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Mundo W, Vaughn J, Odetunde A, Donovan T, Alvarez A, Smith K, Brown C, Brown I, Datta S, Vora S, Ward‐Gaines J. A national pilot study on simulation-based upstander training for emergency medicine clinicians. AEM EDUCATION AND TRAINING 2024; 8:e10990. [PMID: 38800608 PMCID: PMC11125567 DOI: 10.1002/aet2.10990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 05/29/2024]
Abstract
Objective This study assesses the effectiveness of clinical simulation-based training in boosting self-perceived confidence for using upstander communication skills to confront racism, discrimination, and microaggressions (RDM). Methods We conducted an observational cohort study with emergency medicine professionals at the 2023 Scientific Assembly of the American Academy of Emergency Medicine in New Orleans, Louisiana. The study featured a clinical simulation-based training on upstander communications skills session followed by small- and large-group debriefs. Participants completed pre- and post-training questionnaires assessing demographics and confidence in health equity competencies. This survey was used in a previous study with emergency medicine residents. Data were analyzed using an independent Student's t-test, with a significance threshold of 0.05. Results Thirty-two individuals participated in the simulation-based training, and 24 completed surveys, with a 75% response rate. Most participants were non-Hispanic (24, 85.7%) and women (18, 64%), with racial demographics mostly White (8, 28.6%), Black or African American (8, 28.6%), and Asian (6, 21.4%). After the workshop, there was a notable increase in self-perceived ability and confidence in identifying RDM (from 7 ± 3.2 to 8.6 ± 1.6, p < 0.003), using upstander communication tools (from 6.1 ± 3.5 to 8.5 ± 1, p < 0.0001), and the likelihood of intervening in RDM situations (from 7.1 ± 3.3 to 8.8 ± 1.1, p < 0.0002). Conclusions The clinical simulation-based training significantly improved participants' confidence and self-perceived ability to address RDM in simulated clinical environments. This training method is a promising tool for teaching health equity topics in clinical medicine.
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Affiliation(s)
- William Mundo
- Department of Emergency MedicineDenver Health Hospital and AuthorityDenverColoradoUSA
| | - Jordan Vaughn
- Department of Emergency MedicineLSU Spirit of CharityNew OrleansLouisianaUSA
| | | | - Tai Donovan
- Windsor University School of MedicineCayon St. Kitts CampusCayonSt. Kitts & Nevis
| | - Al'ai Alvarez
- Department of Emergency MedicineStanford UniversityStanfordCaliforniaUSA
| | - Kristyn Smith
- Department of Emergency MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Cortlyn Brown
- Department of Emergency MedicineAtrium Health CarolinasCharlotteNorth CarolinaUSA
| | - Italo Brown
- Department of Emergency MedicineStanford UniversityStanfordCaliforniaUSA
| | - Suchismita Datta
- Department of Emergency MedicineNYU Langone Long Island Hospital, NYCMineolaNew YorkUSA
| | - Samreen Vora
- Department of Emergency MedicineYale UniversityNew HavenConnecticutUSA
| | - Jacqueline Ward‐Gaines
- Department of Emergency MedicineUniversity of Colorado, School of MedicineAuroraColoradoUSA
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Ordonez E, Bradby C, Carey J, Gupta S, Hiller KM, Miller D, Pierce A, Wiesendanger K, Moffett S. Beyond diversity and inclusion: Developing a research agenda for anti-racism in emergency medicine education. AEM EDUCATION AND TRAINING 2023; 7:S68-S77. [PMID: 37383834 PMCID: PMC10294218 DOI: 10.1002/aet2.10876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 06/30/2023]
Abstract
Background Addressing racism in emergency medicine education is vital for providing optimal training and assessment of physicians in the specialty, developing physicians with the skills necessary to advocate for their patients, and recruiting and retaining a diverse group of physicians. To form a prioritized research agenda, the Society of Academic Emergency Medicine (SAEM) conducted a consensus conference at the annual meeting in May 2022 on addressing racism in emergency medicine, which included a subgroup on education. Methods The education workgroup worked on summarizing the current literature on addressing racism in emergency medicine education, identifying critical knowledge gaps, and creating a consensus-driven research agenda for addressing racism in emergency medicine education. We used a nominal group technique and modified Delphi to develop priority questions for research. We then distributed a pre-conference survey to conference registrants to rate priority areas for research. During the consensus conference, group leaders provided an overview and background describing the rationale for the preliminary research question list. Attendees were then involved in discussions to help modify and develop research questions. Results Nineteen questions were initially selected by the education workgroup as potential areas for research. The education workgroup's next round of consensus building resulted in a consensus of ten questions to be included in the pre-conference survey. No questions in the pre-conference survey reached consensus. After robust discussion and voting by workgroup members and attendees at the consensus conference, six questions were determined to be priority research areas. Conclusions We believe recognizing and addressing racism in emergency medicine education is imperative. Critical gaps in curriculum design, assessment, bias training, allyship, and the learning environment negatively impact training programs. These gaps must be prioritized for research as they can have adverse effects on recruitment, the ability to promote a safe learning environment, patient care, and patient outcomes.
