misalignment of values between physicians and their organization is associated with increased risk of burnout, actionable organizational factors that contribute to perceived values alignment are poorly understood. OBJECTIVE To evaluate the association between the leadership behaviors of immediate supervisors and physicians' perception of personal-organizational values alignment. DESIGN, SETTING, AND PARTICIPANTS This survey study of faculty physicians and physician leaders at Stanford University School of Medicine was conducted from April 1 to May 13, 2019. The survey included assessments of perceived personal-organizational values alignment, professional fulfillment, and burnout. Physicians also evaluated the leadership behaviors of their immediate supervisor (eg, division chief) using a standardized assessment. Data analysis was performed from May to December 2020. MAIN OUTCOMES AND MEASURES Association between mean leadership behavior score (range, 0-10) of each supervisor and the mean personal-organizational values alignment scores (range, 0-12) for the physicians in their work unit. RESULTS Of 1924 physicians eligible to participate, 1285 (67%) returned surveys. Among these, 651 (51%) were women and 729 (57%) were aged 40 years or older. Among the 117 physician leaders evaluated, 66 (56%) had their leadership behavior independently evaluated by at least 5 physicians and were included in analyses. The mean (SD) personal-organizational values alignment score on the 0 to 12 scale was 6.19 (3.21). As the proportion of work effort devoted to clinical care increased, values alignment scores decreased. Personal-organizational values alignment scores demonstrated an inverse correlation with burnout (r = -0.39; P < .001) and a positive correlation with professional fulfillment (r = 0.52; P < .001). The aggregate leader behavior score of the 66 leaders evaluated correlated with the mean values alignment score for physicians in their work unit (r = 0.53; P < .001). Aggregate leader behavior score was associated with 21.6% of the variation in personal-organizational values alignment scores between work units. After adjusting for age, gender, academic rank, work hours, physician-leader gender concordance, and time devoted to clinical care, each 1-point increase in leadership score of immediate supervisor was associated with a 0.56-point (95% CI, 0.46-0.66; P < .001) increase in personal-organizational values alignment score. CONCLUSIONS AND RELEVANCE This survey study's results suggest that physicians experience their organization through the prism of their work unit leader. Organizational efforts to improve values alignment should attend to the development of first-line physician leaders.
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Affiliation(s)
- Tait D. Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Hanhan Wang
- WellMD Center, Stanford University School of Medicine, Stanford, California
| | - Mary Leonard
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Mary Hawn
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Quinn McKenna
- Stanford Health Care, Stanford Medicine, Stanford, California
| | - Rick Majzun
- Stanford Children's Health/Lucile Packard Children's Hospital, Stanford Medicine, Stanford, California
| | - Lloyd Minor
- Department of Otolaryngology, Stanford University School of Medicine, Stanford, California
| | - Mickey Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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Abuali M, Bonner R, Irigoyen M. Operationalizing an academic pediatric practice during the COVID-19 crisis. Am J Infect Control 2021; 49:226-228. [PMID: 32652255 PMCID: PMC7343646 DOI: 10.1016/j.ajic.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 11/25/2022]
Abstract
We report on innovating protocols at an Academic Pediatric practice during the COVID-19 (2019 novel coronavirus) crisis. Facing the challenges of limited personal protective equipment and testing capacity, we rapidly and efficiently changed processes to optimize infection control, providing safe and effective care for our vulnerable population.
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Affiliation(s)
- Mayssa Abuali
- Einstein Medical Center Philadelphia, Philadelphia, PA, USA.
| | - Robert Bonner
- Einstein Medical Center Philadelphia, Philadelphia, PA, USA
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Seifert T, Becker T, Büttcher AF, Herwig N, Raupach T. Restructuring the clinical curriculum at University Medical Center Göttingen: effects of distance teaching on students' satisfaction and learning outcome. GMS J Med Educ 2021; 38:Doc1. [PMID: 33659606 PMCID: PMC7899111 DOI: 10.3205/zma001397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/16/2020] [Accepted: 11/24/2020] [Indexed: 05/28/2023]
Abstract
Introduction: In summer term 2020, the clinical phase of the undergraduate medical curriculum at University Medical Center Göttingen was restructured since distance teaching had to be used predominantly due to contact restrictions during the COVID-19 pandemic. This paper investigates the impact of restructuring the clinical curriculum on medical students' satisfaction and learning outcomes. Methods: In each cohort, the 13-week curriculum was divided into two parts: During the first 9 weeks, factual knowledge was imparted using distance teaching by means of a modified inverted classroom approach. This was followed by a 4-week period of adapted classroom teaching involving both real and virtual patients in order to train students' practical skills. The evaluation of the 21 clinical modules comprised students' satisfaction with distance teaching as well as students' learning outcome. The latter was assessed by means of comparative self-assessment (CSA) gain and the results of the module exams, respectively. Data of summer term 2020 (= distance teaching, DT) were compared with respective data of winter term 2019/20 (= classroom teaching, CT) and analysed for differences and correlations. Results: Response rates of evaluations were 51.3% in CT and 19.3% in DT. There was no significant difference between mean scores in module exams in CT and DT, respectively. However, CSA gain was significantly lower in DT (p=0.047) compared with CT. Further analyses revealed that CSA gain depended on the time point of data collection: CSA gain was lower the more time had passed since the end of a specific module. Moreover, we found positive correlations between CSA gain and students' satisfaction with various aspects of distance teaching, particularly with "communication between teachers and students" (rho=0.674; p=0.002). Discussion and conclusions: Although some limitations and confounding factors have to be taken into account (such as evaluation response rates, assessment time points, and proportion of familiar items in module exams), the following recommendations can be derived from our findings: A valid assessment of students' learning outcome by means of exam results requires that as few exam items as possible are familiar to the students. CSA gain seems to be valid if assessment time points are standardised and not contaminated by students' learning activities for other modules. Good communication between teachers and students may contribute to increase students' satisfaction with distance teaching.