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Affiliation(s)
- Edgardo Ordonez
- Henry JN Taub Department of Emergency MedicineBaylor College of MedicineHoustonTexasUSA
| | - Cassandra Bradby
- Department of Emergency MedicineThe Brody School of Medicine at East Carolina UniversityGreenvilleNorth CarolinaUSA
| | - Jennifer Carey
- Department of Emergency MedicineUMass Chan Medical SchoolWorcesterMassachusettsUSA
| | - Sanjey Gupta
- Department of Emergency MedicineZucker School of Medicine at Hofstra/NorthwellBayshoreNew YorkUSA
| | - Katherine M. Hiller
- Department of Emergency MedicineIndiana University School of MedicineBloomingtonIndianaUSA
| | - Danielle Miller
- Department of Emergency MedicineUniversity of Colorado School of MedicineDenverColoradoUSA
| | - Ava Pierce
- Division of Emergency MedicineUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Kathryn Wiesendanger
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Shannon Moffett
- Department of Emergency MedicineRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
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Tsuchida R, Doan J, Losman E, Haggins A, Huang R, Hekman D, Perry M. Cultural Humility Curriculum to Address Healthcare Disparities for Emergency Medicine Residents. West J Emerg Med 2023; 24:119-126. [PMID: 36976587 PMCID: PMC10047734 DOI: 10.5811/westjem.2023.1.58366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/10/2023] [Indexed: 03/20/2023] Open
Abstract
Introduction: Emergency medicine (EM) residency programs have variable approaches to educating residents on recognizing and managing healthcare disparities. We hypothesized that our curriculum with resident-presented lectures would increase residents’ sense of cultural humility and ability to identify vulnerable populations.
Methods: At a single-site, four-year EM residency program with 16 residents per year, we designed a curriculum intervention from 2019-2021 where all second-year residents selected one healthcare disparity topic and gave a 15-minute presentation overviewing the disparity, describing local resources, and facilitating a group discussion. We conducted a prospective observational study to assess the impact of the curriculum by electronically surveying all current residents before and after the curriculum intervention. We measured attitudes on cultural humility and ability to identify healthcare disparities among a variety of patient characteristics (race, gender, weight, insurance, sexual orientation, language, ability, etc). Statistical comparisons of mean responses were calculated using the Mann-Whitney U test for ordinal data.
Results: A total of 32 residents gave presentations that covered a broad range of vulnerable patient populations including those that identify as Black, migrant farm workers, transgender, and deaf. The overall survey response was 38/64 (59.4%) pre-intervention and 43/64 (67.2%) post-intervention. Improvements were seen in resident self-reported cultural humility as measured by their responsibility to learn (mean responses of 4.73 vs 4.17; P < 0.001) and responsibility to be aware of different cultures (mean responses of 4.89 vs 4.42; P < 0.001). Residents reported an increased awareness that patients are treated differently in the healthcare system based on their race (P < 0.001) and gender (P < 0.001). All other domains queried, although not statistically significant, demonstrated a similar t rend.
Conclusion: This study demonstrates increased resident willingness to engage in cultural humility and the feasibility of resident near-peer teaching on a breadth of vulnerable patient populations seen in their clinical environment. Future studies may query the impact this curriculum has on resident clinical decision-making.
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Affiliation(s)
- Ryan Tsuchida
- University of Wisconsin, School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, Madison, Wisconsin
| | - Jessica Doan
- University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Eve Losman
- University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Adrianne Haggins
- University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Robert Huang
- University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan
| | - Daniel Hekman
- University of Wisconsin, School of Medicine and Public Health, BerbeeWalsh Department of Emergency Medicine, Madison, Wisconsin
| | - Marcia Perry
- University of Michigan Medical School, Department of Emergency Medicine, Ann Arbor, Michigan
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Ellis J, Landry AM, Darling A, Cabrera P, Ullman E, Grossestreuer AV, Dubosh NM. Racial disparities in emergency medicine: Implementation of a novel educational module in the emergency medicine clerkship. AEM EDUCATION AND TRAINING 2023; 7:e10837. [PMID: 36777103 PMCID: PMC9899628 DOI: 10.1002/aet2.10837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 11/02/2022] [Accepted: 11/09/2022] [Indexed: 06/18/2023]
Abstract
Objectives Despite decades of literature recognizing racial disparities (RDs) in emergency medicine (EM), published curricula dedicated to addressing them are sparse. We present details of our novel RD curriculum for EM clerkships and its educational outcomes. Methods We created a 30-min interactive didactic module on the topic designed for third- and fourth-year medical students enrolled in our EM clerkships. Through a modified Delphi process, education faculty and content experts in RD developed a 10-question multiple-choice test of knowledge on RD that the students completed immediately prior to and 2 weeks following the activity. Students also completed a Likert-style learner satisfaction survey. Median pre- and posttest scores were compared using a paired Wilcoxon signed-rank test and presented using medians and 95% confidence intervals (CIs). Satisfaction survey responses were dichotomized into favorable and neutral/not favorable. Results For the 36 students who completed the module, the median pretest score was 40% (95% CI 36%-50%) and the posttest score was 70% (95% CI 60%-70%) with a p-value of <0.001. Thirty-five of the 36 students improved on the posttest with a mean increase of 24.2% (95% CI 20.2-28.2). The satisfaction survey also showed a positive response, with at least 83% of participants responding favorably to all statements (overall mean favorable response 93%, 95% CI 90%-96%).ConclusionsThis EM-based module on RD led to improvement in students' knowledge on the topic and positive reception by participants. This is a feasible option for educating students in EM on the topic of RD.
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Affiliation(s)
- Joshua Ellis
- Department of Emergency MedicineBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
| | - Alden M. Landry
- Department of Emergency MedicineBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
| | - Alanna Darling
- Department of Emergency MedicineBaystate Medical CenterSpringfieldMassachusettsUSA
| | - Payton Cabrera
- Department of Emergency MedicineBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Edward Ullman
- Department of Emergency MedicineBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
| | - Anne V. Grossestreuer
- Department of Emergency MedicineBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
| | - Nicole M. Dubosh
- Department of Emergency MedicineBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMassachusettsUSA
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Akhetuamhen AI, Ibiebele AL, Leibowitz MK, Welch SB, Campbell M, Shakeri N, Bailitz JM. A novel emergency medicine cultural competency curriculum addressing health care disparities. AEM EDUCATION AND TRAINING 2022; 6:e10815. [PMID: 36425792 PMCID: PMC9677360 DOI: 10.1002/aet2.10815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/22/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
Background Effective cultural competency (CC) training for future health professionals is an important first step towards improving healthcare disparities (HCD). The Accreditation Council for Graduate Medical Education (ACGME) now requires that institutions train residents and faculty members in CC relevant to the patient population they serve. Methods Using Kern's Model, we created and implemented a novel CC curriculum tailored to specific program needs in an emergency medicine residency program. Results At the end of the curriculum, respondents reported having a better understanding of the importance of CC for their practice (p = 0.004) and of how a patient's personal and historical context affects treatment (p = 0.002). They also reported an increase in the frequency of practicing strategies to reduce bias in themselves (p < 0.001) and others (p < 0.001), as well as comfort interacting with and treating patients from different backgrounds (p < 0.001). Lastly, they reported improved preparedness to collaborate with communities to address HCD (p = 0.004) and to identify community leaders to do so (p < 0.001). Conclusions The challenges of CC training demonstrate the need for a standard yet adaptable framework. We have designed, implemented, and evaluated a novel curriculum tailored to the specific needs of our EM residency program. The curriculum improved participants' attitudes, preparedness, and self-reported behaviors regarding CC and HCD. This framework represents an example of a successful model to meet ACGME requirements.