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Affiliation(s)
- Theresa Seifert
- Universitätsmedizin Göttingen, Bereich Medizindidaktik und Ausbildungsforschung, Göttingen, Germany
| | - Tim Becker
- Universitätsmedizin Göttingen, Bereich Medizindidaktik und Ausbildungsforschung, Göttingen, Germany
| | | | - Nadine Herwig
- Universitätsmedizin Göttingen, Bereich Medizindidaktik und Ausbildungsforschung, Göttingen, Germany
| | - Tobias Raupach
- Universitätsmedizin Göttingen, Bereich Medizindidaktik und Ausbildungsforschung, Göttingen, Germany
- Universitätsmedizin Göttingen, Klinik für Kardiologie und Pneumologie, Göttingen, Germany
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Chen J, Goldstein IH, Lin WC, Chiang MF, Hribar MR. Application of Machine Learning to Predict Patient No-Shows in an Academic Pediatric Ophthalmology Clinic. AMIA Annu Symp Proc 2021; 2020:293-302. [PMID: 33936401 PMCID: PMC8075453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Patient "no-shows" are missed appointments resulting in clinical inefficiencies, revenue loss, and discontinuity of care. Using secondary electronic health record (EHR) data, we used machine learning to predict patient no-shows in follow-up and new patient visits in pediatric ophthalmology and to evaluate features for importance. The best model, XGBoost, had an area under the receiver operating characteristics curve (AUC) score of 0.90 for predicting no-shows in follow-up visits. The key findings from this study are: (1) secondary use of EHR data can be used to build datasets for predictive modeling and successfully predict patient no-shows in pediatric ophthalmology, (2) models predicting no-shows for follow-up visits are more accurate than those for new patient visits, and (3) the performance of predictive models is more robust in predicting no-shows compared to individual important features. We hope these models will be used for more effective interventions to mitigate the impact ofpatient no-shows.
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Affiliation(s)
- Jimmy Chen
- Department of Ophthalmology, Casey Eye Institute, and
| | | | - Wei-Chun Lin
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR
| | - Michael F Chiang
- Department of Ophthalmology, Casey Eye Institute, and
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR
| | - Michelle R Hribar
- Department of Ophthalmology, Casey Eye Institute, and
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR
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Kuczero JL, Staffileno BA, Grenier JM. Evaluation of a Bed Reaggregation Initiative at an Urban Academic Medical Center. J Nurs Adm 2021; 51:19-25. [PMID: 33278197 DOI: 10.1097/nna.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Hospital flow disruptions have been linked to treatment delays, longer length of stay (LOS), poor patient outcomes, and overburdened staff leading to disengagement. OBJECTIVE This project was designed to evaluate and determine if the bed reaggregation was successful at meeting its goals. METHODS Donabedian's framework guided the following evaluation points: 1) patient placement accuracy, 2) LOS variance, 3) emergency department (ED) boarding times, 4) hospital bypass hours, 5) operational declination rates, 6) patient satisfaction, and 7) RN engagement. Data were analyzed using pre-post percent change and χ analysis. RESULTS Primary placement of patients, LOS variance, and operational declinations improved. Hours on bypass and ED boarding times were not reduced. RN engagement scores varied widely with significant decreases on 2 of the reaggregated units. Patient satisfaction scores varied, but overall did not decrease. CONCLUSION Further consideration is needed for improving hospital bypass, ED boarding times, and RN engagement.
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Affiliation(s)
- Jennifer L Kuczero
- Author Affiliations: Adult-Gerontology Acute Care Nurse Practitioner Graduate (Dr Kuczero), Rush University; and Professor, Adult Health & Gerontological Nursing (Dr Staffileno), College of Nursing, and Codirector, Center for Clinical Research & Scholarship; and Associate Chief Nursing Officer (Dr Grenier), MacNeal Hospital, Berwyn, Illinois
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