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Lie Ken Jie C, Finn YF, Bish M, Carlson E, Kumlien C, Chan EA, Leung DY. Mechanisms Driving Postgraduate Health and Social Science Students' Cultural Competence: An Integrated Systematic Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1707-1721. [PMID: 35476677 PMCID: PMC9592147 DOI: 10.1097/acm.0000000000004714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The COVID-19 pandemic revealed a global urgency to address health care provision disparities, which have largely been influenced by systematic racism in federal and state policies. The World Health Organization recommends educational institutions train clinicians in cultural competence (CC); however, the mechanisms and interacting social structures that influence individuals to achieve CC have received little attention. This review investigates how postgraduate health and social science education approaches CC and how it accomplishes (or not) its goals. METHOD The authors used critical realism and Whittemore and Knafl's methods to conduct a systematic integrated review. Seven databases (MEDLINE, CINAHL, PsycINFO, Scopus, PubMed, Web of Science, and ERIC) were searched from 2000 to 2020 for original research studies. Inclusion criteria were: the use of the term "cultural competence" and/or any one of Campinha-Bacote's 5 CC factors, being about postgraduate health and/or social science students, and being about a postgraduate curriculum or a component of it. Thematic analysis was used to reveal the mechanisms and interacting social structures underlying CC. RESULTS Thirty-two studies were included and 2 approaches to CC (themes) were identified. The first theme was professionalized pedagogy, which had 2 subthemes: othering and labeling. The second theme was becoming culturally competent, which had 2 subthemes: a safe CC teaching environment and social interactions that cultivate reflexivity. CONCLUSIONS CC conceptualizations in postgraduate health and social science education tend to view cultural differences as a problem and CC skills as a way to mitigate differences to enhance patient care. However, this generates a focus on the other, rather than a focus on the self. Future research should explore the extent to which insight, cognitive flexibility, and reflexivity, taught in safe teaching environments, are associated with increasing students' cultural safety, cultural humility, and CC.
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Affiliation(s)
- Christopher Lie Ken Jie
- C. Lie Ken Jie is a medical student, School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Galway, Ireland
| | - Yvonne F. Finn
- Y.F. Finn is a lecturer, clinical skills and clinical methods, School of Medicine, and vice dean for internationalization, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Galway, Ireland; ORCID: https://orcid.org/0000-0002-9935-8453
| | - Melanie Bish
- M. Bish is associate professor, associate head, and director of academic partnerships, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia; ORCID: https://orcid.org/0000-0003-4305-6760
| | - Elisabeth Carlson
- E. Carlson is professor, Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden; ORCID: https://orcid.org/0000-0003-0077-9061
| | - Christine Kumlien
- C. Kumlien is professor and vice dean, Department of Care Science, Faculty of Health and Society, Malmö University, and Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden; ORCID: https://orcid.org/0000-0002-1437-5060
| | - E. Angela Chan
- E.A. Chan is associate professor and associate head of undergraduate education, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong; ORCID: https://orcid.org/0000-0003-4411-6200
| | - Doris Y.L. Leung
- D.Y.L. Leung is adjunct assistant professor, School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong; ORCID: https://orcid.org/0000-0002-9636-3118
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Hart A, Romney D, Sarin R, Mechanic O, Hertelendy AJ, Larson D, Rhone K, Sidel K, Voskanyan A, Ciottone GR. Developing Telemedicine Curriculum Competencies for Graduate Medical Education: Outcomes of a Modified Delphi Process. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:577-585. [PMID: 34670239 DOI: 10.1097/acm.0000000000004463] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Telemedical applications have only recently begun to coalesce into the field of telemedicine due to varying definitions of telemedicine and issues around reimbursement. This process has been accelerated by the COVID-19 pandemic and the ensuing expansion of telemedicine delivery. This article demonstrates the development of a set of proposed competencies for a telemedicine curriculum in graduate medical education. METHOD A modified Delphi process was used to create a panel of competencies. This included a systematic review of the telemedicine literature through November 2019 to create an initial set of competencies, which were analyzed and edited by a focus group of experts in January 2020. Initial competencies were distributed in a series of 3 rounds of surveys to a group of 23 experts for comments and rating from April to August 2020. Competencies that obtained a score of 4.0 or greater on a 5-point Likert scale in at least 2 rounds were recommended. RESULTS Fifty-five competencies were developed based on the systematic review. A further 32 were added by the expert group for a total of 87. After 3 rounds of surveys, 34 competencies reached the recommendation threshold. These were 10 systems-based practice competencies, 7 professionalism, 6 patient care, 4 practice-based learning and improvement, 4 interpersonal and communication skills, and 3 medical knowledge competencies. CONCLUSIONS Half (17/34) of the competencies approved by the focus group and surveyed expert panel pertained to either systems-based practice or professionalism. Both categories exhibit more variation between telemedicine and in-person practice than other categories. The authors offer a set of proposed educational competencies that can be used in the development of curricula for a wide range of providers and are based on the best evidence and expert opinion available.
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Affiliation(s)
- Alexander Hart
- A. Hart is director of research, Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and emergency physician, Hartford Hospital, Hartford, Connecticut; ORCID: https://orcid.org/0000-0002-0910-2316
| | - Douglas Romney
- D. Romney is director of education, Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, and instructor of emergency medicine, Harvard Medical School, Boston, Massachusetts
| | - Ritu Sarin
- R. Sarin is affiliated faculty, Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Oren Mechanic
- O. Mechanic is director of telehealth, Harvard Medical Faculty Physicians, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Attila J Hertelendy
- A.J. Hertelendy is assistant professor, Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, Florida, and director of innovation and technology, Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-6174-0289
| | - Deanna Larson
- D. Larson is senior vice president, Avera Health, and chief executive officer, Avera eCare, Sioux Falls, South Dakota
| | - Kelly Rhone
- K. Rhone is medical director of outreach and innovation, Avera eCare, Sioux Falls, South Dakota, and assistant professor, University of South Dakota Sanford School of Medicine, Vermillion, South Dakota
| | - Kristi Sidel
- K. Sidel is director of telemedicine education, American Board of Telehealth, Sioux Falls, South Dakota
| | - Amalia Voskanyan
- A. Voskanyan is co-director, Disaster Medicine Fellowship, Department of Emergency Medicine, Harvard Medical Faculty Physicians, Boston, Massachusetts
| | - Gregory R Ciottone
- G.R. Ciottone is director, Disaster Medicine Fellowship, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, and associate professor of emergency medicine, Harvard Medical School, Boston, Massachusetts
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Kruse MI, Voloshin D, Wan M, Clarizio A, Bigham BL, Upadhye S. Care of Sexual and Gender Minorities in the Emergency Department: A Scoping Review. Ann Emerg Med 2021; 79:196-212. [PMID: 34785088 DOI: 10.1016/j.annemergmed.2021.09.422] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE This scoping review was conducted to collate and summarize the published research literature addressing sexual and gender minority care in the emergency department (ED). METHODS Using PRISMA-ScR criteria, an electronic search was conducted of CINAHL, Embase, Ovid Medline, and Web of Science for all studies that were published after 1995 involving sexual and gender minorities, throughout all life stages, presenting to an ED. We excluded non-US and Canadian studies and editorials. Titles and abstracts were screened, and full-text review was performed independently with 4 reviewers. Abstraction focused on study design, demographics, and outcomes, and the resulting data were analyzed using an ad hoc iterative thematic analysis. RESULTS We found 972 unique articles and excluded 743 after title and abstract screening. The remaining 229 articles underwent full-text review, and 160 articles were included. Themes identified were HIV in sexual and gender minorities (n=61), population health (n=46), provider training (n=29), ED avoidance or barriers (n=23), ED use (n=21), and sexual orientation/gender identity information collection (n=9). CONCLUSION The current literature encompassing ED sexual and gender minority care cluster into 6 themes. There are considerable gaps to be addressed in optimizing culturally competent and equitable care in the ED for this population. Future research to address these gaps should include substantial patient stakeholder engagement in all aspects of the research process to ensure patient-focused outcomes congruent with sexual and gender minority values and preferences.
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Affiliation(s)
- Michael I Kruse
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Daniel Voloshin
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Wan
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alexandra Clarizio
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Blair L Bigham
- Division of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Suneel Upadhye
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
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Gwanyalla NK, Asker S, Abazaid N, Aromolaran K, Jackson T, Okpere H. "Say their names:" Thoughts on residency leadership response to police brutality and social injustices. AEM EDUCATION AND TRAINING 2021; 5:S149-S151. [PMID: 34616991 PMCID: PMC8480498 DOI: 10.1002/aet2.10665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/31/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
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10
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Michael SH, Kaplan B, Sungar WG, Ward‐Gaines J. Building residents' competence to support diverse, equitable, and inclusive environments in emergency medicine must start with the milestones. AEM EDUCATION AND TRAINING 2021; 5:S144-S148. [PMID: 34616990 PMCID: PMC8480490 DOI: 10.1002/aet2.10673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/23/2021] [Accepted: 05/06/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Sarah H. Michael
- Department of Emergency MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Bonnie Kaplan
- Department of Emergency MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Denver Health Medical CenterDenverColoradoUSA
| | - W. Gannon Sungar
- Department of Emergency MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Denver Health Medical CenterDenverColoradoUSA
| | - Jacqueline Ward‐Gaines
- Department of Emergency MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
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Grossman LG, Mechanic OJ, Orr Z, Cioe‐Peña EC, Landry A, Unger S, Greenstein J, Alpert EA. An analysis of social determinants of health and structural competency training in global emergency medicine fellowship programs in the United States. AEM EDUCATION AND TRAINING 2021; 5:S28-S32. [PMID: 34616970 PMCID: PMC8480506 DOI: 10.1002/aet2.10660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/19/2021] [Accepted: 04/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Clinicians must be aware of the structural forces that affect their patients to appropriately address their unique health care needs. This study aimed to assess the participation of global emergency medicine (GEM) fellowship programs in formal social determinants of health (SDH) and structural competency (SC) training to evaluate the existence and procedures of such programs. METHODS A cross-sectional study conducted with a short, online survey with questions regarding the presence of curriculum focused on SDH, SC, educational metrics, and the desire for further formal training in this domain was sent to all 25 GEM fellowship directors through the Global Emergency Medicine Fellowship Consortium (GEMFC) email listserv. RESULTS Eighty percent (20/25) of GEM fellowship directors responded to the survey. All (20/20) of participating fellowship programs included SDH and SC training in their didactic curriculum, and eight of 20 (40%) programs offered similar training for faculty. Additionally, 19 of 20 (95%) of respondents indicated interest in an open-source tool for emergency medicine (EM) fellowship training in SDH and SC. CONCLUSIONS While multiple GEM programs offer formal training on SDH and SC, gaps exist regarding similar training for faculty. Additionally, there is a lack of metrics to determine fellows' comfort with the content of this training. As a majority of GEMFC programs requested, an open-source tool would allow a uniform curriculum and measurement of EM fellowship training in SDH and SC.
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Affiliation(s)
- Lindsay G. Grossman
- Perelman School of MedicineThe University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Oren J. Mechanic
- Harvard Medical Faculty PhysiciansBostonMassachusettsUSA
- Department of Emergency MedicineMount Sinai Medical CenterMiami BeachFloridaUSA
| | - Zvika Orr
- Department of NursingJerusalem College of TechnologyJerusalemIsrael
| | | | - Alden Landry
- Department of Emergency MedicineBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Shifra Unger
- Department of NursingJerusalem College of TechnologyJerusalemIsrael
| | - Josh Greenstein
- Department of Emergency MedicineNorthwell Staten Island University HospitalStaten IslandNew YorkUSA
| | - Evan Avraham Alpert
- Department of Emergency MedicineShaare Zedek Medical CenterFaculty of Medicine, Hebrew University of JerusalemJerusalemIsrael
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Smith KJ, Harris EM, Albazzaz S, Carter MA. Development of a health equity journal club to address health care disparities and improve cultural competence among emergency medicine practitioners. AEM EDUCATION AND TRAINING 2021; 5:S57-S64. [PMID: 34616974 PMCID: PMC8480496 DOI: 10.1002/aet2.10675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/18/2021] [Accepted: 06/14/2021] [Indexed: 05/07/2023]
Abstract
Health care disparities have been magnified by the COVID-19 pandemic. Only recently has the medical community acknowledged implicit bias and systemic racism as a public health emergency. Graduate medical education has been slow to adopt curricula beyond lecture-based formats that specifically address social determinants of health (SDOH) and its impact on communities. Curricula addressing unconscious (implicit) biases and their influence on patient care has not been widely adopted. The emergency department (ED) has a unique role in addressing health care disparities. Approximately 69% of emergency medicine residency programs incorporate cultural competency training in their curricula. Most are primarily lecture-based without a longitudinal component, and gaps exist in content, quality, and expertise of the presenters. Lecture-based formats may not be best suited to manage the nuanced conversations necessary to dismantle biases and socialized beliefs that result in disparities for marginalized communities. Reporting little or no education in medical school related to SDOH, residents acknowledge that barriers to care exist, but have limited or no knowledge of what those barriers are or how mitigate them. To improve health equity, understanding and competence in caring for culturally and ethnically diverse populations, we developed a monthly, longitudinal, SDOH- and cultural competency-based "health equity journal club" (HEJC) for all levels of ED staff. Four educational domains were developed, and specific content within each domain was selected based on predetermined criteria. Content for each session was mapped to the ACGME program and core competency milestone requirements, ACGME Clinical Learning Environment (CLER) mandates, and The Joint Commission's institutional recommendations for culturally competent care. The HEJC series has been successful in reducing barriers to identifying biases in health care; translating literature to clinical care; generating initiatives and interdisciplinary research; and cultivating interest in community health, health advocacy, and public policy.
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Affiliation(s)
- Kristyn J. Smith
- Department of Emergency MedicineAlbert Einstein Healthcare NetworkPhiladelphiaPennsylvaniaUSA
| | - Erica M. Harris
- Department of Emergency MedicineAlbert Einstein Healthcare NetworkPhiladelphiaPennsylvaniaUSA
| | - Samara Albazzaz
- Department of Emergency MedicineAlbert Einstein Healthcare NetworkPhiladelphiaPennsylvaniaUSA
| | - Merle A. Carter
- Department of Emergency MedicineAlbert Einstein Healthcare NetworkPhiladelphiaPennsylvaniaUSA
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Dixon G, Barqadle F, Gill E, Okoroafor W, Fromme B, Ganem J. Diversity, Inclusion and Cultural Competency in Pediatric Hospital Medicine Fellowship Programs. Hosp Pediatr 2021; 11:779-785. [PMID: 34312213 PMCID: PMC8336456 DOI: 10.1542/hpeds.2020-004515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The objectives with this study were to describe the current state of Pediatric Hospital Medicine (PHM) fellowship programs with regards to (1) diversity of fellows and programs' leadership, (2) current diversity and inclusion (D&I) programs and measures of their success, and (3) the state of cultural competency training. METHODS In 2018, fellowship directors of the 35 active PHM fellowship programs were invited to participate in a survey of diversity, inclusion, and cultural competency at PHM fellowship programs. Participants were invited via in-person invitations at the annual PHM fellowship directors meeting and through e-mail invitations from July to September to complete an online survey. RESULTS There was an 89% response rate of the survey. Most fellows, faculty, and program directors in PHM were female (74%, 70%, and 70%, respectively) and white (53%, 67%, and 60%, respectively). There were no African American, American Indian or Alaskan Native, or Native Hawaiian or other Pacific Islander program directors. Forty-five percent of programs reported that neither the fellowship program nor their hospital had a strategic plan that addresses D&I. Approximately 61% of programs had cultural competency training for fellows. CONCLUSIONS This is the first survey to report on the state of D&I in PHM fellowship programs. There is lack of racial and ethnic diversity in programs fellows, faculty, and directors. Although most programs have cultural competency training, strategic planning to promote D&I is not widely implemented among PHM fellowship programs.
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Affiliation(s)
- Gabrina Dixon
- Children's National Hospital and School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Fatuma Barqadle
- Children's Hospital Los Angeles and University of Southern California, Los Angeles, California
| | - Edward Gill
- Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
| | | | - Barrett Fromme
- Department of Pediatrics, University of Chicago, Chicago, Illinois
| | - Jorge Ganem
- Dell Children's Medical Center of Central Texas and 10 University of Texas-Austin Medical School, Austin, Texas
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Abrahams S, Kim EJ, Marrast L, Uwemedimo O, Conigliaro J, Martinez J. Examination of resident characteristics associated with interest in primary care and identification of barriers to cross-cultural care. BMC MEDICAL EDUCATION 2021; 21:218. [PMID: 33874946 PMCID: PMC8056670 DOI: 10.1186/s12909-021-02669-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND There is an increasing shortage of primary care physicians in the U.S. The difficult task of addressing patients' sociocultural needs is one reason residents do not pursue primary care. However, associations between residents' perceived barriers to cross-cultural care provision and career interest in primary care have not been investigated. OBJECTIVE We examined residents' career interest in primary care and associations with resident characteristics and their perceived barriers in providing cross-cultural care. METHODS We conducted a cross-sectional analysis of a resident survey from the 2018-2019 academic year. We first described residents' sociodemographic characteristics based on their career interest in primary care (Chi-square test). Our primary outcome was high career interest in primary care. We further examined associations between residents' characteristics and perceived barriers to cross-cultural care. RESULTS The study included 155 family medicine, pediatrics, and internal medicine residents (response rate 68.2%), with 17 expressing high career interest in primary care. There were significant differences in high career interest by race/ethnicity, as Non-White race was associated with high career interest in primary care (p < 0.01). Resident characteristics associated with identifying multiple barriers to cross-cultural care included disadvantaged background, multilingualism, and foreign-born parents (all p-values< 0.05). There were no significant associations between high career interest in primary care and barriers to cross-cultural care. CONCLUSION Residents from diverse racial/ethnic and socioeconomic backgrounds demonstrated higher career interest in primary care and perceived more barriers to cross-cultural care, underscoring the importance of increasing physician workforce diversity to address the primary care shortage and to improve cross-cultural care.
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Affiliation(s)
- Sara Abrahams
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, 11549, USA.
| | - Eun Ji Kim
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and Division of General Internal Medicine, Northwell Health, Hempstead, NY, USA
| | - Lyndonna Marrast
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and Division of General Internal Medicine, Northwell Health, Hempstead, NY, USA
| | - Omolara Uwemedimo
- Occupational Medicine, Epidemiology, and Prevention at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA
| | - Joseph Conigliaro
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and Division of General Internal Medicine, Northwell Health, Hempstead, NY, USA
| | - Johanna Martinez
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and Division of General Internal Medicine, Northwell Health, Hempstead, NY, USA
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Willging C, Gunderson L, Shattuck D, Sturm R, Lawyer A, Crandall C. Structural competency in emergency medicine services for transgender and gender non-conforming patients. Soc Sci Med 2018; 222:67-75. [PMID: 30605801 DOI: 10.1016/j.socscimed.2018.12.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 12/20/2018] [Accepted: 12/22/2018] [Indexed: 11/19/2022]
Abstract
In this formative qualitative research, we draw upon the concepts of structural vulnerability and structural competency to examine how transgender and gender non-conforming (TGGNC) patients and healthcare personnel experience service delivery in Emergency Departments (EDs), and how this experience can be improved upon. Between October 2016 and June 2017, we undertook 31 semi-structured interviews with TGGNC patients (n = 11) and physicians (n = 6), nurses (n = 7), and non-clinical staff (n = 7) in four community-based EDs in New Mexico. Our iterative coding and analysis process resulted in eight sets of findings: (1) reasons why TGGNC patients seek care from EDs; (2) perceptions about and experiences of TGGNC patients; (3) relevance of gender identity and sex at birth; (4) bureaucracy and communication; (5) spatial considerations; (6) preparing providers and staff to care for TGGNC patients; (7) the lack of resources for structural prescriptions; and (8) respect, humanity, and sameness. Findings suggest that structural issues adversely impact the health and wellbeing of TGGNC patients and service-delivery practices in the ED. We describe study implications for training ED personnel and modifying this practice setting to prevent delayed care and ensure appropriate services for TGGNC patients in need of structurally competent emergency medicine.
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Affiliation(s)
- Cathleen Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106, USA; Department of Anthropology, University of New Mexico, MSC01-1040, 1 University of New, Mexico, Albuquerque, NM, 87131, USA.
| | - Lara Gunderson
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106, USA; Department of Anthropology, University of New Mexico, MSC01-1040, 1 University of New, Mexico, Albuquerque, NM, 87131, USA.
| | - Daniel Shattuck
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106, USA; Department of Anthropology, University of New Mexico, MSC01-1040, 1 University of New, Mexico, Albuquerque, NM, 87131, USA.
| | - Robert Sturm
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, 851 University Boulevard, SE, Suite 101, Albuquerque, NM, 87106, USA; New Mexico Community AIDS Partnership, 903 West Alameda #764, Santa Fe, NM, 87501, USA.
| | - Adrien Lawyer
- Transgender Resource Center of New Mexico, 149 Jackson Street, NE, Albuquerque, NM, 87108, USA.
| | - Cameron Crandall
- Department of Emergency Medicine, University of New Mexico, MSC11-6025, 700 Camino de Salud, Albuquerque, NM, 87131, USA.
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